Eating disorders Flashcards
Name the four main eating disorders
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant Restrictive Food Intake Disorder (ARFID)
What is anorexia nervosa?
Self induced weight loss by lack of eating.
What are the types fo AN?
Subclinical anorexia
Restrictive (ANR)
Binge-purge (ANBP)
What is subclinical anorexia?
Some but not all symptoms are present.
What can subclinical anorexia progress to?
AN
What are some symptoms of AN?
Weight <15% of normal
Irrational fear of fatness/intense drive for thinness
Body image distortion and excessive reliance on weight or shape for self-esteem
Endocrine disturbances
Sexual dysfunction in men
What tactics can be used in AN to reduce weight?
Self restricted food intake- Measure portion size, Eat alone Over exercise Purging Laxative/diuretic misuse Appetite suppressors Mis/interest in cooking etc
What endocrine disorders can be seen in AN?
Amenorrhoea
Elevated cortisol
Elevated GH
What conditions can AN be associated with?
Anxiety Depression OCD Alcohol/drug misuse Autism
What complications can be associated with AN?
Delay puberty
Sexual dysfunction
Electrolyte disturbances- Hypokalemia/natremia
Cardiac disturbances- Low HR and BP, arrhythmias
Dental problems
GI- Oesophageal or gastric tears
Oedema and Dehydration
Neurological- peripheral paraesthesia, tetany or seizures
Renal damage
Endocrine disturbances
Hepatic- raised LFTs as liver is broken down
Dermatology- Dry skin, lagunar hair
MSK- Muscle wasting
Hematology- low WBC
Mood- Low moods, anxiety, irritability
Personality- narrowed range of interests; rigid thinking; social withdrawal
Cognition- poor conc, impaired decision making
How do you treat AN?
Change attitude to body image
Help increase weight
Avoid refeeding syndrome
Pharma
How do you change attitude to body image in AN?
Family Based Therapy
CBT
Interpersonal Therapy
Special Supportive Clinical Management
What is the first choice treatment for AN?
Family Based Therapy
How does FBT work?
The parents are guided to appropriately feed the child calmly but persistently.
How does CBT work in AN?
Focuses on recognising unhelpful and incorrect thoughts and behaviours around eating and body weight/shape then challenging them and learning healthier ways of thinking and behaving.
How does interpersonal therapy work?
Focuses on the various roles of the different relationships in an individual’s life with a view to using them in a more supportive way.
How does Special Supportive Clinical Management?
Combines clinical management like giving information, advice and encouragement with a supportive therapeutic style.
What pharma treatment can be used for AN?
Vitamin supplements
VD and Ca
Oestrogen patches
Antidepressants
What is bulimia nervosa?
Uncontrolled eating binges (more than twice a week). Excessive, repetitive and associated with self-induced vomiting and other means to negate the calorific effect of the binges.
What are some symptoms of BN?
Loss of control during binges Compensation after bingeing by purging Regret or shame after bingeing Irrational fear of fatness/distortion of body image Normal body weight
How is body weight present in BN?
Normal
What is the difference between BPAN and BN?
BN does not meet diagnostic criteria for anorexia nervosa
What are some complications of BN?
Pitted teeth (eroded by gastric acid)
Calluses on knuckles (Russell’s sign)
Hoarse voice
Metabolic disturbances
What can BN often be associated with?
Depression
Alcohol/drug abuse
Shoplifting
What types of BN are there?
Purging (80%)
Compensation (20%)
How do you treat BN?
CBT
IPT
Antidepressants- Fluoxetine (high dose)
What is binge eating disorder?
Recurrent bingeing at least once a week for 3 months without the use of compensatory behaviours that causes significant distress.
What are some potential symptoms of binge eating disorder?
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts of food when not physically hungry
Eating alone because of being embarrassed by how much one is eating
Feeling disgusted, depressed or guilty about overeating
What is Avoidant Restrictive Food Intake Disorder (ARFID)?
An eating disturbance manifested by a restrictive eating pattern with persistent failure to meet appropriate nutritional needs. This can be related to sensory issues such as being unable to tolerate certain food textures rather than due to body image concerns.
What can ARFID be associated with?
Autism Spectrum Disorder
What kind of thought is the fear of fat?
Obsessive or overvalued ideas
Is AN a delusional disorder?
Yes because delusions over fat
Do you get a loss of interest in food with AN?
No, that would more be depression
