Eating Disorders

Question 1

What comorbidity is common in eating disorders?

Answer 1

• OCD
• anxiety disorders
• autism spectrum disorders
• compulsive exercise

Question 2

What is the SCOFF questionnaire?

Answer 2

Sensitivity 100%, specificity 90% for anorexia nervosa

2 or mor positive answers raise suspicion

• do you ever make yourself SICK because you feel uncomfortable full?
• do you worry you have LOST CONTROL of how much you eat?
• have you recently lost more than ONE STONE in a 3mnth period?
• Do you believe you are FAT when others say you’re too thin?
• Would you say FOOD dominates your life?

Question 3

Briefly describe anorexia nervosa

Answer 3

Low weight obsessively achieved bc fear fatness

2 subtypes; AN-R and AN-BN

Question 4

Briefly describe bulimia nervosa

Answer 4

Attempted weight loss by starvation leads to vicious cycle of restriction/bind/purge at normal weight

Question 5

Briefly describe binge eating disorder

Answer 5

Binges and periods of attempted restriction but no other compensatory behaviours - often overweight

Question 6

What are psychological consequences of eating disorders?

Answer 6

Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food

Depression at low weight rarely responds to medication

People who rely on eating-disordered behaviour to ‘solve’ problems fail to develop other ways to cope

Question 7

What are social consequences of eating disorders?

Answer 7

Turn others into obstacles to eating disorder

Normally honest people lie and cheat about eating disorder concerns

Withdraw from friendships and lose interest in sexual relationships

Question 8

What are physical consequences of eating disorders?

Answer 8

Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity, anaemia, bone loss and fertility problems

Purgin causes neuro-chemical disruption with special damage to brain (seizures) and hear (arrythmias)

Question 9

What are treatment options in eating disorders?

Answer 9

CBT; for normal weight Bulimia Nervosa

Alternatively IPT or fluoxetine 60mg daily

Question 10

What is MARSIPAN?

Answer 10

Risk management document for eating disorders

1. Awareness high risk in adults with AN admitted to medical wards
2. Risk Assess; BMI, physical exam, muscle power, ECG
3. Refer to specialist eating disorders unit
4. Criteria from medical admission: treatment not available on SEDU or unavailability of bed

Question 11

What are key tasks in MARSIPAN?

Answer 11

safely re-feed patient avoiding over and under-feeding

manage behavioural problems including those that sabotage renutrition

when appropriate to use mental health act

manage family concerns

arrange safe transfer to SEDU as soon as patient safely managed there

Question 12

What are obstacles to treating patients with eating disorders?

Answer 12

• may appear to have capacity but might have significantly impaired decision making abiltity (SIDMA)
• treatment consists mainly of food; is food a “medical treatment” - by law yes
• can children over 12 be detained; yes they are presumed to have capacity
• legal challenges may focus unduly on patient BMI but there is no BMI/weigth cut-off for detention; EDs are mental disorders

Question 13

What are the weight loss requirements for a diagnosis of anorexia nervosa?

Answer 13

BMI < 17.5

OR

Loss of >15% body weight in 6 months