Eating disorders

Question 1

List of EDs

Answer 1

• anorexia nervosa
• bulimia nervosa
• binge-eating disorder
• otherwise specified (do not conform to criteria of others)

Question 2

Clinical features of AN

Answer 2

• relentless self-starvation
• lack of maintenance of healthy body weight
• loss of mentruation
• bone loss
• loss of skin integrity
• increases stress on the heart
• low rates of recovery and highest mortality rate of any psych disorder

Question 3

Subtypes of AN

Answer 3

1. restricting type → during the last 3 months, the person has not engaged in recurrent episodes of
   binge eating or purging behavior (ie. self-induced vomiting, misuse of laxatives/diuretics/enemas)
2. Binge/purge type – during the last 3 months, the person has engaged in recurrent episodes of
   binge eating or purging behavior

Question 4

Clinical features of BN

Answer 4

Recurrent binge-eating (episodes of uncontrolled overeating, at least once a week for at least 3
months), with extreme compensatory weigh control behavior (‘purging’ – self-induced vomiting,
laxative misuse, extreme exercise, strict dieting), and over-evaluation of shape and weight

Question 5

Clinical features of BED

Answer 5

CHaracterised by recurring binge eating at least once a week for over a period of three months, while
experiencing lack of control and guilt, impairment and distress after overeating
- No compensatory behaviours, and no over-evaluation of control of eating, weight and shape
- High progression to obesity
- Can develop within individuals of a wide range of ages and socioeconomic classes

Question 6

Briefly discuss pathogenesis of AN and BN

Answer 6

Multlifactorial → genetic predisporition and a range of environmental factors

Altered 5-HT and dopaminergic function is implicated, exacerbated by weight loss – may lead to altered
interoception and reward processes

Question 7

Risk factors

Answer 7

• genetic
  adolescence and early adulthood, living in Western society
• Individual-specific factors (family history): ED of any type, depression, substance misuse (especially
  alcoholism) for BN, obesity for BN

Question 8

What premorbid experiences may lead to ED development?

Answer 8

 Adverse parenting (low contact, high expectations, parental discord)
 Sexual abuse
 Family dieting
 Critical comments about eating, weight and shape from others
 Occupational pressure to be slim
 Early menarche (BN)

Question 9

What premorbid characteristics may lead to ED development?

Answer 9

 Low self-esteem
 Perfectionism (AN)
 Anxiety and anxiety disorders

Question 10

Management of AD

Answer 10

Main aspects to management:
1. Helping patients to see they need help, and to maintain motivation
2. Helping patients to reverse starvation, restore weight; OP, DP, IP
3. Addressing compulsivity and over-evaluation of shape, weight and control over eating (eg. ED
family therapy, CBT-E)
Drug treatment does not currently have an established role