Eating Disorders Flashcards
What is the lifelong prevalence of anorexia nervosa?
0.1-0.9%
Under what age do most cases of anorexia nervosa occur?
22
What is the issue with diagnosing anorexia nervosa?
Can present in variety of ways (infertility, IBS etc.)
50% of patients you see with AN will go unnoticed
In which gender is AN more common?
9x more common in females
What is an eating disorder more common than in adolescence?
Type 1 diabetes and IBS
What is diabulimia?
Type 1 diabetics stop/reduce insulin intake in order to lose weight
Remember diabetics already at increased risk of eating disorders
Why is diabulimia so dangerous?
Can lead to DKA, eye/foot problems
When is the peak onset for eating disorders?
Mid-teens to mid-twenties
Most eating disorder patients are…
Perfectionist, very driven and intelligent
What screening tool can you use for eating disorders?
SCOFF
2+ = eating disorder 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 loss more than 1 stone in three months?
DO you believe yourself to be fat when others call you too thin?
Would you say food dominates your life?
What is the criteria for diagnosis of anorexia nervosa?
Restriction of intake to reduce weight
Relies on compulsive compensatory behaviours when food cannot be avoided (e.g. self induced vomiting, laxatives, diuretics, appetite suppressors, excess exercise)
Body weight 15% below ideal body weight/BMI less than 17/5
There is fear of weight gain
Used to take into consideration amenorrhoea but not now
What are possible signs/symptoms of anorexia nervosa?
Cold tolerance Blue hands/feet Constipation Bloating Delayed puberty Muscle loss Amenorrhoea (primary or secondary) Dry skin Fainting Hypotension Lanugo hair Scalp hair loss Early satiety Weakness, fatigue Short stature Osteopenia/osteoporosis (bone breakdown)
What is the important thing to remember about the signs and symptoms of anorexia/bulimia nervosa?
THEY ARE REVERSIBLE after a period of time after refeeding
What is the classification for the diagnosis of bulimia nervosa?
Episodes of binge eating with sense of loss of control
Binge eating followed by compensatory activity of purging type (self-induced vomiting/laxatives/diuretics) or nonpurging (xs exercise/fasting/diabulimia)
Binges and resulting compensation occurs 2+/wk for three months
There is dissatisfaction with body shape and weight
What are signs and symptoms of bulimia nervosa?
Mouth sores Pharyngeal trauma Dental erosion Heartburn, chest pain Oesophageal rupture Impulsivity (stealing, alcohol, drugs, smoking) Muscle cramps Weakness Bloody diarrhoea Irregular periods Fainting Swollen parotid glands Hypotension
What is really important to be aware of bulimia nervosa?
Electrolyte disturbance from vomiting –> low potassium –> arrhythmias/lower seizure threshold
What characterises binge eating disorder?
Bulimia - purging behaviour
Ongoing/repetitive cycles often include: Unusually fast eating, usually alone Unusually large amounts consumed Uncomfortably full, often buzzed after eating Embarrassment, shame, guilt, depression
How might someone with an eating disorder avoid calorie intake?
Diets (veganism)
Not touching food/grease (for fear of absorbing it)
Developing likes/dislikes/allergies
Interpreting all symptoms as allergy/indigestion
Eating v slowly at certain times only
Avoiding parties/social occasions
Spoiling/messing food/bizarre combos
Refusing to finish eating last/eat more than anyone else
Appetite suppressants - gum, cigarettes, internet meds
How might someone with an eating disorder get rid of calories?
Self-induced vomiting Chewing and spitting out Over-exercise Overactivity (e.g. obsessive housework, twitching) Cooling - burn energy by shivering Blood letting Medication abuse
What factors may perpetuate an eating disorder?
Body checking - measurements, mirror gazing etc.
Pro-ana websites
Competing with others and self to attain lower targets
Compulsive browsing of magazines etc.
Deliberate self harm if rules broken
What are the psychological consequences of eating disorders?
Extreme overvaluation of low weight
Willing to sacrifice highly valued things (education, work, relationships)
Obsessive weight losing feels like the solution, not the problem
Reduced central coherence/narrowed focus of interest
Inability to interpret emotion
Anxiety, depression, loss of concentration on anything but food due to malnourished brain
NB - those with an ED less likely to respond to antidepressants
What are the social consequences of an eating disorder?
People become obstacle to eating disorder - forced to lie, cheat, steal
Withdrawal from friendships
Loss of interest in sex
Isolation
What are the physical consequences of an ED?
Physical damage Poor repair and resistance Heart damage Reduce immunity (bone marrow supressed) Anaemia Bone loss Fertility issues
Purging –> neurochemical disruption –> seizures/arrhythmias
Growth restriction (brain and body)
What are the hypothetical natural history of anorexia nervosa?
High risk individual with obsessionality –> life event (separation, loss, stress) –> anorexia
Resilience and protective factors –> remission but perpetuation and amplifying factors worsen health
What are the causes of AN?
Precisely unknown
Genetic risk
Perinatal factors
Life events and traumas
What is AN associated with genetically?
OCD, anxiety disorders, Aspergers
What are the precipitating factors of AN?
Puberty - hormonal and physical changes Dieting/non-deliberate weight loss --> may lead to viscous cycle Increased exercise (--> compulsive) Stressful life event )neglect, abuse, transitions, bullying)
What are the perpetuating factors of an ED?
Starved brain less receptive to changing
Delayed gastric emptying –> sensation of fullness interpreted as eating too much
Narrowing focus (food becomes salient stimulus)
Obsessionality and body checking
Families, school, clinic staff
What is the biggest killer of all psychiatric disorders?
Anorexia nervosa
20% have premature death
What is the management for AN?
Re-feeding CBT-ED (40 sessions), Mantra, SSCM IPT Fluoxetine 60mg Olanzapine Family therapy for younger patients
