Eating disorders Flashcards
How is an eating disorder defined?
An eating disorder is characterised by a persistent disturbance of eating or eating related behaviour that results in altered consumption or absorption of food that significantly impairs physical or psychosocial functioning
What are the main types of eating disorders? (4)
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- Atypical eating disorder
What are the main risk factors for developing anorexia nervosa or bulimia nervosa? (4 categories… lots of risk factors)
- Genetic factors - female sex, adolescence and early adulthood living in a western society
- Family history - of an eating disorder of any type, depression, or substance misuse
- Premorbid experiences - sexual abuse, criticism regarding eating or body shape and weight, dieting behaviours starting in adolescence or in the family, preoccupation with slimness, occupational or recreational pressure to be slim (e.g. ballet dancing, modelling, athletics), onset of puberty, leaving home
- Premorbid characteristics - low self-esteem, perfectionism, anxiety and anxiety disorders, obsessional personality, borderline personality disorder, obesity, early menarche, difficulty resolving conflict
What are the two subtypes of anorexia?
- Restrictive
2. Binge/purge
What constitutes a binge?
Large consumption of calories over short period of time with loss of control
Why can people with anorexia with binge/purge subtype, still be underweight?
Because the binge is a very low number of calories, i.e. 10 grapes instead of 4
In the diagnostic criteria for anorexia, what is the BMI cut off?
<18.5
What are the five points associated with core psychopathology?
- Fear of fatness
- Pursuit of thinness
- Body dissatisfaction
- Body image distortion
- Self evaluation based on weight and shape
What did the Minnesota experiment find?
Direct link between starvation and developing: depression anxiety suicidal ideation OCD symptoms/rigidity
What are the common behaviours associated with eating disorders?
- Dieting
- Fasting
- Calorie counting
- Excessive exercise
- Water loading (risk of hyponatraemia)
- Diet pills, thyroxine, diuretics, appetite suppressants
- Excessive weighing
- Body checking
- Culinary behaviours
- Avoidance
- Isolation
- Bingeing
- Purging
- Starve-binge-purge cycle
- Misuse of insulin
- DSH
- Substance misuse
What questions are involved in the SCOFF questionnaire?
S - do you make yourself SICK because you feel uncomfortably full?
C - do you worry you have lost CONTROL over how much you eat?
O - have you recently lost more than ONE stone in a 3-month period?
F - do you believe yourself to be FAT when others say you are too thin?
F - would you say that FOOD dominates your life?
What is the risk to electrolyte disturbance in someone who purges frequently?
Hypokalaemia (arrythmias)
What % of deaths in anorexia nervosa are due to suicide?
20-40%
In someone with anorexia nervosa, what BMI would lead to detention under the mental health act?
BMI of <13.5 ?! - although re-feeding is curing physical problems, it will also treat the mental health problem
How is rapid weight loss defined?
Loss of >1kg/week
What is proximal myopathy a good indicator of?
Protein-muscle mass?!
What electrolyte disturbances are seen in re-feeding syndrome? (4)
- Hypophosphataemia
- Hypomagnesaemia
- Hypocalcaemia
- Hypokalaemia
What are the psychological treatments for anorexia nervosa?
- MANTRA - Maudsley approach - manualised, delivered on an individual and group basis
- CBT
- SSCM - specialist supportive counselling/management
- Other therapies; compassion focussed therapy, psychodynamic focussed therapy
(MANTRA & CBT first line)
What are the psychological treatments for bulimia nervosa?
- Inter-personal therapy; focus on interpersonal relationships rather than focussing on food and disordered eating
- Fluoxetine 60mg - no medication licensed to treat anorexia itself - it interrupts the binge-purge cycle and is not effective in everyone. It can be helpful as an adjunct, but shouldn’t be used solely.
- Other therapies - nasal bridles, benzodiazepines - paediatric doses
What are the recommendations for guided self-help in eating disorders?
- Evidence based self-help materials
- Education
- Increased awareness and responsibility e.g. food/thought diaries
- Structured eating
- Identify and challenge beliefs
What is the meaning behind ego-syntonic and the relation with eating disorders?
People with eating disorders, particularly at first, will like their eating disorder, it will provide emotional comfort more than those surrounding them can and will give them a sense of control/contentment
What questions are asked to encourage thought surrounding someones eating disorder and start to challenge the disordered thoughts? (4)
- What do you like about your eating disorder?
- What do you dislike about your eating disorder?
- What have you stopped doing because fo your eating disorder?
- What stops you from giving up your eating disorder?
What are the foundations of treatment for people with eating disorders? (7)
- Adequate nutrition
- Stopping purging behaviours
- Reducing excessive exercise
- Individual/group therapy
- Family interventions
- Medication
- Education
What is the cycle of bulimia nervosa typically like?
Restricted diet –> low blood sugars –> cravings –> binge –> guilt –> purge –> guilt –> restricted diet
