Eating Disorders

Question 1

Define Anorexia Nervosa

Answer 1

Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances

Question 2

Give four predisposing risk factors for Anorexia Nervosa

Answer 2

Family History
Female
Sexual Abuse
Perfectionism

Question 3

Give three perpetuating risk factors for Anorexia Nervosa

Answer 3

Starvation causes neuroendocrine changes that perpetuate anorexia
Perfectionism
Western Society

Question 4

Describe the ICD10 diagnosis of Anorexia Nervosa

Answer 4

Present for Atleast 3 months in the absence of recurrent binge eating

• Fear of weight gain
• Endocrine disturbance resulting in Amenorrhoea/Impotence
• Emaciated (BMI<17.5)
• Deliberate Weight Loss
• Distorted Body Image

Question 5

Give four physical symptoms of Anorexia Nervosa

Answer 5

Fatigue
Hypothermia
Bradycardia
Lanugo Hair

Question 6

Describe the expected Appearance, Speech, Mood and Thought of an anorexic patient

Answer 6

Appearance - Thin, Weak, Slow, Anxious
Speech - Slow, Slurred
Mood - Euthymic or Low
Thoughts - Preoccupation with food/weight/appearance

Question 7

Describe the typical blood results of an Anorexic Patient

Answer 7

Increased Urea and Creatinine 
Low Electrolytes
Low Albumin
Low Thyroid Hormones
High Cholesterol
High Cortisol

Question 8

Other than bloods, Name three other investigations for Anorexic Patients

Answer 8

VBG (Alkalosis - Vomiting, Acidosis - Laxatives)
DEXA
ECG (Bradycardia or Long QT)

Question 9

Name three complications that people with Anorexia Nervosa are at increased risk of

Answer 9

Pancreatitis
Hepatitis
Cardiac Failure

Question 10

Describe the Biological Management of Anorexia Nervosa

Answer 10

SSRIs for Comorbid Depression

Aim for weight gain of 0.5-1kg/week if inpatient, or 0.5kg/week if outpatient

Question 11

Name four Psychological interventions for Anorexia Nervosa

Answer 11

Psychoeducation about Nutrition
CBT
Interpersonal Psychotherapy
Family Therapy (ANFFT)

Question 12

What is Refeeding Syndrome?

Answer 12

Downregulation of enzymes causes metabolic abnormalities if feeding is started at a rate too quick

Causes Fluid Imbalance, Hypokalaemia, Hypophosphataemia, Decreased Muscle Activity

Question 13

How can Refeeding Syndrome be prevented?

Answer 13

Start feeding at 1200kcal and increase every 5 days

Question 14

Define Bulimia Nervosa

Answer 14

Eating disorder characterised by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ideal shape and weight

Question 15

Describe the aetiological cycle of Bulimia Nervosa

Answer 15

1) Sense of compulsion to eat
2) Binge eating
3) Fear of Fatness
4) Compensatory Weight Loss Behaviours

Patients often have a history of childhood obesity

Question 16

What are the two types of Bulimia Nervosa?

Answer 16

Purging - the patient uses self induced vomiting/laxatives/diuretics after eating

Non Purging - less common, excess exercise or fasting

Question 17

Describe the ICD10 criteria of Bulimia Nervosa

Answer 17

Behaviours to prevent weight gain
Preoccupation with eating
Fear of fatness
Overeating (Atleast 2 episodes a week for 3 months)

Question 18

Give 5 consequences of repeated vomiting

Answer 18

Hypokalaemia
Mallory Weiss Tear
Dental Erosions
Russell’s Sign
Aspiration Pneumonitis

Question 19

Describe the expected Appearance, Speech, Mood and Thought of a patient with Bulimia Nervosa

Answer 19

Appearance - Depression or Anxiety, Normal Weight, Parotid Swelling, Russell Sign
Speech - Slow or Normal
Mood - Low
Thought - Preoccupation with size/shape/eating

Question 20

Define Kline Levin Syndrome

Answer 20

Sleep disorder characterised by recurrent episodes of BingeEating and Hypersomnia

Question 21

Describe the biological management of Bulimia Nervosa

Answer 21

Fluoxetine
Treat any complications
Electrolyte Monitoring

Question 22

Describe the Psychological management of Bulimia Nervosa

Answer 22

Psychoeducation about Nutrition
CBT-BN
Interpersonal Psychotherapy

Question 23

Describe the Social management of Bulimia Nervosa

Answer 23

Food Diaries

Techniques to avoid binging (distractions, having company)