Eating Disorders, Vertrees Flashcards
what is an eating disorder
undue preoccupation with body image leading to impaired intake
types of anorexia nervosa
restricting type and binge/purge type
binge
limited period with intake greater than others
sense of lack of control over eating in episode
almost always followed by built, sadness, disgust
purge
self induced vomiting or misuse of laxatives, diuretics or enemas
criteria anorexia nervosa
restriction energy intake relative to requirements below BMI 18.5
intense fear of gaining weight or getting fat
significant disturbance in perception of shape or weight of body
restricting type anorexia nervosa
last 3 mo, not engaged in recurrent binge eating or purging
weight loss achieved through diets, fasts and excessive exercise
binge purge type anorexia nervosa
las 3 mo has engaged in recurrent binges and/or purges
epidemiology anorexia nervosa
common onset 14-18
F>M
higher in modeling, ballet, cross country
biologic anorexia
higher concordance in monozygotic twins than dizygotic
mood disorders common in family
higher social risk anorexia
heterosexual women and gay men
pyschodynamic
family where excellence is demanded lack of sense of autonomy and selfhood self starvation= discipline, self mastery wrest control of self from mother rigid and perfectionist
what accompanies onset anorexia
dec sex
what psych disorders common with anorexia
MDD social anxiety OCD GAD 80% are single
complicaitons anorexia
lowered cognition, anhedonia/apathy cold intolerance bradycardia reduced thyroid metabolism low LH and FSH, estrogen/testosterone osteoporosis, hypocalcemia chronic dehydration and constipation
Tx anorexia
weight normalization physical complications CBT: distorted body image, low self esteem, destructive coping strategies SSRI family therapy
hospitalize for anorexia when
BMI under 17
evidence organ system failure: HR
adult onset anorexia
Sx onset after 18 y.o
adolescent onset prognosis anorexia
5 yr post tx
most full recovery
no deaths reported
adult onset prognosis
4 yrs post Tx
15% recover
40% “good” outcome
5% dead
lifetime mortality anorexia
25%
bulimia nervosa
recurrent binge eating with inappropriate compensatory methods to avoid weight gain
binge avg 1/week for at least 3 mo
onset bulimia nervosa
late teens early 20s
which NT implicated in bulimia
serotonin- satiety
SSRI dec binging and purgin
psychodynamics of bulimia
less superego control
more outgoing, impulsive, emotional lability
engage in substance use and destructive sexual relations
significant BPD assoc traits
family viewed as conflictual, neglectful and rejecting
complications of bulimia
dehydration and electrolyte disturbances laxatives- metabolic acidosis vomiting- metabolic alkalosis low Mg elevated amylase irregular menses
Which SSRI used in bulimia
fluoxetine
binge eating disorder
recurrent binge eating (weekly in 3 mo)
no compensation
binges: eat fast, uncomfortably full, large amounts when not hungry, eating alone, post binge disgust
epidemiology binge eating
most common
50% obese
Tx binge eating
CBT
SSRI
self help groups
When trying to Dx binge eating
why are they disordered eating
look at BMI
look for complicaitons form behavior
substance abuse more likely with bulimia or anorexia
bulimia
OCD assoc with
anorexia
borderline personality disorder associated with
bulimia
avoidant personality disorder
anorexia and bulimia
