Eating disorders Flashcards
1) Which people do eating disorders typically affect?
2) When does dieting become an eating disorder?
3) What does Anorexia Nervosa involve?
4) What does Bulimia Nervosa involve?
1) They typically affect perfectionist, high-achieving young women with low self-esteem.
2) When the pursuit of thinness becomes all-consuming.
3) AN involves weight loss methods causing extreme emaciation.
4) BN involves binge eating followed by vomiting.
1) What does binge eating disorder involve?
2) What can binge eating disorder result in?
3) Who is more commonly affected by eating disorders?
4) What percentage of eating disorders affect men?
1) It is essentially Bulimia Nervosa without the purging.
2) Can result in obesity.
3) Women are more commonly affected.
4) Incidence in men accounts for 10% of cases.
1) Describe the lifetime prevalence of the 3 main eating disorders.
2) Who is at a lower risk of developing AN?
3) Onset of AN is usually seen in who?
4) Why might a lot of cases of BN go undetected?
1) AN - 0.6%, BN - 1.0%, BED - 2.8%.
2) Black and ethnic minority groups are at a lower risk that white populations.
3) Girls aged 16-22, and it affects all social classes.
4) Because patients are as secretive as in AN, but are not as obviously emaciated.
1) When does BN usually start?
2) What 2 other mental health disorders are commonly comorbid with eating disorders?
3) What is heritability estimated to be in AN?
4) What are the 2 main characteristics which are thought to be causative of AN and BN?
1) Mid-adolescence.
2) Depression and substance misuse.
3) 58%.
4) Perfectionism and low self-esteem.
Give and describe the 3 main psychological theories thought to be aetiological of AN.
1) Successful weight loss enhances the patient’s sense of achievement, autonomy and perfectionism.
2) When life feels uncontrollable, AN comforts by providing the ability to control something.
3) The disorder can also be seen as a way of avoiding separation from family or becoming an independent sexual being; it maintains dependency on close family and a peri-pubertal physique.
1) Name 2 social pressures which are important influences on the development of AN and BN.
2) Give an example of a social group at high risk of developing eating disorders.
3) What do People with BN often have a history of?
4) Past experiences of what are commonly found in AN and BN?
1) Social pressures to be thin and the promotion of dieting are important influences.
2) Occupations where there is emphasis on weight and body image; models, athletes and dancers.
3) Obesity and up to 50% have previously suffered from AN (the reverse pattern occurs less frequently).
4) Experiences of child abuse are commonly found in AN and BN.
1) What 2 family dynamics are associated with development of AN?
2) What does ‘enmeshment’ describe?
3) What 3 family qualities is BN associated with?
4) What 3 factors in a family history are risk factors for BN?
1) Parental overprotection and family enmeshment are associated with AN.
2) Enmeshment describes relationships that are over-involved, with poor boundaries which make it difficult for members to feel independent.
3) BN is connected with disturbed family dynamics, parental weight concern and high parental expectation.
4) Obesity, depression and substance misuse.
Name the describe the 4 diagnostic points in Anorexia Nervosa.
1) BMI <17.5 (or weight 15% less than expected).
2) Deliberate weight loss: people go to extraordinary lengths to lose weight, becoming extremely emaciated.
3) Distorted body image: patients are preoccupied with body shape and a dread of weight gain. They hold overvalued that they are fat.
4) Endocrine dysfunction: HPA axis is affected, causing amenorrhoea in women and impotence in men. Libido is lost in both sexes.
1) How do patients with AN restrict calorie intake?
2) Name 4 types of drugs that patients with AN may use to lose weight.
3) What might diabetics with anorexia nervosa do in order to attempt to lose weight?
4) If AN happens before puberty, onset of what are delayed or arrested?
1) Avoid fattening foods, use of laxatives, vomiting and excessive exercise.
2) Appetite suppressants, thyroxine, diuretics and stimulants.
3) Diabetics may ‘skip’ insulin doses in order to prevent fat deposition.
4) Puberty, menarche or breast development could be delayed or arrested.
Give the 6 categories of physical complications that can occur with Anorexia Nervosa.
1) General: Lethargy, cold intolerance, infections due to decreased immunity.
2) Cardiovascular: bradycardia, hypotension (postural drop), arrhythmias (usually secondary to hypokalaemia), mitral value dysfunction and cardiac failure. Can lead to sudden cardiac death.
3) GI: Constipation, abdominal pain, oesophageal tears, gastric rupture due to vomiting.
Reproductive: amenorrhoea (diagnostic criterion), infertility, loss of libido, loss of morning erections.
MSK: Osteoporosis leading to fractures and severe proximal myopathy.
Neurological: Peripheral neuropathy, delirium, convulsions, coma.
1) Why might pancytopenia occur in severe AN?
2) What 3 haematological abnormalities might occur in patients with milder AN?
3) Why might patients with AN feel bloated after eating small amounts?
4) How might nutritional hepatitis be detected in a patient with AN?
1) Due to bone marrow hypoplasia.
2) Anaemia, leucopenia or thrombocytopenia.
3) Due to delayed gastric emptying.
4) low serum protein, raised bilirubin, raised LDH and raised alkaline phosphatase.
1) Why does infertility occur in AN?
2) Why do patient’s with anorexia develop Laguno hair?
3) What might become swollen after bingeing?
1) Due to atrophy of the ovaries or testes.
2) It is the body’s attempt to keep warm following body fat loss.
3) Parotid and submandibular glands may become affected.
List the 6 differentials of Anorexia Nervosa.
1) Medical causes of weight loss: hyperthyroidism, malignancy, GI disease, Addison’s disease, AIDS, inflammatory conditions, chronic infection.
2) Depression: weight loss can be severe in depression but would not usually be denied.
3) BN: patient not usually underweight and bingeing and vomiting would be predominant.
4) Eating disorder not otherwise specified: describes an atypical presentation of AN.
5) Body dysmorphic disorder: Characterised by body image distortion - deliberate weight loss would be unusual.
6) Psychosis: self-starvation might occur if food is thought to be poisoned.
Name 5 investigations that you might wish to carry out in a patient with AN.
1) Height, weight and BMI.
2) Squat test: ask patient to squat down and rise to standing without using their arms (difficult with proximal myopathy)
3) Essential bloods: ESR (normal or low in anorexia), TFTs, FBC, U&E, phosphate, albumin, creatinine kinase, glucose (to evaluate nutritional state and risk).
4) ECG: bradycardia, arrhythmias and a prolonged QT interval.
5) Other tests indicated: DEXA scans (low bone density).
1) What is Melanosis coli and what does is result from?
2) How are most patients with eating disorders managed?
3) For patients with anorexia nervosa, what might be preferable to full-time inpatient admission?
4) What is needed to enable HCPs to treat patient’s by compulsory feeding?
1) Pigmentation of the colonic mucosa which results from laxative abuse.
2) Most people are managed long term as outpatients.
3) Day hospitals and partial hospitalisation.
4) The MHA.
