Eating Disorders - Vertrees Flashcards
undue preoccupation with body image - leading to impaired intake
eating disorder
disordered behavior, thinking, physiology
anorexia nervosa types
restricting
binge/purge
split roughly 50/50
2 hour with intake significantly greater than others would consume in similar circumstance
binge
sense of lack of control
followed by guilt, sad, disgust
purge
self-induced vomiting or misuse of laxatives, diuretics, enemas
diagnosis of anorexia nervosa
below BMI 18.5
intense fear gaining weight or getting fat
significant disturbance in perception of shape or weight of body
restricting anorexia
in last 3 months - not engaged in recurrent binge eating or purging
weight loss - diets, fasts, excessive exercise
binge/purge anorexia
in last 3 months - engaged in recurrent binges/purges
BMI of 18.5
5'1 - 98 5' - 104 5'7 - 118 5'9 - 125 6'1 - 140 6'5 - 155
anorexia epidemiology
14-18yo onset
female 10:1 ratio
more in modeling, ballet, cross country
genetic anorexia
higher in monozygotic twins
mood disorders common in family
social of anorexia
heterosexual women and gay men - high rates
heterosexual men and lesbian women - lower risk
psychodymanic of anorexic
mommie dearie
domineering family
-excellence demanded
control of self from mother
rigid and perfectionist
-ego-syntonic
anorexics and loss of appetite
no - often think about food alot
decreased with anorexia
socializing - isolate and secret
decreased sex
loved ones drag pt to tx
restrictive vs. bunge/purge anorexia
restricting - high achievers
binge/purge - less self control - substance abuse
psych disorders with anorexia
65% major depressive 35% social anxiety 25% OCD 12% GAD 80% single
phys of anorexia
slow HR low BP amenia kidney stones low lytes constipation period stops growth problems bruise easily grow fine hair over body
complications anorexia
lower cognition anhedonia - can't experience pleasure cold intolerance low LH and FSH osteoporosis lanugo
tx anorexia
weight normalization
treat physical complications
CBT
SSRIs - comorbid depression/anxiety
hospitalize anorexic
BMI
anorexia progonis
age of onset
adolescent onset - 70% recover post tx adult onset (>18yo) - 15% recover post tx
lifetime mortality adult onset anorexia
25%
bulimia nervosa
recurrent binge eating with inappropriate compensatory methods to avoid weight gain
binge and compensate - 1/week for 3 months
self eval - influenced by weight or shape
bulimia epidemiology
more in females
late teen, early 20s
biology of bulimia
linked to satiety - serotonin
SSRIs - decreases binge/purge and depression
more bulimia in first degree relatives
psych of bulimia
more outgoing, emotional labile
substance use
destructive sexual relations
BPD associations
complications of bulimia
dehydration and lyte abnormalities
- laxatives - met acid
- vomiting - met alkalosis - chipped teeth, enlarge parotid
low Mg - elevated amylase
irregular menses
tx bulimia
psychotherapy - 50% sx reduction
- CBT most effective
- psychodynamic - once binge/purge sx improve
meds for bulimia
SSRIs - fluoxetine
best results - combine meds with CBT
prognosis bulimia
episodic course
-3 months - 70% remission
10 years - 60% recovered
binge eating disorder
recurrent binge eating - weekly in 3 months
no compensation
eat fast, uncomfortably full, large amounts when not hungry, eat alone
epidemiology binge eating
more in females
-50% are obese
tx binge eating
CBT
SSRIs
self help groups
normal weight
bulimia
as incidence of overweight and obesity rise
so does incidence of eating disorders
42% girls age 6-9
want to be thinner
50% 4th grade girls - on diet
90% high school girls - on diet
substance abuse
with 23-40% bulimia
12-18% anorexia
borderline PD
with bulimia
O/C PD
with anorexia
avoidant PD
with anorexia and bulimia
sexual abuse
with bulimia and anorexia
