Eating Disorders-Sweeny

Question 1

What is a normal BMI range? Overweight? Obese?

Answer 1

Normal: 20-24.9

Overweight: 25-30

Obese: 30+

Question 2

How do you calculate BMI?

Answer 2

(weight X 703)/(height in inches)2

Question 3

What is Diabulimia?

Answer 3

Diabetes and bulimia:

-people with Type 1 Diabetes do not adhere to their insulin administration, for the sole purpose of weight loss.

Question 4

What does the psychological profile for Anorexia include?

Answer 4

• Low self-esteem
• knowledgeable about nutrition
• delayed sexual psychosocial adjustment
• perfectionism
• family conflict
• terrified of embarrassment
• always “good” in family system

Question 5

What is the DSM IV criteria for Anorexia Nervosa?

Answer 5

• Body weight <85% of normal expected weight (equal to or below BMI of 17.5)
• intense fear of gaining weight
• disturbed body image
• Amenorrhea: missed 3 consecutive periods (removed in DSM V)

Question 6

What are the 2 types of Anorexia Nervosa?

What are some common comorbid disorders?

Answer 6

1. Restricting Type: not regularly engaged in binge eating or purging. s), obsessive compulsive,
   - substance abuse
   - social phobias

Question 7

What is the best treatment for Anorexia Nervosa?

Answer 7

Cognitive Behavioral Therapy in the context of a multi-disciplinary approach

-family therapy, cognitive therapy

Question 8

What is the 10 year outcome for full recovery in anorexia?

Answer 8

only 25% recover completely

50% improve and function fairly well

other 25% function poorly, chronic weight issues

Question 9

What are the differences between Anorexia and Bulimia?

Answer 9

Anorexia: intense fear of obesity, denial of symptoms, lack of sexual interest, denies depression

Bulimia: worry about gaining weight, feel “out of control”, weight can be normal or overweight, DISTRESS about symptoms, normal sexuality, depression

Question 10

What are some physical signs associated with anorexia?

Answer 10

• Russell’s signs: metacarpal-phalangeal calluses from inducing vomiting
• kidney stones
• high cholesterol
• late stages: hypothermia, dependent edema, bradycardia, lanugo (baby fine hairs on trunk), amenorrhea, dehydration, EKG changes (K+ imbalance–> T wave flattening or ST depression and lengthening QT interval)
• abnormal electrolytes, increased liver enzymes and serum urea nitrogen, mild anemia and leukopenia

Question 11

What are the immediate and long term treatment goals for anorexia nervosa?

Answer 11

1. immediate: restore body weight to save pt’s life
2. long term: strategies to prevent relapse!!

-hospitalize if body weight 20% below normal

Question 12

What are some common symptoms seen in purging eating disorders?

Answer 12

1. Esophageal varices (repeated vomiting)
2. Enamel erosion-dental caries (gastric acid)
3. Swelling or infection of parotid glands.
4. Metacarpal-phalangeal calluses (Russell’s sign)
5. EKG Changes: long QT and ST depression

Question 13

What is the common psychological profile for Bulimia?

Answer 13

• Compassionate, empathetic, social
• Prone to peer pressure
• Get bored easily
• Low self-directedness
• High harm avoidance
• Impulsivity temperament

Question 14

What is the DSM IV criteria for Bulimia Nervosa?

Answer 14

A. Recurrent binge-eating episodes coupled with

 1. eating, in a discrete period of time (e.g. within any 2 hour    	period), an amount of food that is definitely larger than most people would eat during a similar period of time.
 2. a sense of lack of control over eating

B. Recurrent inappropriate compensatory behavior (vomiting; laxatives, diuretics, enemas or other medications; fasting; or excessive exercise

C. Binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa

Question 15

What are the two types of Bulimia?

Answer 15

Purging: vomiting or laxatives, diuretics, enemas

Non-purging: other inappropriate compensatory behaviors (fasting or excessive exercise)

Question 16

What is the best treatment for Bulimia?

Answer 16

CBT with pharmacological treatment (anti-depressants, MAOIs, SSRIS)

Question 17

What are some comorbid disorders of Bulimia?

Answer 17

• Mood Disorders - Dysthymic Disorder Major Depressive Disorder
• Anxiety Disorders: Social Anxiety, Panic D/O, GAD, PTSD
• Personality D/O’s: Borderline PD (most frequent)
• Substance Abuse or Dependence

Question 18

What medication is contraindicated in Bulimia?

Answer 18

Buproprion

can increase seizure risk

Question 19

What is the DSM IV criteria for Eating Disorder NOS?

Answer 19

-Used for disorders of eating that do not meet criteria for any specific Eating Disorder.

• Examples include
  1. For females, all of the criteria for AN are met except that the individual has regular menses.
  2. All criteria for AN met except that, despite significant weight loss, current weight is in the normal range.
  3. All criteria for BN are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week OR for a duration of less than 3 months.
  4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g. self-induced vomiting after the consumption of two cookies).
  5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
  6. Recurrent episodes of binge eating in the absence of regular use of inappropriate compensatory mechanisms.