Eating Disorders Flashcards
How common are eating disorders?
- Lifelong prevalence of AN is 0.1-0.9%
- 75% of AN cases occur before age 22
- 5-10% of young women attending surgery will have eating disorders
- 5-10% of adolescent girls will have used pathological weight reducing techniques
- Approximately 90% of cases present in females.
When is the peak onset for eating disorders?
Mid teens to mid twenties
How does university affect eating disorders?
- Increase in “mild to moderate” Eating Disorders
- Can affect all areas of student life
- Our patients tell us they wished their school had noticed their eating disorder in time to have treatment before going to university
What screening tool is used?
SCOFF questionnaire
What are the components of the SCOFF questionnaire?
If patients score 2 or more positive answers, then an eating disorder is likely:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Why is anorexia nervosa thought of as an obsessive weight loss disorder?
- There is obsessive fear of fatness with avoidance of food and other sources of calories and a range of compulsive ‘compensatory’ behaviours when food cannot be avoided
- In time, these behaviours are the only way to avoid the experience of anxiety AND there are secondary physical and psychological consequences of starvation
What is the ICD10 criteria for anorexia nervosa?
- Restriction of intake to reduce weight
- Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics
- Considered anorexic if he/she is 15% below ideal body weight/BMI 17.5 or <
- Fear of weight gain
- In postmenarchal females, absence of the menstrual cycle or amenorrhoea (greater than 3 cycles)
What is the ICD10 criteria for bulimia nervosa?
- Episodes of binge eating with a sense of loss of control
- Binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets).
- Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months
- Dissatisfaction with body shape and weight
What techniques will patients use to avoid calories?
- Diets
- Not touching food or grease
- Developing dislikes, pickiness and ‘allergies’
- Interpreting all symptoms as allergy or indigestion
- Eating very slow, or at certain times
- Avoiding parties and social occasions
- Spoiling or messing with food
- Refusing to eat more than the person who eats the least
- Medication abuse
What techniques will patients use to get rid of calories?
- Self-induced vomiting
- Chewing or spitting out
- Over exercise
- Over activity
- Cooling
- Blood letting
- Medication abuse
What behaviours may patients adopt to maintain their disorder?
- Body checking
- Displaying emancipation to elicit reassuringly shocked attention
- Cruising pro-ana websites
- Competing with self and others to attain lower targets
- Compulsive browsing of gossip magazines ‘thinspiration’
- Deliberate self harm if ‘rules’ are broken
Why do eating disorders matter?
- Psychological consequences
- Social consequences
- Physical consequences
What are the potential psychological consequences of eating disorders?
- Extreme overvaluation of low weight and thin/lean shape
- Obsessive weight-losing dells like a solution
- Reduced central coherence and narrowed focus of interest
- Inability to interpret emotion
- Depression, anxiety, obsessionality and loss of concentration
- Failure to cope with life, tolerate distress or feel rewarded or fulfilled
- Guilt after eating
What are the potential social consequences of eating disorders?
- Withdrawal from friendships
- Forced to lie and cheat about their consumption
- Lose interest in sexual relationships
What do people who have recovered from eating disorders value most about their recovery?
Recovery of interpersonal life
What are the potential physical consequences of eating disorders?
- Physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss, fertility problems
- Purging behaviours cause neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias). Potassium is only one crude measure of the problem
- Good nutrition needed to allow growth – height, pubertal development, brain growth and development (especially frontal lobe growth), so re-nutrition is more urgent the younger the patient
What are the 3Ps of causes?
- Predisposing factors
- Precipitating factors
- Perpetuating factors
What are the causes of anorexia?
Exact cause unknown
- Genetic predisposition – OCD, anxiety disorders, perfectionism
- Perinatal factors
- Life events – and traumas
- Perpetuating consequences of starvation and of avoidance
What are some precipitating factors for eating disorders?
Puberty
-Physical effects of hormonal changes on the brain , also psychological response to body changes
Dieting or non-deliberate weight loss
Increased exercise
Stressful life events
-Neglect, abuse, difficult transitions, deaths, family breakups, bullying, stresses such as exams
What are some perpetuating factors fro eating disorders?
Consequences of starvation syndrome
Delayed gastric emptying
-Sensations of fullness interpreted as fatness
Narrowing focus
-Food becomes most salient stimulus
Obsessionality
- Phobia of fat
- Body checking
Families, school, clinic staff
-High EE in family may delay recovery
What is the association between anorexia and death?
- Anorexia nervosa has the highest mortality rate of any psychiatric disorder
- 20% of die prematurely
- Modern specialist Units are associated with lower mortality rates
- AN still multiplies risk of premature death at least 10fold
- Risk of self-harm and suicide
What are the possible outcomes of anorexia?
- Death
- Recovery time varies (can be 6-7 years)
- Specialist centres report some recoveries after decades
What interventions are there for eating disorders?
- Re-feeding
- CBT-ED
- IPT or fluoxetine
- Olanzapine
- Specialised family work for anorexia nervosa, particularly for younger patients
What are the pricniples of approach when managing eating disorders?
- Diagnosis. Not accusation. Climate o sympathetic awareness
- Patients are obliged by their illness to defend their weight-losing behaviour
- What the patient says is not the same as what the patient is able to do
- Patience and urgency
- Empowerment of parents and all adults working against the illness together
How do our human rights influence the management of eating disorders?
- The Human Rights Act (1998) gives us many rights - freedom, confidentiality, home life etc
- Some Absolute Rights take precedence over the others, even the right to liberty
- One such is the RIGHT TO LIFE
- The ScottishMental Health Act gives us responsibility to treat people even in the absence of consent to save life or prevent serious deterioration
What are the signs and symptoms of anorexia nervosa?
- Cold intolerance
- Blue hands and feet
- Constipation
- Bloating
- Delayed puberty
- Primary or secondary amenorrhea
- Dry skin
- Fainting
- Hypotension
- Lanugo hair
- Scalp hair loss
- Early satiety
- Weakness, fatigue
- Short stature
- Osteopenia & osteoporosis
What are the signs and symptoms of bulimia nervosa?
- Mouth sores
- Pharyngeal trauma
- Dental caries
- Heartburn, chest pain
- Oesophageal rupture
- Impulsivity including stealing, alcohol abuse, drugs and tobacco
- Muscle cramps
- Weakness
- Bloody diarrhoea
- Irregular periods
- Fainting
- Swollen parotid glands
- Hypotension
What are the feature of binge eating disorder?
Similar to bulimia nervosa; absence of purging behaviours.
Ongoing and/or repetitive cycles often include
- Unusually fast eating, usually alone.
- Unusually large amounts consumed.
- Uncomfortably full; often “buzzed” after eating.
- Embarrassment, shame, guilt, depression.
