Eating Disorders

Question 1

What is an eating disorder?

Answer 1

Persistent disturbance

Of eating behavior

Or behavior intended to control weight

Which significantly impairs physical health

Or social functioning

Question 2

What are the important facts on anorexia nervosa?

Answer 2

Deliberate weight loss

Induced and sustained by patient

0.5% prevalence among adolescent girls and young women

Associated with depression and sexual abuse

Risk if OCD, dependent and avoidant personality, genetic

BMI 17.5 or less

Self induced vomiting and purging, excessive exercise, use laxatives and diuretics, binging

Body image distortion

Amenorrhea, loss of libido

Question 3

What are the complications of anorexia nervosa?

Answer 3

Failed breast development

Parotid swelling

Stunted growth

Alkalosis

Hypokalemia

HPO dysfunction, amenorrhea, loss of libido

Less E2, T4, DHT

High cortisol

Suicidal ideas, DSH, depression, substance abuse

Question 4

What are the DDx for anorexia nervosa?

Answer 4

Physical

Malabsorption
Gastric outlet obstruction
Crohn’s disease

Psychiatric

Depression
Schizophrenia
OCD

Question 5

What is different in bulimia nervosa over anorexia nervosa?

Answer 5

Not underweight

Striking history of binge eating

Induced vomiting

Treat with CBT, SSRI

Normal menstruation

More likely to be depressed

Question 6

How do you treat anorexia nervosa?

Answer 6

Supervised re-feeding

Manage physical complications

Educate on nutrition

CBT

Family support

SSRI if comorbid psychiatric disorders

Prevent relapse