Eating Disorders COPY Flashcards
What screening tool is used for eating disorders?
SCOFF questionnaire
SCOFF questionnaire features
If score 2 or more positive answers, then an eating disorder is more 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 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?
Key features of obsessive weight losing disorders
Obsessive fear of fatness with avoidance of food and other sources of calories
A range of compulsive compensatory behaviours when food cannot be avoided
In time these behaviours are the only way to avoid the experience of anxiety AND there are secondary physical and psychological consequences of starvation
ICD-10 classification for anorexia nervosa
Body weight < 15% of expected
Body image distortion
Self induced
(amenorrhoea)
Who gets anorexia nervosa?
75% occur before age 22
90% in females
Presentation of anorexia nervosa
Restriction of intake to reduce weight Relies on compulsive compensatory behaviours when food cannot be avoided fear of weight gain cold intolerance blue hands and feet constipation bloating delayed puberty primary / secondary amenorrhoea dry skin fainting hypotension lanugo hair scalp hair loss early satiety weakness, fatigue short stature osteopenia and osteoporosis loss of muscle (including cardiac muscle) Infertility
Examples of compensatory behaviours
Self induced vomiting/purging excessive exercise abuse of appetite suppressants / diuretics / laxatives strict diet fasting
How can constipation of anorexia nervosa relate to the psychological aspect of it?
Gut slows down - reduced peristalsis and so this can lead to e.g. a tight tummy which can contribute to the psychological aspect
What is bulimia nervosa?
Binges and the resulting compensatory behaviour - which must occur a minimum or two times per week for 3 months
Presentation of bulimia nervosa
Episodes of binge eating with a sense of loss of control
Binge eating with a sense of loss of control
Binge eating is followed by a compensatory behaviour of the purging type or non purging type
Dissatisfaction with body shape and weight
mouth sores
Hoarse voice
pharyngeal trauma
dental caries / damaged teeth
heartburn
chest pain
oesophageal rupture
impulsivity (stealing, alcohol abuse, drugs/tobacco)
muscle cramps
weakness
bloody diarrhoea
irregular periods
fainting
swollen parotid glands (Parotid enlargement)
hypotension
Electrolyte abnormalities
Dehydration
Why do upper GI problems occur in bulimia nervosa?
Due to vomiting and gastric acid in the upper GI
What is a particular worry in bulimia nervosa?
Electrolytes - especially potassium as this can cause cardiac arrhythmias
What is binge eating disorder?
Similar to bulimia nervosa but in the absence of purging behaviours
Presentation of binge eating disorder
ongoing and/or repetitive cycles often including
- unusually fast eating, usually alone
- unusually large amounts consumed
- uncomfortably full; often buzzed after eating
- embarrassment, shame, guilt
- depression
Methods of avoiding calorie intake
Diets - veggie / vegan
Not touching food or grease
Developing dislikes, pickiness or even ‘allergies’
Interpreting all the symptoms as allergy or ingestion
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 the least
rules about finishing last etc
medication abuse
- appetite suppressants (gum, cigarettes)
- alternative, OTC and www medications
Methods of getting rid of calories
Self induced vomiting Chewing or spitting it out Over exercise - often secret Overactivity - obsessive housework - fidgeting / twitching - never sitting down - fetching one item at a time - carrying heavy loads Cooling making the body shiver - inadequate dress - open windows Blood letting - cutting themselves and letting blood out Medication abuse - alternative, OTC and www medications - excessive caffeine and stimulant consumption - laxatives, ipecac - pain killers to allow exercise despite damage
Presentation of body checking
Repeated weighting mirror gazing self measurement self photographing trying on particularly tight clothes
Other eating disorder behaviours
Body checking
displaying emaciation to elicit reassuringly shocked attention
cruising pro ana websites/facebook/emailing fellow disorders
competing with self and others to attain lower and lower targets
compulsive browsing of gossip magazines and websites
deliberate self harm if ‘rules’ are broken
Psychological consequences of eating disorder
Obsessive weight losing feels like a solution not a problem
Extreme overvaluation of low weight and thin shape resembles religious belief - with the patient willing to sacrifice even other highly valued things to the cause
reduced coherence and narrowed focus of interest (a difficulty in seeing the bigger picture)
starved person is unable to interpret emotion
Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food
Depression at low weight rarely responds to medication
Anxiety eating in company, followed by guilt after eating
People who rely on eating disordered behaviour to ‘solve’ their problems fail to develop other ways to cope in life, tolerate distress or feel rewarded and fulfilled
What is binge eating disorder?
