Eating disorders Flashcards
Define eating disorders
Disturbance of eating behaviour/ behaviour to control weight
driven by extreme fear of fatness
Explain the aetiology / risk factors of eating disorders
Perfectionism
Low self esteem
commonly comorbid with other mental health disorders, especially depression and substance misuse
GENETICS!!:
11x inc risk with 1st degree relative
Anorexia, heritability is 58%, and the MZ:DZ
twin concordance rates are 65:32
Bulimia - less genetic inheritance
- hx of obesity
- 50% previously had anorexia
- fhx obesity
- parental weight concern
- high parental expectation
psychological and sociocultural theories
Summarise the epidemiology of eating disorders
affects perfectionist, highachieving
young women with low self-esteem
define anorexia
GET DSM5 Definition
anorexia nervosa
involves weight loss methods causing extreme emaciation
subtypes;
- restrictive
- binge/purge
define bulimia
involves binge eating followed by
vomiting or exercising to get the weight off
define binge eating disorder
binge eating disorder is bulimia without
the purging.
list the eating disorders in order of prevalence?
anorexia nervosa—0.6%
• bulimia nervosa—1.0%
• binge eating disorder—2.8%
which study describes genetic pattern in eating disorders?
Wade et al. 2007
outline the theories explaining eating disorders?
Psychological theories;
When life feels uncontrollable, Anorexia comforts by providing the ability to control something (weight).
The disorder is a way of avoiding separation from family
or becoming an independent sexual being.
Sociocultural theories;
Social pressures to be thin and the promotion of dieting
are important influences.
High-risk groups: models, athletes, and dancers.
outline the DSM5 criteria for anorexia nervosa diagnosis?
- BMI <17.5 or weight 15% less than expected
- Deliberate weight loss
- distorted body image. dread weight gain
- endocrine dysfunction; amennorhea, impotence, loss of libido
-If AN begins before puberty, menarche and
breast development are delayed or arrested.
what are the physical complications of anorexia?
- General;
Lethargy and cold intolerance.
Milder disorders;
anaemia, leucopenia, or thrombocytopenia. Infections
may result from decreased immunity. amennorhea
Severe disorder: Pancytopenia - bone marrow hypoplasia.
growth stunting
death
pregnancy complications - infertility
- Cardiovascular
- GI
- Reproductive
- MSK; proximal myopathy, osteoporosis
- Neurological
mental health issues post recovery
list cvs complications of anorexia?
80% of AN patients experience
cardiac complications; risking sudden death.
bradycardia, hypotension (postural drop),
arrhythmias (usually secondary to hypokalaemia),
mitral valve dysfunction, and cardiac failure.
list GI complications of anorexia?
constipation
abdominal pain to ulcers, oesophageal tears, and
gastric rupture due to vomiting.
Delayed gastric emptying makes patients feel bloated after eating
even small amounts.
Nutritional hepatitis in 1/3rd
patient presents. her bloods show;
low serum protein,
with raised bilirubin, lactate dehydrogenase, and
alkaline phosphatase.
diagnosis?
nutritional hepatitis due to anorexia
list neurological complications of anorexia?
Peripheral neuropathy, delirium, convulsions
or even coma
what are the differentials for anorexia?
1.Medical causes of weight loss, e.g. hyperthyroidism,
malignancy, gastrointestinal disease, Addison’s disease,
chronic infection, inflammatory conditions, and AIDS.
- Depression: weight loss can be severe in depression,
but would not be denied. Low mood is common in
AN, but weight gain would be resisted. - Bulimia nervosa: bingeing and vomiting can occur
in anorexia nervosa, but BN should be diagnosed if
this is the predominant behaviour and the patient is
not underweight. - Eating disorder not otherwise specified (EDNOS):
the term for atypical presentations. - Body dysmorphic disorder (BDD): BDD is a condition
characterized by body image distortion (e.g.
belief that the nose is misshapen). Deliberate weight
loss in BDD would be unusual. - Psychosis: self-starvation might occur if food is believedto be poisoned.
ivx for anorexia?
- Height, weight, and BMI.
- Squat test: Ask the patient to squat down and rise
to standing without using their arms (difficult with
proximal myopathy). - Essential blood tests
• ESR, TFTs—exclude most organic causes of weight
loss, e.g. hyperthyroidism. ESR is normal or low in
anorexia.
• FBC, U&E, phosphate, albumin, LFT, creatinine
kinase, glucose—evaluate nutritional state and risk. - ECG: Bradycardia, arrhythmias, and a prolonged
QT interval. - Other tests as indicated, e.g. DEXA scans (low bone
density).
the following are seen in which condition;
Russell’s sign (calluses or cuts on the knuckles
from self-induced vomiting)
Swollen salivary glands (puffy face)
Oedema
Binge/purge/vomit
Outline the management for Adult Anorexia according to NICE?
