Eating Disorders

Question 1

What are eating disorders

Answer 1

Obsessive fear of fatness with avoidance of food & other calorie sources

Compulsory compensatory behaviours when food cannot be avoided

• To avoid the experience of anxiety

Question 2

Epidemiology of eating disorders

Answer 2

5-10% adolescent girls used pathological weight reducing techniques

90% female

Question 3

Risk factors for eating disorders

Answer 3

Genetic predispositions

• OCD
• Anxiety disorders
• Perfectionism

Perinatal factors

Life events – trauma

Media

Question 4

Precipitating factors of eating disorders

Answer 4

Puberty (hormonal changes on brain, psychological response to body changes)

Non-deliberate weight loss

Increased exercise

Stressful life events

Question 5

Perpetuating factors of eating disorders

Answer 5

Consequences of ‘starvation syndrome’

• Delayed gastric emptying – sensation of fullness interpreted as ‘fatness’

Obsessionality – phobia of ‘fat’ increases as avoidance increases

Question 6

Presentation of eating disorders

Answer 6

Avoidance of calories

Getting rid of calories

Medication abuse

‘Body-checking’

Displaying emaciation to elicit reassuringly shocked reaction

Competing with self and others to attain lower targets

Self-harm if ‘rules’ are broken

Question 7

Avoidance of calories in eating disorders

Answer 7

Diets

Developing ‘allergies’, interpreting all symptoms as ‘allergies’

Eating slowly, at certain times

Refusing to eat more than anyone else

Medication abuse – appetite suppressants (gum, cigarettes etc.)

Question 8

getting rid of calories in eating disorders

Answer 8

Vomiting

Over exercise

Overactivity

Cooling

Blood letting

Medication abuse

Question 9

Types of eating disorders

Answer 9

Anorexia nervosa

Bulimia nervosa

‘Diabulimia’ – omitting insulin after carbohydrate rich meal

Question 10

Investigations of eating disorders

Answer 10

SCOFF questionnaire – 2 or more, 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 in a 3 months period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?

Question 11

Management of eating disorders

Answer 11

Average recovery time – 6-7 years

Re-feeding

CBT

PIT or fluoxetine 60mg daily (antidepressants in high dose)

Olanzapine

Specialised family work

Question 12

Complications of eating disorders

Answer 12

Death – 20%

Psychological

Social

Physical

Question 13

Psychological complications of eating disorders

Answer 13

Overvaluation of low weight – sacrifice other valuable things to attain

Starved person unable to interpret emotion

Malnourished brain experience depression – low weight rarely responds to medication

Fail to develop other ways to cope with life

Question 14

Social complications of eating disorders

Answer 14

People become obstacles, forced to lie and cheat

Withdraw from friendships and lose interest in sexual relationships

Question 15

Physical complications of eating disorders

Answer 15

Damage to organs

Purging behaviours causes neuro-chemical disruptions

Growth restrictions

Refeeding syndrome

Question 16

What is anorexia nervosa

Answer 16

Restriction of intake to reduce weight

Compensatory disorders when food cannot be avoided

Fear of weight gain

Question 17

Epidemiology of anorexia

Answer 17

Lifelong prevalence - 1-0.9%

Question 18

Risk factors for anorexia

Answer 18

Family history

Low self esteem

Question 19

Presentation of anorexia

Answer 19

Considered anorexic if BMI <17.5

Absence of menstrual cycles or amenorrhoea (>3 cycles)

Question 20

Physical presentation of anorexia

Answer 20

Cold intolerance

Blue hands & feet

Constipated

Bloating

Delayed puberty, short stature

Dry skin

Fainting

Hypotension

Lanugo hair

Scalp hair loss

Early satiety

Weakness, fatigue

Osteopenia & osteoporosis

Decreased creatinine, K⁺, PO₃⁴ , mg²⁺

Anaemia

Decreased immunity (decreased WCC)

Confusion

Question 21

Compensatory behaviours in anorexia

Answer 21

Self-induced vomiting

Laxative abuse

Excessive exercise

Abuse of appetite suppressants/diuretics

Question 22

Classification of anorexia

Answer 22

BMI <17.5

Self-induced weight loss

A morbid fear of fatness

Endocrine dysfunction (e.g. amenorrhoea)

Question 23

Investigations in anorexia

Answer 23

BMI

Bloods

Squat test

Question 24

What is bulimia nervosa

Answer 24

Episode of binge eating with a sense of loss of control

• Past fullness/comfort

Binge eating is followed by compensatory behaviour of the purging or non-purging type

Dissatisfaction with body shape & weight

Question 25

Risk factors for bulimia

Answer 25

Family history

Social

Question 26

Presentation of bulimia

Answer 26

Often normal or increased BMI

Episode of binge eating

Fixated on food

Purging behaviour

Non-purging behaviour

Impulsivity

• Stealing, alcohol abuse, drugs/tobacco

Question 27

Physical presentation of bulimia

Answer 27

Mouth sores

Pharyngeal trauma

Dental cavities

Heartburn, chest pain, arrythmias

Oesophageal rupture - Mallory Weis

Muscle cramps

Weakness

Bloody diarrhoea

Irregular periods

Fainting

Swollen parotid glands

Hypotension

Depletion of electrolytes

Question 28

Classification of bulimia

Answer 28

Binges and compensatory behaviour must occur minimum 2 per week/3 per month

Morbid fear of fatness

Question 29

What is binge eating disorder

Answer 29

Similar to bulimia but with the absence of purging behaviours

Question 30

Presentation of binge eating disorder

Answer 30

Ongoing and/or repetitive cycle often include

• Unusually fast eating, usually alone
• Unusually large amounts consumed
• Uncomfortable full; often ‘buzzed’ after eating
• Embarrassment, shame, guilt, depression