Eating Disorders Flashcards
Categories of Eating Disorders
Anorexia nervosa
Bulimia nervosa
Eating disorder NOS (binge eating included here)
FOR DSM-V these disorders will expand –> pica, rumination disorder, etc.
Predisposing, precipitating and perpetuating factors
Predisposing –> Factors that can INCREASE risk of disease and lead to emergence of symptoms: FEMALE, FAMILY HISTORY, TEMPERAMENT
Precipitating –> factors that DIRECTLY lead to the experience of symptoms –> STRESSES OF ADOLESCENCE, GYMNASTICS?
Perpetuating –> Factors that PREVENT remission: FEEDBACK LOOP (dieting –> binging –> purging –> depression –> dieting) and GENETICS
ANOREXIA NERVOSA overview
Restriction of energy intake, leading to a significantly low body weight
Intense fear of becoming FAT
Distorted body image
Affects 0.9% of women (0.3% men) and typically emerges in EARLY or LATE adolescence
Diff Dx: inflammatory bowel disease, hyperthyroid, malignancy, AIDS, SMA syndrome (compression of duodenum)
Psych disorders –> MDD, schizophrenia, social phobia, obsessive compulsive disorder, body dysmorphic disoder
Manifestations by ORGAN SYSTEM
General – weight loss, emaciation, dehydration, hypothermia
CV – hypotension, bradycardia, dysrhythmias often the cause of death
Derm - pallor, cold dry skin, acrocyanosis (extremities), hair loss, loss of secondary sexual features, Russell’s sign (calluses on knuckles due to purging)
GI – constipation, salivary gland enlargement, esophagitis, delayed gastric emptying
Musculoskeletal - muscle wasting, growth delay, osteopenia/osteoporosis
Osteopenia/osteoporosis
Important consideration in females with AN –> a woman’s bone density is determined in the critical developmental periods, especially RIGHT AFTER PUBERTY; females with AN, however, experience SEVERE bone loss within 6 months of losing weight
Since this typically coincides with early or late adolescence, these women may fail to build up adequate bone density, and thus be at risk for osteoporotic fragility fractures later on!
Psych co-morbidities
MDD, OCD and CLUSTER C PERSONALITY DISORDERS anxious/fearful disorders
Therapy for Anorexia Nervosa
WEIGHT GAIN
Maudsley intervention –> parents put in charge of the re-feeding process; it is stressed to families how lethal the condition is and the patient needs their help in improving
Does NOT work for adults with anorexia –> CBT may prevent relapse in these patients
Medications have not been shown for weight restoration or relapse prevention – most meds are used to treat co-morbidities
1/3 to 1/2 of patients with anorexia will RECOVER FULLY
5% actually die from the disease, often due to STARVATION, metabolic collapse, dysrhythmia and suicide; remaining patients will never fully recover, and will continue to be affected throughout life
BULIMIA NERVOSA overview
Eating disorder characterized by recurrent episodes of BINGE eating and inappropriate compensatory behavior such as USE OF EMETICS and LAXATIVES to purge the system
This occurs in 1.5% women (.5% M); typically LATER ONSET (18-20)
Present with: erosion of tooth enamel, parotid gland hypertrophy, calluses on knuckles due to purging
Metabolic alkalosos/acidosis, HYPO-chloremia,kalemia,magnesemia; occult blood in the stool
Diff Dx –> Kluver Bucy syndrome, Klein-Levin syndrome, hypothalamic tumors; Seizure disorders and atypically depression
Comorbid Conditions with Bulimia
Mood disorders, substance abuse (NOT with anorexia), cluster B personality disorders (dramatic)
Complications = emetine cardiomyopathy, dysrhythmias, cathartic colon (overuse of laxatives), Mallory-Weiss tears (excessive vomiting - tears at the jxn of stomach and esophagus)
THERAPY for Bulimia
CVT focuses now on treatment to help patients identify EMOTIONAL FLUCTUATIONS that may bring about binging/purging, allows them to reconize and avoid these problems
CBT realized as the MOST EFFECTIVE THERAPY
PHARMACOTHERAPY –> HIGH DOSE FLUOXETINE has been shown to be effective in REDUCING BINGE FREQUENCY via appetite suppression, induction of satiety, decreased anxiety and primary anti-binge actions (NE and 5HT mediated)
Psychotherapy + Pharmacotherapy = most effective treatment of bulimia nervosa
ONLY 40% RECOVER COMPLETELY, and relapse is quite common
BINGE EATING DISORDER
Binge eating (at least once a week for 3 months), combined with LACK of control and marked feelings of distress
Patients often eat much more rapidly than normal, eat until uncomfortably full, eat large amounts of food when not hungry, eat alone because of embarrassment, feel disgusted or guilty as a result of overeating
Unlike bulimia nervosa, there is an ABSENCE OF COMPENSATORY BEHAVIORS (purging)
This condition is common - 3.5% of females and up to 50% of people in weight control programs
Patients present later than other disorders, typically in LATE ADOLESCENCE and EARLY ADULTHOOD
CBT has shown to REDUCE binging and reduce psychological impact, but NO effect on weight loss
Fluoxetine can help
Most obese patients have an eating disorder?
FALSE
Eating disorders caused by societal pressures to be thin?
FALSE - although it may have an impact, there are certainly GENETIC factors implicated as well
Antidepressants reduce binge frequency in bulimia nervosa?
TRUE!!! Fluoxetine
