Eating Disorders - "key concepts" Flashcards
essential features of eating disorders
1) significant weight loss (25%), progressive
2) disturbance of body image
3) intense fear of becoming obese
4) absolute refusal to maintain minimal normal body weight
5) no known physical disease to account for weight loss
physical features noted in anorexics
- emaciated appearance, slow movements, weakness (may all be denied)
- low body temp, pulse, BP
- thin hair, hair all over body, appearance of being chronically ill
- cold when others warm
- amenorrhea (girls)
- muscle wasting, GI disturbances, liver failure
- changes in thinking/sensorium due to malnutrition
- normal physical exam/lab studies
signs of medical instability
HR: <45 or >100
BP: >120/80
- abnormal electrolytes or liver function tests
- significant orthostatic BP changes (>35 points)
- weight less than 75% IBW
- psychosis
- rapid acute weight loss (>3-5 lbs per week)
medical complications of anorexia
-osteoporosis
-refeeding syndrome
-purging
-substance abuse
-suicide
-erosion of enamel due to vomiting
-
behavioral features of eating disorders
- bizarre eating habits
- sometimes eating binges
- compulsive exercising
- retention of school or work attendance
- progressive social isolation, no dating, etc
- sullen, resistant, fearful behavior at home
- on periphery with peers
- relationships: shallow, dependent, easily ruptured
- marked concern for parents and their well being
psychological features of eating disorders
- denial
- pervasive sense of helplessness and incapacity
- poor self esteem, appearing depressed
- marked non-assertiveness
- avoidance of conflict
- inability to make choices
- perfectionistic, may be highly “moral”
- sense of specialness, mastery, and control are reinforced thru weight loss
- power and control occur thru resistance and refusal
treatments of anorexics
-physician: monitor weight, follow, maintain communication
- therapist
- nutritionist
- psychopharmacologist
physician’s role in treatment of anorexia
- provide clear definitions (medical diagnosis, current physical condition, necessary medical treatment)
- explanation to family of expected physical outcome
- directly tell family of need of psychotherapy
- respectful support of therapist’s work with the family
- maintain communication with therapist
- avoid psychological explanations of family problems, directing them to therapist
factors of prognosis
First 6-12 months: 80-90% reach remission
After 12 months: 30-40% recover, 30% have chronic eating disorder, 25% have persistent significant mental health problems, 5% die
bulimia
Repetitive binge eating and purging through self-induced vomiting or laxative abuse in normal weight individuals
physical features of bulimia
- dehydration
- hypokalemic alkalosis
- GI bleeding
- esophagitis
- cardiac arrhythmias
associated physical signs of bulimia
- dental caries
- parotid swelling
- hiatal hernia
cycle of bulimic symptoms
- unpleasant experience/emotion
- binge eating
- guilt/anxiety
- purging thru vomiting/laxative
- relief coupled with self-deprecation because of pursuing symptoms again
- self deprecation adds to/enhances the next unpleasant experience
- unpleasant experience/emotion
family features: anorexia vs bulimia
ANOREXIA
- middle class
- “sacrifice” for family life
- close family relationships
- denial of family problems
- concern for health of a parent
- marked overprotectiveness
- same responses to situation
- avoidance of resolution of conflict
- symptom focus excessive
BULIMIA
- mutual disrespect and criticism
- impulse control problems in family
- fluctuate btwn overinvovlement and abandonment
- competition btwn mother/daughter (attractiveness, dad’s attention)
- father: harsh, critical, distant, weak
- overly sensitive
