Eating Disorders Flashcards
What percentage of sufferers of eating disorders are female?
90%
How is a SCOFF questionnaire completed and interpreted?
Patients scoring 2 or more positive answers likely being affected by an eating disorder. The questions are:
•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?
How is anorexia nervosa defined?
Anorexia nervosa is associated with a restriction of intake to reduce weight, with a reliance on compulsive compensatory behaviours (self-induced vomiting, laxative abuse, excessive exercise etc) when food cannot be avoided. Patients can be considered anorexic if they are 15% below their ideal body weight or has a BMI <17.5
What are the symptoms of anorexia?
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
How is bulimia nervosa defined?
Bulimia nervosa is associated with episodes of binge eating with a sense of loss of control which is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative/diuretic abuse). Binges and the resulting purges must occur at least twice a week for three months for bulimia to be diagnosed. Bulimia can be associated with any BMI
What are the signs and symptoms of bulimia?
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 Hypokalemia resulting in QT lengthening, arrhythmia or seizures
How is binge eating disorder defined?
Binge eating disorder has similar features to bulimia nervosa but there is an absence of the purging behaviours. Repetitive cycles often include the following:
•Unusually fast eating, usually alone
•Unusually large amounts consumed
•Uncomfortably full after eating
•Associated embarrassment, shame, guilt or depression
How can calorie intake avoidance behaviour present?
- 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
How can behaviours to get rid of calories present?
Self-induced vomiting
Chewing & spitting out
Overexercise
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
Asides from calorie restriction and riddance, what other behaviours can be associated with eating disorders?
Body checking- repeated weighing, checking in mirror etc
Displaying emaciation to elicit reassuringly shocked attention
Competing with self and others to attain lower and lower targets
Deliberate self harm
What are the psychological consequences of eating disorders?
Core psychopathology
Reduced central coherence and narrowed focus of interest
Starved person unable to interpret emotion as is present in Aspergers
Malnourished brains experience depression, anxiety and obsessionality
Depression at low weight rarely responds to treatment
Anxiety related to eating with company
What are the social consequences of eating disorders?
Mainly centre on isolation as other people become barriers to the avoidant or purging behaviour
What are the physical consequences of eating disorders?
Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infection, anaemia, bone loss and fertility problems
Purging behaviours cause neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias)
Reduced growth, pubertal development, brain growth and development
What are the possible causes of anorexia?
Genetic predisposition
Perinatal factors
Life events/traumas
Perpetuating consequences of starvation and avoidance
How is anorexia managed?
Refeeding CBT IPT SSRIs when BMI is sufficient to allow this Olanzapine Mean recovery time of 6-7 years
