Eating Disorders Flashcards
1
Q
How many people are estimated to have eating disorders in the UK?
A
1.25 million
2
Q
Who is affected by eating disorders?
A
- Can affect anyone of any age, gender, culture or ethnicity.
- Can affect anyone at any time, but girls and young women aged 12-20 are most at risk.
- It is the commonest cause of weight loss in teenage girls and the commonest cause of inpatient admision to child and adolescent services.
- 95% of eating disorder cases occur in people ages 12 through 25.
- Of children who have anorexia, 25% are male and 75% are female.
3
Q
What are the different DSM-5 diagnoses?
A
- Anorexia nervosa (AN).
- Bulimia nervosa (BN).
- Binge Eating Disorder (BED).
- Avoidant-Restrictive Food Intake Disorder (ARFID).
- Other Specified Feeding or Eating Disorder (OSFED).
- Eating disorders are complex and some eating issues will not meet diagnostic criteria. All must be taken seriously.
4
Q
Describe Avoidant-Restrictive Food Intake Disorder (ARFID).
A
- Characterised by lack of interest in food, fears of negatice consequences of eating, and selective eating.
-
A - feeding or eating disturbance leading to a persistent failure to meet appropriate nutritional requiremets and one or more of:
- Significant weight loss / failure to gain / faltering growth.
- Significant nutritional deficiency.
- Dependence on supplements.
- Interference with psychosocial functioning.
- B - not explained by cultural practice / lack of food.
- C - no disturbance of perception of body weight / shape.
- D - not due to a medical condition or better explained by another MD.
5
Q
What is Anorexia Nervosa?
List the warning signs.
A
- Characterised primarily by self-starvation and excessive weight loss.
-
Warning signs:
- Dramatic weight loss
- Preoccupation with weight, food, calories and dieting
- Refusal to eat certain foods, progressing to restrictions against whole categories of food.
- Consistent excuses to avoid mealtimes or situations involving food.
- Withdrawl from usual friends and activities.
- Inappropriate and / or extreme exercise.
6
Q
Describe the diagnostic criteria for anorexia.
A
- A - Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health. Significantly low weight is less than that minimally expected.
- B - Intense fear of becoming fat or gaining weight; persistent behaviour interfering with weight gain despite being low weight.
- C - Disturbance in the way one’s body weight or shape is experienced; undue influence of body weight on shape or self-evaluation, or persistent lack of recognition of the seriousness of current low body weight. Subtypes: restriting vs binge-eating / purging.
7
Q
What is bulimia nervosa?
List the symptoms.
A
- Characterised by binge eating and compensatory behaviours, such as self-induced vomiting, in an attempt to undo the effects of binge eating.
-
Symptoms include:
- Frequent episodes of consuming very large amounts of food followed by behaviours to prevent weight gain, such as vomiting, laxative abuse, and excessive exercise.
- Feeling of being out-of-control during the binge-eating episodes.
- Extreme concern with body weight and shape.
- Most people are of a normal weight.
8
Q
Describe the diagnostic criteria for bulimia.
A
-
A - Recurrent episodes of binge eating:
- Eating more than what most people would eat in a similar circumstance in a discrete period of time.
- Lack of control over eating during the episode.
- B - Recurrent inappropriate compensatory behaviours to prevent weight gain.
- C - A and B occur on average once a week for 3 months.
- D - Self-evaluatory is unduly influenced by body shape and weight.
- E - The behaviour does not occur exclusively during episodes of AN.
9
Q
Describe the diagnostic criteria for Binge Eating Disorder.
A
-
A - Recurrent episodes of binge eating characterised by:
- Eating more than what most people would eat in similar circumstances in a discrete perios of time.
- Lack of control over eating during the episode.
-
B - Binge eating episodes associated with 3 or more of:
- Eating more repidly than normal
- Eating until uncomfortably full
- Eating large amounts when not hungry
- Eating alone due to embarrassment
- Feeling disgusted, depressed or guilty afterwards
- C - Marked distress over binge eating.
- D - Occurs on average once a week for 3 months.
- E - No inappropriate compensatory behaviours nor exclusively during the course of BN or AN.
10
Q
What are the biological risk factors for development of an eating disorder?
A
- Gender: females more likely than males.
- Genetics:
- Concordance: mono > dizygotic twins
- Those with a mother or sister who has had AN are 12x more likely to develop and eating disorder than those with no family hx. (Biological or environmental?)
- Comorbidities: depression, anxiety, OCD, T1DM
11
Q
What are the psychological risk factors for development of an eating disorder?
A
- Low self-esteem / poor relationship with self.
- Poor coping mechanisms.
- Personality traits: perfectionism, obsessive thinking, rigidity.
- Anorexia: family with high perfectionistic and obsessive traits.
- Bulimia or bingeing: family with obesity, depression, substance misuse.
12
Q
What are the social risk factors for development of an eating disorder?
A
- Historical trauma - bereavement, sexual abuse, trauma.
-
Peer pressure - frequent negative comments, bullying or body shaming.
- Bullying: 60% of those affected by eating disorders said that bullying contributed to the decelopment of their eating disorder.
- Body shaming / weight stigma: can increase body dissatisfaction, a leading risk factor in the development of eating disorders.
-
Media / modern culture - what is the media’s idea of perfection?
- Promotion of idealistic and unrealistic body shapes.
- Airbrushing / photoshop being used in magazines.
- Social media - need for ‘likes’.
- Proana
13
Q
What are the essential details to include in a referral for eating disorders?
A
- What are you worried about?
- Why?
- Current eating and its progression.
- Current weight (and height).
- Past weights and idea of how quickly weight is being lost.
- Impact on physical health.
- Cognitions around eating / weight.
- Stressors.
- Comorbidities (physical or mental health e.g. depression).
- Done decent physical health assessment including bloods.
14
Q
What are the questions in the SCOFF questionnaire?
A
- 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 Over 1 stone (14lb) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Yes = 1 point; score of >2 suggests AN or BN
Do not use screening tools as the sole method to determine whether or not people have an eating disorder.
15
Q
What are the health consequences of eating disorders?
A
-
Cardiovascular
- Muscle loss, low or irregular heartbeat.
-
Gastrointestinal
- Gastroparesis = bloating, nausea, feeling full after only small amounts.
- Constipation
-
Neurologial
- Brain consumes up to 1/5th of the body’s calories.
- Difficulty concentrating. sleep apnoea.
-
Endocrine
- Hormonal changes - oestrogen, testosterone, thyroid.
-
MSK
- More prone to fractures.
16
Q
What are the effects specifically of anorexia nervosa on the different body systems?
A
17
Q
What are the effects specifically of bulimia nervosa on the different body systems?
A
19
Q
What are the issues to consider when managing AN?
A
- Challenging management of acute physical risk.
- Precipitous weight loss >1kg / week
- Purging
- Substance use
- Weakness in emaciated patients
- Behavioural risk.
- Urgency refeeding underweight children.
- Consequences of starvation on developing brain and cognition.
- Importance of family / caregiver education.
- Specialist dietetic input.
- Family-based therapy most effective.
- Individual therapy for depression before re-nutrition likely ineffective.