Similar to bulimia nervosa but in the absence of purging behaviours
Presentation of binge eating disorder
ongoing and/or repetitive cycles often including
- unusually fast eating, usually alone
- unusually large amounts consumed
- uncomfortably full; often buzzed after eating
- embarrassment, shame, guilt
- depression
Methods of avoiding calorie intake
Diets - veggie / vegan
Not touching food or grease
Developing dislikes, pickiness or even ‘allergies’
Interpreting all the symptoms as allergy or ingestion
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 the least
rules about finishing last etc
medication abuse
- appetite suppressants (gum, cigarettes)
- alternative, OTC and www medications
Methods of getting rid of calories
Self induced vomiting Chewing or spitting it out Over exercise - often secret Overactivity - obsessive housework - fidgeting / twitching - never sitting down - fetching one item at a time - carrying heavy loads Cooling making the body shiver - inadequate dress - open windows Blood letting - cutting themselves and letting blood out Medication abuse - alternative, OTC and www medications - excessive caffeine and stimulant consumption - laxatives, ipecac - pain killers to allow exercise despite damage
Presentation of body checking
Repeated weighting mirror gazing self measurement self photographing trying on particularly tight clothes
Other eating disorder behaviours
Body checking
displaying emaciation to elicit reassuringly shocked attention
cruising pro ana websites/facebook/emailing fellow disorders
competing with self and others to attain lower and lower targets
compulsive browsing of gossip magazines and websites
deliberate self harm if ‘rules’ are broken
Psychological consequences of eating disorder
Obsessive weight losing feels like a solution not a problem
Extreme overvaluation of low weight and thin shape resembles religious belief - with the patient willing to sacrifice even other highly valued things to the cause
reduced coherence and narrowed focus of interest (a difficulty in seeing the bigger picture)
starved person is unable to interpret emotion
Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food
Depression at low weight rarely responds to medication
Anxiety eating in company, followed by guilt after eating
People who rely on eating disordered behaviour to ‘solve’ their problems fail to develop other ways to cope in life, tolerate distress or feel rewarded and fulfilled
Social consequences of eating disorders
Other people are turned into obstacles to the eating disorder
Honest people forced to lie and cheat, even to steal about eating disorder concerns
withdrawal from friendships - ISOLATION
Loss of interest in sexual relationships
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 the brain (seizures) and to the heart (arrhythmias) - potassium
Who is re-nutrition most urgent in and why?
Younger patients - as need good nutrition to allow growth, pubertal development and brain growth and development
Causes of anorexia
Genetic predisposition - Eating disorders run in families - OCD - anxiety disorders - perfectionism Perinatal factors Life events and traumas Perpetuating consequences of starvation and avoidance
Precipitating factors of anorexia / eating disorders
puberty - hormonal changes in brain - psychological response to body changes Dieting or non deliberate weight loss - possibly turn into a viscous cycle Increased exercise Stressful life events - neglect, abuse - difficult transitions e.g. high school to uni - deaths and losses - seperations and family break up - bullying - stresses esp exams
Perpetuating factors of anorexia / eating disorders
Delayed gastric emptying
- sensations of fullness interpreted as fatness
Narrowing focus
- avoidance of personal interest, changes of values so that food becomes the most salient stimulus
Obsessionality
- phobia of fat increases as avoidance increases
- body checking amplifies body image concern
Families, school
High EE in family and other carers may delay recovery
What are perpetuating factors of eating disorders a result of?
The ‘starvation syndrome’
Which condition has the highest mortality of all the psychiatric disorders?
Anorexia nervosa
Time for recovery in anorexia nervosa is approx..
6-7 years
Death in anorexia nervosa may be from …..
Direct consequences of starvation
Self harm - may or may not have been truly suicidal
Treatment of anorexia nervosa
RE-FEEDING Dietary supplements Prokinetics CBT Mantra SSCM IPT or fluoxetine 60mg daily SSRIs (obsessional) Olanzapine (antiphyscotic) - severe Specialised family work, particularly for younger patients
What does the Scottish Mental health act allow?
Gives doctors responsibility to treat people even in the absence of consent to save life or prevent serious deterioration
What to ask in a history of eating disorders
Diet / when started Binges Compensatory behaviour Body shape Psychiatric history Motivation to change Physical assessment Collateral history if possible
Under what BMI is considered to be anorexia nervosa?
BMI 17.5
What is the most important electrolyte causing the problems in refeeding syndrome?
Phosphate
Indicators of anorexia nervosa
Controlling in kitchen Daily exercise Withdrawn Avoiding eating in public Intolerant of disruptions to daily routine Baggy clothes Eating in secret Picking at food Low calorie food - obsessed with calorie counting (constantly reads food labels) Strange selections of foods
When should anorexia nervosa be referred for specialist help?
Rapid weight loss BMI < 16 Marked vomiting / laxative abuse Physical complications Simple interventions failed Marked depression
Indicators for bulimia
Worried about body weight Excessive food consumption Trips to the bathroom after eating Blood shot eyes Sore throat and swollen parotid glands Dental problems Exercises excessively Irregular menstrual periods Depression and/or mood swings
