Eating disorders

Question 1

Main types of eating disorders

Answer 1

• anorexia nervosa - significant weight loss through excessive dieting
• bulimia Nervosa - Characterised by a cycle of negative beliefs, dieting, binge eating followed by purging and intense feelings of guilt and shame

Question 2

pathophysiology of eating disorders

Answer 2

• Cultural/Social factors: Media and fashion industry emphasis on thinness. Family and social emphasis on physical appearance.
• Psychological factors: Clinical perfectionism, Low self-esteem, Body Dysmorphia, Cluster “B” personality traits.
• Biological factors: Imbalanced serotonin, adrenaline and dopamine re-uptake. Suppression of hunger and appetite

Question 3

physical symptoms of anorexia

Answer 3

• GI effects: feeling bloated or full even after eating small amounts
• Skin changes due to protein-calorie malnutrition
• Thinning of hair
• Re-feeding syndrome due to imbalance in electrolytes and fluids
• Irregular periods (Metrorrhagia)

Question 4

DSM-V criteria for anorexia nervosa

Answer 4

• Refusal to maintain body weight at or above minimum normal body weight for age and height
• Intense fear of gaining weight or becoming fat even though underweight
• Dissatisfaction with body weight or shape, undue influence of body weight and self-evaluation and denial of the seriousness of current low weight
• Absence of at least 3 menstrual cycles

Question 5

medical complications of anorexia

Answer 5

• Cardiac irregularities due to protein-calorie malnutrition.
  Renal dysfunction: Reduced glomerular filtration rate.
• Electrolyte abnormalities: low potassium and sodium levels
• Brain atrophy

Question 6

Clinical features of bulimia

Answer 6

• Sufferers of Bulimia often have negative beliefs about themselves, and strive for the approval of others.
• Bulimia is often a feature of other issues such as a low self-esteem and depression.
• People with bulimia usually do not feel secure about their own self-worth
• Food becomes a source of comfort, followed by extreme feelings of shame and guilt, which reinforce the person’s negative self beliefs.

Question 7

physical issues with bulimia

Answer 7

• The high acid content of vomit can damage teeth, causing enamel erosion, tooth sensitivity, and gum disease.
• Sore throat.
• Scarred hands from repeated exposure to acidity in throat.
• Facial swelling as a result of damaged salivary glands.
• De-hydration.

Question 8

presentation of bulimia

Answer 8

• Recurrent episodes of binge eating
• Eating in a discrete period within any 2 hours, eating much larger amounts of food than most would eat
• Sense of lack of control during eating episode and recurrent inappropriate compensatory behaviour (overuse of laxatives, induced vomiting, excessive exercise, fasting etc.) to prevent weight gain
• Above – occur at least twice weekly for 3 months period
• Self-evaluation is unduly influenced by body shape and weight

Question 9

Management of eating disorders

Answer 9

• The gold standard evidence based therapy for eating disorders is Cognitive Behavioural Therapy.
• CBT aims to “restructure” the beliefs and assumptions that are causing the problem.
• Beliefs like: “I’m fat” or “I’m ugly”
• Assumptions like “I must stay in control of my weight or people will discover I’m a bad person”
• …are challenged through a set of self directed behavioural experiments which test the validity of the cognition, where the aim is to introduce evidence based logic, and decrease irrationality.