Eating Disorders - Titus-Lay Flashcards
DSM 5 Diagnostic Criteria for Anorexia
Restriction of energy intake leading to a significantly low body weight
Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight
Disturbance in the way in which one’s body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Body weights lowest to highest based on eating disorders (anorexia, binge and purge, binge, bulemia)
Anorexia < Bulemia/binge and purge < healthy eating < binge eating < obesity
Anorexia is more prevalent in males or females?
Females
0.9% lifetime prevalence in females
Female to male ratio of anorexia prevalence?
3:1
Other conditions common in people with anorexia?
Depression
OCD
Suicidal ideation
2 types of anorexia
Restricting type
Binge-eating/purging type
Restricting type of AN
In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior
Has NOT
Weight loss is accomplished through dieting, fasting, and/or excessive exercise
Binge-eating/purging type
In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior
Has
What is the main difference between the binge-eating/purging type of AN and bulimia nervosa disorder?
binge-eating/purging type of AN typically have a lower body weight
BMI of mild AN
> 17
BMI of moderate AN
16-16.9
BMI of severe AN
15-15.9
BMI of extreme AN
<15
What is the lowest normal BMI according to the CDC and WHO?
18.5
Health consequences of AN
Slow HR and low BP - risk for HF and fatal arrhythmia
Reduced bone density
Muscle loss/weakness
Severe dehydration
Fainting, fatigue, overall weakness
Dry skin, hair loss
Growth of a downy layer of hair all over the body (including the face)
How does the body cope with not having enough energy to perform daily function?
It slows down to preserve energy
What results in re-feeding syndrome?
A shift from fat metabolism to glucose metabolism
Consequences and main concern of re-feeding syndrome?
Electrolyte imbalances (K, Mg, and Phos)
Water retention
Severe edema
Multiple organ failure (main concern!)
Inpatient treatment of AN
Electrolyte and fluid correction
Increase calories by 500 kcal/d every 4 days to 3500 kcal/d
Cognitive behavioral therapy
Pharmacotherapy
Outpatient treatment of AN
1200-1500 kcal/d
Increase weekly by 500 kcal
Cognitive behavioral therapy
Pharmacotherapy
Pharmacotherapy for AN
No drug therapy is FDA approved yet
Fluoxetine and TCAs may be helpful
What drug is contraindicated in AN?
Bupropion
DSM 5 Diagnostic Criteria for Binge eating disorder
Marked distress regarding binge eating
Occurs, on average, at least once a week for 3 months
NOT associated with recurrent use of inappropriate compensatory behavior
Recurrent episodes of binge eating characterized by BOTH of the following:
- Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time
- A sense of lack of control over eating during the episode
Binge-eating episodes are associated with 3 or more of what 5 criteria?
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed or very guilty afterward
Female to male ratio of prevalence of binge eating disorder
1:0.7
What other conditions are common in people with binge eating disorder?
Depression
Anxiety
Borderline personality disorder
Substance use disorders
How many calories count as a binge?
~3500 kcal
Some people can eat upwards of 6,000-10,000 kcal in one episode
How many episodes in mild binge eating disorder?
1-3 per week
How many episodes in moderate binge eating disorder?
4-7 per week
How many episodes in severe binge eating disorder?
8-13 per week
How many episodes in extreme binge eating disorder?
14 or more per week
Health consequences of binge eating disorder?
High blood pressure High cholesterol Heart disease T2DM Gallbladder disease
Binge eating disorder treatment
Cognitive behavioral therapy
Pharmacotherpy
CBT + medication provides best outcomes
Pharmacotherapy for binge eating disorder
Lisdexamfetamine (FDA approved for moderate-severe)
SSRIs, TCAs, armodafinil, topiramate (not FDA approved)
DSM 5 Criteria for Bulimia Nervosa diagnosis
Recurrent inappropriate compensatory behaviors in order to prevent weight gain (vomiting, laxatives, diuretics, excessive exercise)
Occur on average at least once weekly for 3 months
Self-evaluation is excessively influenced by body shape and weight
Disturbance does not occur exclusively during episodes of anorexia nervosa
Recurrent episodes of binge eating characterized by both of the following:
- Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time
- A sense of lack of control over eating during the episode
Female to male ratio of prevalence of bulmia nervosa
3:1
What puts individuals at an increased risk of developing bulimia nervosa
Individuals with anxiety as a child
History of sexual or physical abuse
Childhood obesity
Early pubertal maturation
What disorders are common in people with bulimia nervosa?
Atypical depression
Seasonal affective disorder
Impulsive disorders (borderline personality disorder, substance use disorders, bipolar disorder)
How many episodes in mild bulimia?
1-3 per week
How many episodes in moderate bulimia?
4-7 per week
How many episodes in severe bulimia?
8-13 per week
How many episodes in severe bulimia?
14 or more per week
Methods of purging for bulimia nervosa?
Vomiting Laxatives Diuretics Excessive exercise "diabulimia"
What is diabulimia?
When type 1 diabetics do not give themselves insulin to make themselves lose weight
Health consequences of bulimia?
Electrolyte imbalances
Inflammation, gastric rupture, esophageal rupture from frequent vomiting
Tooth decay and staining from stomach acid released during frequent vomiting
Chronic irregular bowel movements and constipation as a result of laxative abuse
Physical sores from exercising too much
Diabetic ketoacidois from withholding insulin in type 1 DM
Treatment of bulimia nervosa
CBT
Pharmacotherpay
CBT + medication provides best outcomes
Pharmacotherapy for bulimia
Fluoxetine (FDA approved - also useful for underlying depression)
TCAs, trazodone, and MAOIs (not FDA approved)
FDA approved drug(s) for treatment of binge eating disorder
Lisdexamfetamine
FDA approved drug(s) for treatment of AN
None!
FDA approved drug(s) for treatment of bulimia
Fluoxetine
What eating disorder meets all the criteria for AN except that despite significant weight loss, the individual’s weight is within or above the normal range
Atypical anorexia nervosa
What eating disorder meets all the criteria for bulimia except the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months
Bulimia nervosa of low frequency and/or limited duration
What eating disorder meets all the criteria for binge-eating except that the binge eating occurs, on average, less than once a week and’or for less than 3 months
Binge-eating disorder of low frequency and/or limited duration
What eating disorder is characterized by recurrent purging behavior to influence weight or shape in the absence of binge eating
Purging disorder
What eating disorder is characterized by recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal?
Night eating syndrome
During night eating syndrome there (is/is not) awareness and recall of the eating
is
Night eating syndrome can not be better explained by what 2 things?
External influences such as changes in the individual’s sleep-wake cycle or by local social norms
Binge-eating disorder or another mental disorder, including substance use, adn is not attributable to another medical disorder or to an effect of a medication
