Eating Disorders Flashcards
What is the SCOFF screening tool for eating disorders?
If patients score 2 or more positive answers, then an eating disorder is likely:
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 more than One stone (14 pounds or 6.35 kg) in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
What is anorexia nervosa?
Anorexia nervosa (AN) is an eating disorder characterised by restriction of caloric intake leading to low body weight, an intense fear of gaining weight, and a body image disturbance.
Restriction of intake to reduce weight
Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics
Considered anorexic if he/she is 15% below ideal body weight/BMI 17.5 or <
Fear of weight gain
[In postmenarchal females, absence of the menstrual cycle or amenorrhoea (greater than 3 cycles)]
What are the signs and symptoms of Anorexia nervosa?
Cold intolerance Blue hands and feet Constipation Bloating Delayed puberty Primary or secondary amenorrhea Dry skin Fainting Hypotension Lanugo hair Scalp hair loss Early satiety Weakness, fatigue Short stature Osteopenia & osteoporosis
What is bulimia nervosa?
Episodes of binge eating with a sense of loss of control
Binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or non purging type (excessive exercise, fasting, or strict diets).
Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months
Dissatisfaction with body shape and weight
What are the signs and symptoms of bulimia nervosa?
Mouth sores Pharyngeal trauma Dental caries Heartburn, chest pain Esophageal rupture Impulsivity: Stealing Alcohol abuse Drugs/tobacco Muscle cramps Weakness Bloody diarrhoea Irregular periods Fainting Swollen parotid glands Hypotension
What is binge eating disorder?
Similar to bulimia nervosa; absence of purging behaviours.
Ongoing and/or repetitive cycles often include
unusually fast eating, usually alone.
unusually large amounts consumed.
uncomfortably full; often “buzzed” after eating.
embarrassment, shame, guilt, depression.
What are methods used to avoid taking calories in by patients with eating disorders?
diets – becoming vegetarian, vegan
not touching food or grease
developing dislikes, pickiness, even ‘allergies’
Interpreting all symptoms as allergy or indigestion
Eating very slowly, only eating at certain times
Avoiding parties and social occasions
Spoiling or messing of food, bizarre combinations
Refusing to eat more than the person who eats least, rules about always finishing last etc
Medication abuse - Appetite suppressants – including gum, cigarettes - alternative, OTC & www medications
What are methods used to get calories back out by patients with eating disorders?
Self-induced vomiting
Chewing & spitting out
Overexercise – often secret
Overactivity – obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads
Cooling – inadequate dress, open windows etc
Blood letting
Medication abuse – including alternative, OTC & www medications, excessive caffeine and stimulant consumption – laxatives, ipecac, pain killers to allow exercise despite damage
What is diabulimia?
2 types, restrictive and bulimic where the patient enjoys a carbohydrate rich diet but then omits their insulin so as to “ effectively purge” calories and insulin omission is now recognised as a purging behaviour in diabetic patients
What are some causes of AN?
Genetic predisposition – OCD, anxiety disorders, perfectionism
Perinatal factors
Life events – and traumas
Perpetuating consequences of starvation and of avoidance
What are some precipitating factors for eating disorders?
Puberty – physical effects of hormonal changes on the brain , also psychological response to body changes
Dieting or even non-deliberate weight loss
Increased exercise
Stressful life events
What are perpetuating factors for eating disorders?
Consequences of ‘starvation syndrome’
Delayed gastric emptying - sensations of fullness interpreted as fatness,
Narrowing focus with avoidance of interpersonal interest, change of values so that food becomes the most salient stimulus.
Obsessionality. Phobia of ‘fat’ increases as avoidance increases. ‘Body checking’ amplifies body image concern
Families, School, Clinic staff
High EE in family(and other carers) may delay recovery
What is the management of eating disorders?
Re-feeding.
CBT –ED, ( 40 sessions)Mantra (20 sessions) SSCM( 20 sessions) CBT(including self-help) for normal weight
Alternatively IPT, or fluoxetine 60mg daily
(in fact any antidepressant in high dose)
Olanzapine
Specialised family work for anorexia nervosa, particularly for younger patients
Potassium and electrolyte rebalancing
