Eating disorders Flashcards
What are the three eating disorders described by the ICD-10?
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified
What are the defining features of anorexia nervosa vs bullimia nervosa according to DSM-V?
ANOREXIA NERVOSA
BMI<18.5
Core psychopathology
BULLIMIA NERVOSA
BMI>18.5
Core psychopathology
Regular binge/purge 1x/week
How many men and how many women does anorexia nervosa affect?
Men - 1 in 2000
Women - 1 in 250
What are some examples of core beliefs of those with anorexia nervosa ? (5)
Fear of fatness
Pursuit of thinness
Body dissatisfaction
Body image distortion - finding fat where there is none
Self evaluation based on weight and shape
What other psychopathologies are included in anorexia nervosa and how does this play into the disease?
Depression Anxiety Suicidal ideation OCD ***it is thought that starvation might cause some of these conditions
What questions would you ask to determine behaviours related to anorexia nervosa?
EATING HABITS
- Tell me what you eat on day to day
- Avoid certain foods?
- Drink a lot of water?
- Who do you eat with?
- How does eating make you feel?
THROUGHOUT THE DAY
- Are you aware of calories?
- Do you weigh yourself (ideal weight/ thoughts of current weight/how do you feel when you put weight on)
AFTER EATING
-Do you do anything to compensate for eating? (exercise/vomit)
-Do you take any laxatives after you eat?
-Do you take any medication to help you lose weight/manage hunger?
ARE YOU AWARE THAT THIS IS BAD FOR YOU
What kind of affect does starvation have on the CVS system?
starvation can cause hypotension, bradycardia, sudden death
What kind of affect does starvation have on Heam system?
Starvation can cause anaemia, thrombocytopenia and leukopenia
What kind of affects can the binging/purging nature of bulimia nervosa have on the CVS system?
binging/purging can cause arrhythmias, cardiac failure and sudden death
What kind of affects can the binging/purging nature of bulimia nervosa have on the other systems in the body?
Oligomenorrhoea
Impaired temperature regulation
Calluses on the dorsal of hands - RUSSEL’S SIGN
There is an imbalance of many hormones and substances in the body in anorexia nervosa , what is a good way of remembering which things are high and which are low?
Most things low
• Hypokalaemia
• Hypochloraemic alkalosis (both due to vomiting and/or diuretic/laxative abuse)
• Low WCC
•The erythrocyte sedimentation rate (ESR) is normal or reduced.
•Libido may decline in males due to hypogonadotrophic hypogonadism.
•low FSH, LH, oestrogens and testosterone
•low T3
apart from Gs and Cs
G - growth hormone, glucose, salivary Glands,
C- cortisol, cholesterol, carotinaemia
What is a good way to SCREEN for eating disorders?
SCOFF questionnaire
S - do you ever make yourself SICK after eating?
C - Do you every worry you have lost CONTROL over how much you eat/
O - Have you every lost more than ONE stone in any three month period?
F - Do you believe yourself to be FAT (when others say you’re thin)?
F - Would you say FOOD dominates your life?
***also always ask about physical symptoms
What investigations should be done in a patient with anorexia nervosa ? (3)
- Weight them and check BMI
- Ask about physical symptoms
- ECG (80% deaths in AN from cardiac arrest) - QTc prolongation
- Bloods
What blood test would you want to check for eating disorders?
FBC Us Es LFTs TFT Phosphate, Magnesium, Calcium, zinc glucose creatinine kinase
What is the prognosis for someone with anorexia nervosa ?
This is directly linked to their BMI If it is: <18.5 - confirmed AN <15 - moderate risk of death <13 - High risk of death
