Eating Disorders - Vertrees

Question 1

definition of anorexia nervosa

Answer 1

Restriction of energy intake relative to requirements, leading to significantly low weight
Below a BMI of 18.5
Intense fear of gaining weight or getting fat, or persistent weight loss behavior despite medical starvation
Significant disturbance in perception of shape or weight of body

50/50 restricting type versus bing-purge type

Most common onset 14-18
About 1% of adolescent females
F:M ratio >10:1
Higher in modeling, ballet, cross-country

decrease in sex

Question 2

restricting type anorexia

Answer 2

In last 3 months, has not engaged in recurrent binge eating or purging.
This means, weight loss is achieved through diets, fasts, excessive exercise

Usually attempting to consume

Question 3

for a pt that is 5’7 what weight would you need for BMI of 18.5

Answer 3

118

Question 4

social and biological reasons for anorexia?

Answer 4

Biologic
Higher concordance in monozygotic twins than dizygotic
Mood disorders are more common in family

Social
Heterosexual women and gay men – equally high
Heterosexual men and lesbian women – lower risk

Question 5

what is the pscyhodynamic reason for anorexia

Answer 5

mommie dearest

Often close family, but domineering and lacking in empathy
Family where “excellence” is demanded
Patients lack a sense of autonomy and selfhood
Self-starvation = discipline, self-mastery
Wrest control of self from (often) mother
Rigid and perfectionistic (ego-syntonic)

Question 6

do anorexics have a loss of appetite?

Answer 6

no

Anorexics spend vast majority of time thinking about food.
Collecting food, hiding it, making meals for others, reading recipes, rearranging it on the plate

Question 7

binge type anorexia

Answer 7

Represents a failure to adhere to pure anorexic goals
Less “self-control”, more substance use and impulsivity

In last 3 months, has engaged in recurrent binges and/or purges

Question 8

what are some comorbidities of anorexia

Answer 8

65% of patients meet MDD criteria

35% meet Social Anxiety criteria

25% meet OCD criteria

12% meet GAD criteria

80% are single

Question 9

effects on the body of anorexia

Answer 9

Lowered cognition, anhedonia / apathy

Cold intolerance

Bradycardia

Reduced thyroid metabolism (low T3)

Low LH and FSH, estrogen/testosterone
Delayed sexual development

Osteoporosis, hypocalcemia - fractures
Lanugo

Chronic dehydration and constipation
Plus purging complications as below

Question 10

treatment for anorexia?

Answer 10

manage weight

treat physical complications

CBT- body image, self esteem

SSRI’s for depression and anxiety

SGA’s are used for obsessive thinking and wt gaining

Question 11

when do you hospitalize anorexic pt’s

Answer 11

Evidence of organ system failure

HR

Question 12

what is the prognosis of anorexia in adults

Answer 12

4 years post treatment
15%  fully recovered
40% “good” outcomes
Weight within 85% of expected
Regular menstruation 
40% enduring morbid food and weight preoccupation
5% dead

Question 13

lifetime mortality rate of anorexia

Answer 13

25%

5.6 % per decade
death secondary to medical complications of starvation and suicide

Question 14

how does age at onset affect prognosis

Answer 14

Adult onset = age of symptom onset after 18 years old

Question 15

prognosis for adolescent onset anorexia

Answer 15

Adolescent Onset Prognosis

5 years post treatment
> 70% full recovery 
25% other specified E.D. 
5% meet criterion for full syndrome
No deaths reported

versus adult
4 years post treatment
15%  fully recovered
40% “good” outcomes
Weight within 85% of expected
Regular menstruation 
40% enduring morbid food and weight preoccupation
5% dead

Question 16

what is bulimia nervosa

onset?
prevalence?

Answer 16

Recurrent binge eating with inappropriate compensatory methods to avoid weight gain.

Binge, and compensation, average once a week for at least 3 months

Self-evaluation unduly influenced by weight or shape

1-4% lifetime prevalence in females

Onset is usually late teens to early twenties

Question 17

Biologic reasons for bulimia

Answer 17

Serotonin: linked to satiety
SSRIs decrease binging and purging, and depression
Increased rate of Bulimia in first degree relatives

Question 18

psychodynamic reasons for bulimia

Answer 18

Less superego control
More outgoing, impulsive, emotional lability
Engage in substance use and destructive sexual relations
Significant BPD-associated traits
Often view family as conflictual, neglectful, and rejecting

More often, dislike the disordered eating
“Ego-dystonic”

Question 19

how is bulimia and the personality type different than anorexia

Answer 19

Disorder is less “controlled”
Failed attempt at anorexia
Binges as “breakthrough eating”
Eating as self soothing in times of stress
Binge is soothing
High calorie, sweet, soft/smooth
Secret, fast, and not always chewed
Binges provoke panic state
Pt proves to self “lack of control”

Question 20

what are the complications of bulimia

Answer 20

Dehydration and electrolyte disturbances
Laxatives can lead to metabolic acidosis
Vomiting can lead to a metabolic alkalosis
Also chipped teeth and enlarged parotids
Leads to renal excretion of K+

low magnesium and elevated amylase

irregular menses

Question 21

how do you treat bulimia

1st intervention
intervention for post binge/purge

Answer 21

Psychotherapy: 50% symptom reduction

Cognitive Behavioral Therapy
most effective form of short-term intervention
Psychodynamic Psychotherapy
Useful once binge/purge symptoms improve
Targets both E/D and broader personality issues
Family Therapy
Very important for adolescents

Meds:
SSRI’s (Fluoxetine)- decrease behavior

CBT + SSRI = best

Question 22

at 3 months post treatment how many bulimia pt’s reached remission

Answer 22

70 percent

Question 23

at 10 years post treatment, what are the outcomes of bulimic pt’s

Answer 23

60% Fully Recovered
10% E.D. NOS
30% Still meet diagnostic criteria

Question 24

binge eating disorder

Answer 24

Recurrent binge eating (weekly in 3 mos)
No compensation in any way
Binges are associated with:
Eating much faster than normal
Get uncomfortably full
Very large amounts when not hungry
Eating alone due to embarrassment
Post-binge disgust, depressed, guilty
Marked distress regarding binge eating

Question 25

what is the pt profile of binge eating disorder

Answer 25

Most common Eating Disorder
Females: 4% Males: 2%
50% of pts are obese

Present in 25% of pts seeking care for obesity
Present in >50% of pts with severe obesity (BMI >40)

Question 26

treatment for binge eating disorder

Answer 26

CBT

SSRIs

Self-help groups (OA)

Question 27

what percentage of women in the US are dissatisfied with their apperance

Answer 27

4/5

42% of girls age 6 to 9 “want to be thinner”

In 1970 the average age a girl started dieting was 14;
by 1990 the average age dropped to 8 years old

One half of 4th grade girls are on a diet
And stated they felt better about themselves when adhering to a diet

90% of female high school juniors & seniors diet, yet only one out of ten high school girls are overweight

Overall - 62% of girls & 29% of boys are dieting,
yet only 6.9% of these girls and 14.2% of the boys actually overweight

Question 28

substance abuse comorbidity percentages with bulimia and anorexia

Answer 28

23-40% with Bulimia

12-18% with Anorexia

Question 29

sexual abuse percentages with bulimia and anorexia

Answer 29

20-50% both Bulimia and Anorexia

Question 30

personality disorders seen in bulimia and anorexia

Answer 30

Avoidant Personality D/O
Both Anorexia and Bulimia

Obsessive/Compulsive Personality D/O
Anorexia Nervosa

Borderline Personality D/O
Bulimia Nervosa