Eating Disorders Flashcards
What are eating disorders
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
Epidemiology of eating disorders
5-10% adolescent girls used pathological weight reducing techniques
90% female
Risk factors for eating disorders
Genetic predispositions
- OCD
- Anxiety disorders
- Perfectionism
Perinatal factors
Life events – trauma
Media
Precipitating factors of eating disorders
Puberty (hormonal changes on brain, psychological response to body changes)
Non-deliberate weight loss
Increased exercise
Stressful life events
Perpetuating factors of eating disorders
Consequences of ‘starvation syndrome’
- Delayed gastric emptying – sensation of fullness interpreted as ‘fatness’
Obsessionality – phobia of ‘fat’ increases as avoidance increases
Presentation of eating disorders
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
Avoidance of calories in eating disorders
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.)
getting rid of calories in eating disorders
Vomiting
Over exercise
Overactivity
Cooling
Blood letting
Medication abuse
Types of eating disorders
Anorexia nervosa
Bulimia nervosa
‘Diabulimia’ – omitting insulin after carbohydrate rich meal
Investigations of eating disorders
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?
Management of eating disorders
Average recovery time – 6-7 years
Re-feeding
CBT
PIT or fluoxetine 60mg daily (antidepressants in high dose)
Olanzapine
Specialised family work
Complications of eating disorders
Death – 20%
Psychological
Social
Physical
Psychological complications of eating disorders
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
Social complications of eating disorders
People become obstacles, forced to lie and cheat
Withdraw from friendships and lose interest in sexual relationships
Physical complications of eating disorders
Damage to organs
Purging behaviours causes neuro-chemical disruptions
Growth restrictions
Refeeding syndrome
What is anorexia nervosa
Restriction of intake to reduce weight
Compensatory disorders when food cannot be avoided
Fear of weight gain
Epidemiology of anorexia
Lifelong prevalence - 1-0.9%
Risk factors for anorexia
Family history
Low self esteem
Presentation of anorexia
Considered anorexic if BMI <17.5
Absence of menstrual cycles or amenorrhoea (>3 cycles)
Physical presentation of anorexia
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
Compensatory behaviours in anorexia
Self-induced vomiting
Laxative abuse
Excessive exercise
Abuse of appetite suppressants/diuretics
Classification of anorexia
BMI <17.5
Self-induced weight loss
A morbid fear of fatness
Endocrine dysfunction (e.g. amenorrhoea)
Investigations in anorexia
BMI
Bloods
Squat test
What is bulimia nervosa
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
Risk factors for bulimia
Family history
Social
Presentation of bulimia
Often normal or increased BMI
Episode of binge eating
Fixated on food
Purging behaviour
Non-purging behaviour
Impulsivity
- Stealing, alcohol abuse, drugs/tobacco
Physical presentation of bulimia
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
Classification of bulimia
Binges and compensatory behaviour must occur minimum 2 per week/3 per month
Morbid fear of fatness
What is binge eating disorder
Similar to bulimia but with the absence of purging behaviours
Presentation of binge eating disorder
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
