Eating Disorders

Question 1

List the criteria for anorexia nervosa.

Answer 1

Persistent restriction of energy intake = significantly low body weight expected for age, sex, developmental trajectory and physical health.
Either intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain.
Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 2

What is the main difference between anorexia nervosa and bulimia.

Answer 2

Bulimia = normal weight 
Anorexia = underweight

Question 3

List the criteria of bulimia nervosa.

Answer 3

Recurrent episodes of binge eating
Recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. self induced vomiting, misuse of laxatives, diuretics or other medications, fasting, excessive exercise.
The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.

Question 4

Describe how an episode of binge eating is characterized.

Answer 4

Eating, in a discrete period of time (any 2 hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode.

Question 5

Name the criteria of binge eating disorder.

Answer 5

Recurrent episodes of binge eating.
The binge eating episodes are associated with 3 or more of the following:
- eating much more rapidly than normal or until uncomfortably full
- eating large amounts of food when not physically hungry
- eating alone because of feeling embarrassed by how much one is eating
- feeling disgusted with oneself, depressed or very guilty afterward
Marked distress regarding binge eating is present.
Binge eating occurs, on average, at least once a week for three months.
Binge eating is not associated with the recurrent use of inappropriate compensatory behaviours.

Question 6

Describe the sociocultural etiological factors.

Answer 6

Exposure to the pervasive slim ideal of female beauty.
Slim ideal is concentrated in cultures where food is abundant. In cultures of scarcity, ideal is more likely to be plump.
EDs increase in non Western cultures following exposure to Western influences.
If internalized by the individual, slim ideal leads to body dissatisfaction and dieting.

Question 7

Explain the family etiological factors.

Answer 7

Often found to be over-protective, controlling, critical, mother-daughter conflict. These dynamics can follow rather than precede the ED.

Question 8

Describe the individual etiological factors.

Answer 8

Traumatic/stressful background - abuse, bullying, teased about weight
Negative emotionality - low mood, high anxiety, low self-esteem
Body dissatisfaction
Personality: perfectionism, need for control, obsessive tendencies, impulsiveness

Question 9

What are the physical outcomes of anorexia nervosa?

Answer 9

Secondary amenorrhea, low bone density 
Cardiorespiratory (hypotension, dysregulated heart rhythm and rate)
Abnormal renal and liver function 
Electrolyte disturbances 
Hair loss and lanugo

Question 10

Discuss the impact of anorexia nervosa on role function.

Answer 10

Profound, but not admitted by sufferer.

Severe disruption in cognitive, social functioning; major impact on education and development.

Question 11

What are the outcomes of anorexia nervosa.

Answer 11

After 10 years: 30% recovered, 30-50% partial recovery, 20-40% enduring. High risk of suicide or mortality from emaciation or physical complications (15% after 20 years)

Question 12

What are the physical outcomes of bulimia nervosa?

Answer 12

Dental problems from vomiting 
Electrolyte disturbances (low potassium) from  vomiting, laxative, drug abuse.

Question 13

Discuss the impact of bulimia nervosa on role function.

Answer 13

Not so disruptive of role function - often hidden to observers for years.

Question 14

What are the outcomes of bulimia nervosa?

Answer 14

50% make good recovery
50% partial recovery
Increased risk of chronic physical illnesses

Question 15

What are the physical outcomes associated with binge eating disorder?

Answer 15

All the outcomes associated with obesity.

Question 16

Discuss the impact of BED on role function.

Answer 16

Least disruption in role function of all eating disorders.

Question 17

What are the outcomes for BED?

Answer 17

Unknown, but probably similar to bulimia nervosa.

Question 18

List the treatment principles for eating disorders.

Answer 18

Psychoeducation 
Medical monitoring 
Target underlying psychological issues 
Monitor weight and eating behaviour 
Target binge eating and dietary restraint 
Relapse prevention

Question 19

Describe the treatment concept of psychoeducation.

Answer 19

About the disorder, about the effects of eating behaviour on thinking, feelings and physical health.

Question 20

Describe what medical monitoring incorporates.

Answer 20

Electrolytes, renal, cardiac function etc.

Question 21

How do you target underlying psychological issues?

Answer 21

Address body dissatisfaction and low self esteem

Address other psychological factors as necessary (abuse, anger, anxiety, family issues)

Question 22

How do you monitor weight and eating behaviour?

Answer 22

Use daily records and food diaries.
Education and CBT focused on re-establishing normal eating:
- recognition of normal amount to eat and need for weight gain (AN)
- demand feeding/intuitive eating principles - distinguishing physical from emotional hunger (BN and BED)
- Medical admission for AN if weight drops below 65% to 75% of expected (BMI 13-15)

Question 23

How do you target binge eating and dietary restraint?

Answer 23

Identify cognitive and emotional triggers to bingeing, and help to develop alternative behavioural responses.

Question 24

How do you target relapse prevention?

Answer 24

Identification of factors that help maintain the eating pathology or trigger relapse.

Question 25

Key points for doctors…

Answer 25

AN is rare, medical oversight is critical as BMI drops
BN/BED - hidden, consider this in young women with dental enamel erosion, electrolyte disturbances, GI problems, cardiac irregularities. Note association with vegetarian/vegan diets.
EDs require referral to specialist service, or clinical psychologist or psychiatrist.
All EDs have long term impacts, may take years to resolve.
Really stressful for families, need support and services.