eating disorders Flashcards
anorexia nervosa
disordered eating
food/body acceptand–> food/body obsessed–> disordered eating–> Eating disorders (anorxia, bulemia, binge eating)
distorted body image
literally means loss of appetite- they do have an appetite (early) but refuse to eat
Characterized by: an intense pursuit of weight loss and self induced starvation- fear of becoming obese, engages in dieting and excessive exercise, paradoxically focused on food
A disturbance in body image
Medical signs/symptoms of starvation
significantly low weight
amenorreha could be
BMI>17 mild, 16 mod, 15 severe, extreme is<15
Subtypes of anorexia
Restricting type: excessive diet and exercise, especially limitng carbs and fats
Binge eating/purging type- binge (eating a large amount of food in short period of time), purge (engaging in compensatory behavior to get rid of the food or weight)
Feelings of loss of control during the episode
Females>males, 1%, higher SES
multifactorial, dieting is the #1 risk facotr
Hormonal, biochemicaland starvation effects: associated with onset of puberty- endorphin increases, onset of puberty, HPA axis changes, NT
Psychological factors
Temperament- Perfectionist, harm avoidant, high achieving
Control issues- Feeling helpless, not able to establish autonomy
Maturation fears- fear of becoming an adult, being shapely or sexual
Demands to increase independence- overwhelming, focuses on food versus normal activites
Beliefs- desires- greedy unacceptable
Symptoms- Cold intolerance, postural dizziness and faining, early satiety, abdominal bloating, discomfort and pain, constipation, fatigue, muscles weakness and cramp, poor concentration
Diagnosis
Complicated by denial, secrecy, disinterest in or resistance to treatment
Rule out- medical chronic infection, thyroid problems, addisons, IBD, CT disorder, CF, PUD, celiac disease, infectious disease, disease of the esophagus/small intestine, DM occult malignancy
Psych- other eating disorder (bulemia, ARFID), depression, anxiety (social, separation, OCD, GAD, swalloing phobia
Substance use, somatization, schizophrenia, rumination disorder, personality disorder (dependent OCPD, passive aggressive
refeeding syndrome
Fluid and electorolyte shift during nutritional rehabilitation
Risk- rapidid of weight restoration
Potentially life threatening- hypophosphatemia, delerium, arrythmias, etc
6-12 months before clinical diagnosis, wt loss, TEAM approach
hospitalization is needed, reinstant
Treatmetn- psychopharmacology
no meds, meds often for other comorbidities
prognosis- 75%, mortality around 10%
bulemia
voracious appetitie, =hunger
Episodes of overeating, prevent weight gain- may engage in purging or excessive exercise, normal weight but overweight or obese
Binge eating, recurrent inappropriate compensatory behavior in order to prevent weight gain, once a week for 3 months
purging
vomiting, misuse of laxatives, diuretics, enemas
Diet pills, excessive exercise, restrictive dietign fastign, skipping meals steroids are other compensations
labs in Bulemia
vomiting and diuretic use- metabolic alkalosis- low potassium low soium, high bicarb, hypochloremia
Laxitives- Hyperchloremia metabolic acidosis, low potassium, high chloride low bicarb
Low magnesium elevated amylase normal lipase
fluoxetinr is a good treatment
Binge eating disorder
Epidemiology- affecting 3-5% of the population, late adolescence or early adulthood,
Episodes weekly for 3 mo of 3+ sx: eating fast, until uncomfortably full, eating when not hungry, eating alone due to emarrasment about amount of fodd consumed, feeling disgust, depressionor guilt
no compensation, appetite wuppressants, SSRIs, stimulants
avoidant restrictive food intake disorder
failure to meet appropriate nutritional energy needs, not better explained by lack of food/culture
really selective food,
Pica
1 month eating weird things
Remination disorder
1 month regurf, rechewm re seallowed,
non specified
etc
