Eating disorders Flashcards
Epidemiology of anorexia nervosa/anorexia
- Lifelong prevalence of anorexia nervosa is 0.1-0.9%
- And on estimate 75% of AN cases occur before the age of 22.
- 5-10% of young women attending surgery will have eating disorders - you won’t know about it in 50% of cases
- 5-10% of adolescent girls will have used pathological weight reducing techniques
- Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Death is from direct consequences of starvation or self harm usually
- Average time for recovery from anorexia nervosa – where this occurs – has been estimated at 6 – 7 years.
What is asked about in the SCOFF questionnaire for anorexia?
If patients score 2 or more positive answers, then an eating disorder is likely:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
What is anorexia nervosa / anorexia?
Anorexia is an eating disorder characterised by a low weight, fear of gaining weight, a strong desire to be thin, and food restriction.
- Many people with anorexia see themselves as overweight even though they are underweight.
- If asked they usually deny they have a problem with low weight.
- Often they weigh themselves frequently, eat only small amounts, and only eat certain foods.
- Compulsive compensatory behaviours when food cannot be avoided - some will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss
What BMI is considered anorexic?
17.5 or below (healthy BMI range is between 20-25) or less than 15% what is expected of them.
Physical symptoms of anorexia nervosa
CV effects - loss of energy stores (fat/glycogen from the liver) then they start to break down skeletal muscle, cardiac muscle and bone. Heart walls become thinner, HR slows down to protect the heart, BP drops so you get:
- Cold intolerance
- Peripheral cyanosis
- Hypotension
- Fainting (secondary to hypotension)
- Primary or secondary amenorrhea
- Constipation
- Bloating
- Delayed puberty
- Dry skin
- Lanugo hair
- Scalp hair loss
- Early satiety
- Weakness, fatigue
- Short stature - depending on timing of anorexia
- Osteopenia & osteoporosis
How are physical symptoms of anorexia reversed?
Sustained weight gain and nutrition
What is Bulimia Nervosa / Bulimia?
Episodes of binge eating with a sense of loss of control followed by compensatory behaviours of purging and non-purging type
- Purging type = self-induced vomiting, laxative abuse, diuretic abuse
- Non-purging type = excessive exercise, fasting, or strict diets
- Binges and the resulting compensatory behaviour must occur a minimum of 2 times per week for 3 months
- Dissatisfaction with body shape and weight
Signs and symptoms of bulimia?
Gastric contents coming up to the mouth:
- Mouth sores
- Pharyngeal trauma - haematemesis (tears in the oesophagus)
- Dental caries
- Heartburn, chest pain
- Oesophageal rupture
Other:
- Swollen parotid glands - very marked, sign of excessive vomiting (excessive saliva production) - can be very painful
- Muscle cramps
- Weakness
- Bloody diarrhoea
- Irregular periods
- Fainting
- Hypotension
More impulsivity in this patient group:
- Stealing
- Alcohol abuse
- Drugs/tobacco
What is the difference between bulimia nervosa and a binge eating disorder?
Absence of compensatory behaviours in a binge eating disorder.
Instead, the ongoing and/or repetitive cycles often include
- unusually fast eating, usually alone.
- unusually large amounts consumed.
- uncomfortably full; often “buzzed” after eating.
- quickly followed by embarrassment, shame, guilt, depression.
Binge eating disorders respond well to which type of treatment?
CBT
What excuses can patients make to avoid calorie intake?
- Diets – becoming vegetarian, vegan
- Not touching food or grease
- Developing dislikes, pickiness, even ‘allergies’
- Interpreting all symptoms as allergy or indigestion
- Eating very slowly, only eating at certain times
- Avoiding parties and social occasions
- Spoiling or messing of food, bizarre combinations
- Refusing to eat more than the person who eats least, rules about always finishing last etc
- Medication abuse - Appetite suppressants – including gum, cigarettes - alternative, OTC & www medications
Other eating disorder behaviours that maintain their illness
- Body-checking’– repeated weighing, mirror gazing, self-measurment, self-photographing, trying on particular tight clothes, putting fingers around their wrists, putting their hands in their pockets
- Displaying emaciation to elicit reassuringly shocked attention - reassurance that they are still thin
- Cruising ‘pro-ana’ websites/facebooking/emailing fellow sufferers
- Competing with self and others to attain lower and lower targets
- Compulsive browsing of gossip magazines and websites – celebrities, ‘thinspirations’
- Deliberate self harm if ‘rules’ are broken
Psychological consequences of eating disorders?
- Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food.
- Depression at low weight rarely responds to medication.
- People who rely on eating-disordered behaviour to ‘solve’ their problems fail to develop other ways to cope with life, tolerate distress or feel rewarded and fulfilled
- Anxiety eating in company, followed by guilt after eating.
Physical consequences of eating disorders?
- Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss, fertility problems
- Purging behaviours cause neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias). Potassium is only one crude measure of the problem
- Young people need good nutrition to allow growth – height, pubertal development, brain growth and development (especially frontal lobe growth), so re-nutrition is more urgent the younger the patient
What are some believed causes of anorexia?
- Genetic predisposition – OCD, anxiety disorders, perfectionism
- Perinatal factors
- Life events – and traumas
- Perpetuating consequences of starvation and of avoidance
- Social pressures
