Eating Disorders - Exam 3 Flashcards
What is body image? What is it influenced by?
The perception that a person has of their physical self
The thoughts and feelings they have as a result of that perception
individual and environmental factors
Body dissatisfaction is strongly tied to chronic _____ of one’s body
negative perception
What makes body dissatisfaction different from an eating disorder?
“Morbid fear of weight gain”
The idea that “one cannot be too thin” overrides all other interests and affairs
What are risk factors for body dissatsifaction?
late childhood/adolescence
female
low self esteem
perfectionism, high achievers, anxiety, “black and white” world views
with emphasis on “thinness” - ballet, modeling, athletics
frequent dieting for weight loss or high body image concerns expressed around patient
larger body size
homosexuality in males
Does body dissatisfaction have a genetic component?
Yes! Mothers/sisters of anorexic pts - 8x as likely to also have
More common in identical (monozygotic) twins
**What is anorexia thought to be an imbalance between? Bulimia?
disturbances in serotonin, dopamine, norepinephrine
deficient in serotonin
possible that is it difficult to recognize hunger and satiety states
What are the family risk factors for eating disorder?
Enmeshed parenting
Conflict-avoidant families
Inflexibility
Push for very high levels of success
Family members with body dissatisfaction or poor eating habits/eating disorders
Anorexic families - rigid, controlling, organized
Bulimic/BED families - chaotic, critical, conflicted
Eating disorders are often related to _____ or ______ of parents
effectiveness and ineffectiveness
Interferes with self-ability to accurately identify
____ versus ____ and feeling helpless as a result. What 2 traits do pts display?
hunger versus and emotions
alexithymia and dependency
Define alexithymia.
unable to feel their emotions
Pts with eating disorders often feel that their ____ is the only important part of their self-image. If they are not thin, what does it make them feel?
body size
If they are not exceedingly thin, they feel it “proves” they are weak, lazy, inferior, unlovable, incompetent
What are four screening tools for eating disorders? Which 2 are self administered?
SCOFF Questionnaire
ESP Questionnaire
EAT Form- Self
PHQ Form- Self
Avoidant / Restrictive Food Intake Disorder when do they commonly present? What is the classic presentation? What is the average BMI?
Typically begins in infancy or early childhood
underweight child (average BMI - 16)
_______ may be due to lack of interest in food, sensory characteristics of food, or conditioned negative response following an aversive experience. What is the tx? What can it NOT be due to?
Avoidant / Restrictive Food Intake Disorder
nutritional counseling
CBT: Family based therapy
Consider referral to speech and language pathologist
NOT due to lack of food availability, culturally/religious practice or other medical condition
What is the age of onset for anorexia? What gender?
Early adolescence - 12-15 yrs
Late adolescence/early adulthood - 17-21 years
Average age at onset - 18 years
women, white
What is anorexia defined by? What must their BMI be under?
restricted energy intake characterized by low body weight
intense fear of gaining weight
distorted perception of weight
**BMI must be less than 17.5
How do you classify anorexia?
What are the 2 subtypes of anorexia?
What are some abnormal food behaviors commonly seen in anorexic pts?
Reduction in total food intake
Exclusion of highly caloric foods
May claim distaste for food or epigastric pain
May have food-related obsessions
Depression, irritability
Fatigue and weakness
bone pain
Constipation
Abdominal pain
Hair loss, brittle nails
Russell’s sign
Dental enamel erosion
Osteoporosis
Bradycardia
Dry and flaky skin
Lanugo
Petechiae on extremities
Sallow complexion
What am I?
What is the Russell’s sign?
anorexia
callouses on the knuckles from making themselves vomit
What is lanugo?
peach fuzz that grows all over the body due to trying to keep the body war,
What is superior mesenteric artery syndrome?
compression due to collapse from anorexia
What are the 3 MC causes of death from anorexia? What labs do you need to order?
consequences of starvation, suicide, or electrolyte imbalance
EKG for cardiac dysrhythmias
UA for specific gravity
What are some reasons to admit a pt for anorexia? Need to admit a pt if their ideal body weight is below _____
Unstable vitals or Hypothermia (<35 C or 95 F)
End-organ complications
Cardiac complications
Psych complications
nutrition complications
weight is below 70% ideal body weight
What is refeeding syndrome?
Potentially fatal shifting of fluids and electrolytes that can occur as a result of refeeding
feeding them too quickly, dying of organ failure
What is the tx for anorexia?
medical stability
healthy weight
healthy nutrition
treat underlying psychopathology
**Psych meds are not first line treatment
Psych meds are not first line for _____ but ____, _____ and _____ have some evidence that they are helpful. NOT FIRST LINE!!!
antipsychotic (olanzapine)
anxiolytic (lorazepam)
fluoxetine (Prozac)
**Some evidence suggests that using ______ at higher doses can prevent relapse once weight is restored.
fluoxetine (Prozac)
What are some indicators of poor outcomes for anorexia pts?
Later age at onset
longer duration
lower minimal weight
lower body fat after weight restoration
psych comorbidities
____ of anorexia pts eventually relapse
35-55%
What are the pt factors for bulimia?
women
average age is 18-20
white adolescent female
What is the DSM criteria for bulimia? What are some common compensatory behaviors?
Recurrent binge eating and inappropriate compensatory behaviors at least once a week for three months
vomiting, laxative, enemas, diuretics, fasting
What are some examples of non-purging behaviors?
fasting or excessive exercise
Do bulimic pts feel bad about binge eating? Do they have control?
YES! often with guilt and depression
Slightly more control over timing of behaviors - arrange around work, school, etc.
If vomiting - eroded dental enamel and “puffy cheeks” due to _____ may be seen. What is the body weight in bulimia?
parotid hypertrophy
**Body weight typically within or above the normal range
In bulimia ____ complaints are the MC? What is xerosis?
GI complications
salivary gland hypertrophy, loss of gag reflex, GI tract dysmotility, GERD, esophageal tears or rupture, malabsorption, diarrhea, constipation, pancreatitis
extreme cracked skin
What is the tx for bulimia? Can use ____ if no improvement with SSRI. What is CI?
CBT!!!
antidepressants are often helpful!! (fluoxetine- first line)
TCA if no improvement with SSRIs
**Bupropion is contraindicated in bulimia and anorexia - can cause seizures
____ of bulimic patients have a positive lifetime history of suicide attempt. High comorbidity with ????. ____ recover in longer follow-up
25-40%
anxiety, depressive disorders, personality disorders, PTSD, and substance use
60%
What is the median age of onset for binge eating disorder?
23 years,
higher prevalence but not as well researched
What is binge eating disorder defined as? How is the severity ranked?
Recurrent binge eating without compensatory behaviors
severity is ranked by frequency of episodes per week:
Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: 14+
Do binge eating patients feel bad about their behavior?
Feelings of shame, guilt, and hopelessness frequently occur during or immediately following a binge-eating episode
will try and hide eating habits
What BMI category does binge eating disorder pts fall into? Have a high risk of _____
About 50% of patients are overweight or obese
More likely to be overweight or obese prior to BED onset
higher risk of cancer
What is tx for binge eating disorder? Would you use antiobesity drugs?
First line: CBT!!
behavioral weight loss therapy
may try meds:
SSRIs- try first
alt: topiramate, zonisamide)
Lisdexamfetamine (Vyvanse)
**Antiobesity drugs not recommended due to SE, limited efficacy in BED patients
