Eating Disorders

Question 1

Anorexia Nervosa - DSM 5 criteria

Answer 1

1. Restriction of energy intake leading to a significantly low body weight
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced

(Note that BMI and amenorrhoea are no longer specifically mentioned)

Question 2

Anorexia Nervosa - clinical features

Answer 2

reduced body mass index (usually < 17.5)
bradycardia (cardiac muscle loss)
hypotension
enlarged salivary glands
muscle loss, fatigue, weak diaphragm (dyspnea)
oedema (pedal)
amenorrhea
GI can't handle meals --> bloating, nausea, constipation
osteoporosis, dry/scaly skin, hair loss

Question 3

Anorexia Nervosa - physiological abnormalities

Answer 3

hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

(Raised G’s and C’s = GH, glucose, salivary Glands - amylase, cortisol, cholesterol, carotinemia)

Question 4

What is refeeding syndrome?

Answer 4

When a starved patient suddenly eats lots of carbs, causing insulin secretion and influx of electrolytes into cells, leading to low serum electrolytes

• hallmark is hypophosphataemia
• can also get hypokalemia and cardiac arrythmias

Question 5

Anorexia Nervosa - management

Answer 5

• individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

In children and young people, NICE recommend ‘anorexia focused family therapy’ as the first-line treatment. The second-line treatment is CBT

Question 6

Bulimia nervosa - DSM 5 criteria

Answer 6

• recurrent episodes of binge eating
• a sense of lack of control over eating during the episode
• recurrent inappropriate compensatory behaviour such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise
• this occurs, on average, at least once a week for three months
• self-evaluation influenced by body shape and weight
• the disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 7

Bulimia nervosa - management

Answer 7

• NICE recommend bulimia-nervosa-focused guided self-help for adults
• If ineffective –> individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
• children should be offered bulimia-nervosa-focused family therapy (FT-BN)
• Medical
  a trial of high-dose fluoxetine