Eating Disorders Flashcards
What is Pica?
persistent eating of nonnutritive, nonfood substances over a period of at least one month
(i.e. eating dirt)
Risk factors for Pica?
parent-child psychopathology, environmental deprivation, pregnancy, epilepsy, brain damage, intellectual disability
At what age does pica become developmentally inappropriate?
in those over 24 months
what are some signs/sxs of pica?
ascariasis, mechanical bowel obstruction/perforations, dental problems
Pica tx
generally goes away on its own in children
psychosocial interventions
What is avoidant/restrictive food intake disorder?
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by not meeting nutritional needs
When does ARFID typically develop? What are some characterisitics?
infancy/childhood and continue into adult
young infants may be sleepy/agitated to feed
ARFID tx?
re-feeding and behavioral interventions
cognitive behavioral therapy
exposure therapy
(no med therapy)
Describe anorexia nervosa
life threatening eating disorder characterized by inability to maintain a normal weight, fear of weight gain
How do we rate the severity of anorexia nervosa?
based on BMI
mild: BMI >17
moderate: BMI 16-16.99
severe: BMI 15-15.99
extreme: BMI <15
What are the 2 subtypes of anorexia nervosa?
restricting type
binge-eating/purging type
Complications of anorexia nervosa?
dif to resolve, CV complications, endocrine/metabolic, GI, neuro, integumentary, renal
Who is at higher risk for anorexia nervosa?
females > men
dancers, runners, skater, models etc.
occurs in both young and old
gay/bisexual males
What screening tools are available for anorexia nervosa?
SCOFF questionnaire
Anorexia Nervosa PE
may have obvious emaciation, may hide under bulky clothing
hair and nails become dry and brittle
Anorexia nervosa tx
dif. to treat due to denial/lack of insight
directed at correcting/preventing disease complications
re-establish normal eating pattern
hospital admission often necessary
psychological therapy
vitamine supplementation- Ca
What types of psychological therapy are available for anorexia nervosa pts?
individual therapy, cognitive (analytic) therapy, cognitive behavioral therapy, interpersonal therapy, group therapy, family based therapy
Anorexia nervosa prognosis?
Guarded
morbidity rates 10-20%
50% make full recovery, other 50% (20% remain emaciated, 25% thin, 10% overweight or die of starvation)
What is bulimia nervosa?
potentially life threatening, cycles of binge eating and compensatory behaviors to undo binge
What is binge eating
eating in a discrete period of time an amt of food larger than what most ppl would eat
sense of lack of control over eating during episode
mild bulimia
1-3 episodes of inappropriate compensatory behaviors/wk
Moderate bulimia
4-7 episodes of inappropriate compensatory behaviors/wk
Severe bulimia
8-13 episodes of inappropriate compensatory behaviors/wk
extreme bulimia
> 14 episodes of inappropriate compensatory behaviors/wk
In which populations is bulimia nervosa most common?
in those where weight gain/weight loss rapidly is required
i.e. wrestlers, competitive body builders
At which age does bulimia typically onset?
~19
What is the female athlete triad?
eating disorder + hypothalamic amennorhea + osteoporosis
What screening tools are available for bulimia?
SCOFF questionnaire, eating disorder screen for primary care (ESP)
Warning signs of bulimia nervosa
disappearance of large amt of food in short period, discarded food wrapper/containers, freq. trips to bathroom after meals, presence of laxatives or diuretics
unusual jaw pain/cheek swelling, calluses on backs of hands and knuckles from self induced vomiting
Bulimia nervosa tx
best: intensive outpt treatment 40hrs/wk 5 days a wk
group psychotherapy
nutritional counseling
antidepressants
Hospitalization is not required for bulimia nervosa unless…
major electrolyte disturbances,
SI or attempt
no response to outpt tx
Which drug is associated with increased incidence of seizures in bulimia pts?
Buproprion
Which drug may decrease the binge-purge cycle in bulimia?
Topiramate (Topamax)
What is binge eating disorder?
recurrent episodes of binge eating
Binge eating disorder: epidemiology
mostly over weight/obese females
binge eating disorder may be a…
familial disorder
Why do ppl binge?
maladaptive coping skill
use food to numb/protect against emotions
attempt to fill an emotional void
form of self-punishment
BUT can intensify all feelings the person is trying to cover up
What are some health consequences of binge eating?
increased psychopathology
HTN, DM, dyslipidemia
moderate obesity develops after about 5 yrs
tx for binge eating disorder
psychotherapy
nutritional counseling
SSRI and venlafaxine (SNRI): reduces binge freq.
Topiramate
Eating disorders in males
less likely to be dx
What labs should you order when you suspect an eating disorder?
CBC (anemia/immune suppression)
CMP LFT Cr, BUN Lipid panel Thyroid func. Hormones ECG
What is included in acute tx of all eating disorders
nutritional and fluid/electrolyte stabilization
- break binge-purge cycle in bulimia
- correct starvation state in anorexia
weight gain of 0.16g/day considered safe
What is considered severe malnutrition?
weight <75% ideal body weight
