Eating Disorders

Question 1

What are the core features of anorexia nervosa?

Answer 1

Refusal to maintain body weight >85% of expected range
--> BMI <17.5
Intense fear of gaining weight
Disturbance of body image
Amenorrhoea
Other co-morbid psychiatric conditions

Question 2

Which electrolyte disturbances might be seen in anorexia?

Answer 2

Hypokalaemia

Hyponatraemia

Question 3

What cardiac problems may occur in anorexia?

Answer 3

Low BP, low HR
Increased QTc interval
Arrhythmias
Cardiac arrest

Question 4

Which GI problems might occur in anorexia?

Answer 4

Dental caries (vomiting)
Enlarged parotid glands
Discomfort and bloating
Oesophageal tears (vomiting)
Constipation or diarrhoea
Incontinence
Delayed gastric emptying
Raised LFTs as liver broken down to provide energy

Question 5

Which renal problems might occur in anorexia?

Answer 5

Damage from chronic hypokalaemia
Oedema and dehydration
- vomiting/laxatives/diuretics

Question 6

Which neurological problems might occur in anorexia?

Answer 6

Deficiencies can lead to

• peripheral paraesthesia
• tetany
• seizures

Question 7

Which endocrine abnormalities might occur in anorexia?

Answer 7

Amenorrhoea

Abnormal TFTs

Question 8

Which dermatological problems might occur in anorexia?

Answer 8

Dry skin
Carotenaemic lanugo hair
Poor circulation
Hair loss

Question 9

Which musculoskeletal problems might occur in anorexia?

Answer 9

Muscle wasting
Weakness
Osteopenia
Russel’s sign (calluses on back of hand)

Question 10

What haematological problems might occur in anorexia?

Answer 10

Low WBC
Anaemia (iron, B12)
Bone marrow suppression
Thrombocytopenia

Question 11

What are the psychological complications of anorexia?

Answer 11

Low mood + anxiety 
Irritability + anger
Narrowed interests, social withdrawal
Poor concentration, impaired decision making
Drowsiness

Question 12

What is the first line treatment for anorexia in children/adolescents?

Answer 12

Family based therapy (FBT)

Question 13

What are the other psychological treatments for anorexia?

Answer 13

CBT
IPT (interpersonal therapy)
SSCM (specialist supportive clinical management)

Question 14

Which medications might be used in anorexia?

Answer 14

Supplements e.g. vit D + calcium, vitamins

Antidepressants for low mood

Question 15

What are the features of bulimia nervosa?

Answer 15

Recurrent binges + compensatory behaviours e.g. vomiting, excessive exercise or fasting
Binge at least once a week for 3 months
Russel's sign
Dental caries
Risk of oesophageal rupture

Question 16

What is the treatment for bulimia nervosa?

Answer 16

Individual or group CBT

High dose fluoxetine may reduce cravings for food

Question 17

What is avoidant restrictive food intake disorder?

Answer 17

Restrictive eating pattern –> failure to meet nutritional needs

• may be to do with sensory issues with food textures
• may be associated autism

Question 18

What is binge eating disorder?

Answer 18

Binging at least once a week for >3 months without compensatory behaviours

Question 19

What is re-feeding syndrome?

Answer 19

Potentially fatal shifts in fluid and electrolytes on re-feeding following a period of starvation

Question 20

What is the hallmark of re-feeding syndrome?

Answer 20

Hypophosphataemia

Question 21

Which electrolyte abnormalities may be seen in re-feeding syndrome?

Answer 21

Low phosphate
Low potassium
Low magnesium 
Abnormal fluids + sodium 
Thiamine deficiency

Question 22

What are the risk factors for re-feeding syndrome?

Answer 22

Very low BMI
Little/no nutrition for several days
Alcohol/substance misuse
Diabetes
Elderly

Question 23

What is the main symptom/sign of re-feeding syndrome?

Answer 23

Oedema

Question 24

How is re-feeding syndrome prevented?

Answer 24

Give thiamine, vitamin B + multivitamin before commencing feeding, and for first 10 days after
Monitor glucose, Mg, PO4, K + Na before and every day for first week of re-feeding