Eating disorders Flashcards
What is an eating disorder?
Any range of psychological disorder characterised by abnormal or disturbed eating habits
What are the different types of eating disorder?
Obesity
Anorexia nervosa
Bulimia nervosa
Atypical eating disorder
What questions should you ask about obesity?
Differentiate from a binge eating disorder
Ask about psychological determinants of comfort eating
What questions should you ask in an eating disorder history?
SCOFF questionnaire
Change in weight (increase, decrease, or failure to thrive)
Dietary restrictions or binge eating
Fear of gaining weight and body image disturbance - ask about perceived ideal weight
Compensatory behaviours - excessive exercise, purging, vomiting, or use of weight loss medications
Complications
Co-morbidities or symptoms suggestive of an alternative cause such as IBS/coeliac disease
Mental health - mood, risk of self-harm/suicide
Social history and social support - stressors/alcohol and drug abuse
FHx of eating disorders, depression, or substance abuse
Medication
What is the SCOFF questionnaire?
2 or more positive answers suggestive of anorexia or bulimia
- Do you ever 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 in a 3-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 are the complications of an eating disorder?
Fatigue Constipation Reflux Hair loss Amenorrhoea Serious complications - syncope, pre-syncope, severe abdominal pain
What are the risks for an eating disorder?
Close relative with eating disorder or other kind of mental health condition History of dieting Negative energy balance T1DM Perfectionism Body image dissatisfaction Personal history of anxiety disorder Behavioural inflexibility Weight stigma Teasing or bullying Appearance ideal internalisation Acculturation Limited social networks Historical trauma
How common is obesity?
Most common eating disorder
Epidemic in most developed countries
Caused by combination of constitutional and social factors
How common is anorexia nervosa?
Incidence rate of 19/100,000 females aged between 15 and 34
Prevalence of approx 1% among schoolgirls and university students
Many women have amenorrhoea accompanied by less weight less than the 15% required for anorexia
Much less common amongst men - ratio of 1 to 10
How common is bulimia nervosa?
Lifetime prevalence between 3% and 7% for women
What is a differential diagnosis for anorexia?
Brain tumour GI disease Acquired immunodeficiency syndrome Malabsorption Chronic infection Uncontrolled DM Hyperthyroidism Adrenal insufficiency Depression Somatisation disorder Schizophrenia
What is the differential diagnosis for bulimia?
Brain tumours
EUPD
Major depressive disorder with atypical features
What is the differential diagnosis for binge eating disorder?
Bulimia Obesity Bipolar Depressive disorders EUPD
How does anorexia present?
Body weight > 15% below standard weight or a BMI < 17.5 Self-induced weight loss Avoidance of eating fattening foods Vomiting, purging, exercise, or appetitie suppressors Distortion of body image Morbid fear of fatness Amenorrhoea in women Onset usually in adolescence Previous history of faddish eating Generally eats little yet obsessed by food Exercising is excessive Sensitivity to cold Constipation Hypotension Bradycardia
How does bulimia present?
Physical consequences of vomiting - Cardiac arrhythmias - Renal impairment - Muscular paralysis - Tetany - from hypokalaemic alkalosis - Swollen salivary glands - Eroded dental enamel Associated psychiatric disorders - Depressive illness - Alcohol misuse Fluctuations in body weight within normal limits Menstrual function - periods irregular but amenorrhoea rare Personality - perfectionism and/or low self-esteem present pre-morbidity
