Eating Disorders - Anorexia nervosa, Bulimia nervosa, Binge-eating disorder

Question 1

Anorexia
-epidemiology
-presentation
-diagnosis
-management

Answer 1

90% female
Teen-young adults
BUT GUYS CAN BE AFFECTED TOO!

Low BMI, BP, HR, K, FSH, LH, O, T, T3
High cortisol, GH, cholesterol, cartoninemia
Impaired glucose control
Enlarged salivary glands

BMI and amenorrhoea are no longer diagnostic features
1. restriction of energy intake relative to requirements => significantly low body weight in context of developmental stage, age, sex and physical health
2. intense fear of weight gain or becoming fat, even when underweight
3. disturbance in how one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

CYP
1st line - anorexia family therapy
2nd line - CBT

Adults
1st line - ED CBT/MANTRA/specialist supportive clinical management

Question 2

Bulimia
-how it differs from other EDs
-presentation + diagnosis
-management

Answer 2

BED + intentional purging

Recurrent episodes of bingeing with a
-lack of control during the episode
-recurrent compensatory behaviour to prevent weight gain (self induced vomiting, misuse of laxatives, diuretics, fasting, excess exercise)
WEEKLY FOR 3 MONTHS
Influenced by body shape/weight

Erosion of teeth
Russell’s sign - callouses on knuckles due to repeated self induced vomiting

CMHT
Adults
1st line - BN guided self-help
2nd line if self help not working after 4wks => ED CBT

CYP
1st line - bulimia nervosa family therapy

Meds have a limited role
-could consider high dose fluoxetine?