Adults;
A. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- 40 sessions over 40 weeks
- 2x weekly for frist 2-3wks
B. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
-20 sessions
C. specialist supportive clinical management (SSCM)
- 20 sessions
what does MANTRA involve?
nutrition, symptom management, and behaviour change
involve family members or carers
- to help with behaviour change etc
based on the MANTRA workbook
waht does individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) involve?
encourage healthy eating and reaching a healthy body weight
cover nutrition, mood regulation, social skills, body image concern, self-esteem, and relapse prevention
includes self-monitoring of dietary intake and associated thoughts and feelings
what does specialist supportive clinical management (SSCM) involve?
provide psychoeducation, and nutritional education and advice
include physical health monitoring
encourage reaching a healthy body weight and healthy eating
what is next line management if the 3 first line therapies have not workeed for anorexia?
Eating-disorder-focused focal psychodynamic therapy (FPT)
40 sessions over 40 weeks
1st line management for Anoxeria in kids and young people? NICE
1st line - FFT:
Consider anorexia-nervosa-focused family therapy for children and young people (FT-AN), delivered as single-family therapy or a combination of single- and multi-family therapy
have option to do it without family or with family.
18-20 sessions over 1 year
2nd line - individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Adolescent focussed therapy - teens
2nd line management for anoxeria in kids and young people? NICE
if the family therapy did not work or is contraindicated;
individual CBT-ED or adolescent-focused psychotherapy for anorexia nervosa (AFP-AN).
40 sessions over 40 weeks
up to 12 sessions must be with family
when is inpatient admission warranted in eating disorders?
(preferably in a specialist eating disorders unit)
- BMI <13 or extremely rapid weight loss; 1kg+ per week
- serious physical complications
- purpuric rash
- cold peripheries, core BT <34.5
- hypotension <80/50
- bradycardia <40 OR prolonged QT
- hypokalaemia, hyponatraemia, low PO4
- cant stand from squatting w/o hands
• high suicide risk.
what framework should be used to guide refeeding?
MARSIPAN
Junior MARSIPAN
what is a recognized
cause of mortality in the early stages of treatment?
aetiology?
refeeding syndrome
characterized by electrolyte imbalance (principally low
serum phosphate, potassium, and magnesium) caused by
their sudden intracellular movement due to the switch
from fat to carbohydrate metabolism and associated
increased secretion of insulin (Hearing 2004).
what is the prognosis for anorexia and bulimia?
list poor prognostic factors
Anorexia;
After 10 years, 50% of patients with AN have no eating
disorder and 10% have died (suicide accounts for a
third of deaths). The remaining 40% have ongoing problems and crossover to BN is common.
Poor prognostic indicators:
very low weight, bulimic features,
later onset, or longer illness duration.
Bulimia;
The prognosis for BN is better. 70% have
recovered completely and only 1% have died at 10 years.
poorer prognosis:
severe binging or purging, low body weight, and comorbid depression
What are the features of Bulimia?
- Binge eating
Repeated bouts of overeating
irresistible cravings - lose control,
eating enormous amounts, of ‘forbidden’ (sweet, high
calorie, high fat)
Thousands of calories may be consumed and
there is often a sense of desperate urgency and compulsion. triggered by distress.
- occurs at least 1x a week for at least 3 weeks - - Purging of binges
feelings of shame and guilt =
measures to undo the ‘damage’,
e.g. vomiting, use of laxatives or diuretics.
Between binges, there may be episodes of fasting and excessive exercise to control weight. - Body image distortion
Patients feel fat, are preoccupied
with their shape and weight, and often hate their body.
- innapropraite compensatory mechanisms - BMI >17.5 In contrast with AN, patients with BN
are of normal or slightly increased weight and periods
are usually present.
very secretive about their binging or purging
behaviour.
physical symptoms are mostly those secondary to vomiting and
purging, e.g. arrhythmias (hypokalaemia) or convulsions
(hyponatraemia).
ivx for bulimia?
attention to electrolytes and ecg
management for bulimia in adults?
- Bulimia-nervosa-focused guided self-help (BNF self help)
- 9 sessions over 16 weeks
-> If unacceptable, contraindicated, or ineffective after 4 weeks of treatment;
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
- 20 sessions over 20 week
management for bulimia in in kids and young adults?
1st line - FFT: bulimia-nervosa-focused family therapy (FT-BN)
2nd line - individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- at least 4 sessions with parents/carers
when can medicatoins prove helpful in bulimia?
SSRIs - fluoxetine to reduce binging and purging by improving impulse control
treatment of comorbid psych illnesses
which are the other eeating disorders
pica
rumination disorder
restrictive food intake disorder
define purging disoder
includes omiission of insulin
characterise avoidant restrictive eating disorder
no weight/shape concerns
interference with psychosocial function - cant eat in a new place etc
what is peak age onset for all eating disorders?
15-19
what are standardised moratility ratio for anorexia?
very high - 5
Die from cardiovascular complicatoins and suicide
what are standardised moratility ratio for anorexia?
very high - 5
Die from cardiovascular complicatoins and suicide
bulimia complications?
dental erosion - from purging
growth stunting
mental health issues post recovery
osteoporosis
pregnancy complications - infertility
