Eating Disorders - Vertrees Flashcards
definition of anorexia nervosa
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
restricting type anorexia
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
for a pt that is 5’7 what weight would you need for BMI of 18.5
118
social and biological reasons for anorexia?
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
what is the pscyhodynamic reason for anorexia
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)
do anorexics have a loss of appetite?
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
binge type anorexia
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
what are some comorbidities of anorexia
65% of patients meet MDD criteria
35% meet Social Anxiety criteria
25% meet OCD criteria
12% meet GAD criteria
80% are single
effects on the body of anorexia
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
treatment for anorexia?
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
when do you hospitalize anorexic pt’s
Evidence of organ system failure
HR
what is the prognosis of anorexia in adults
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
lifetime mortality rate of anorexia
25%
5.6 % per decade
death secondary to medical complications of starvation and suicide
how does age at onset affect prognosis
Adult onset = age of symptom onset after 18 years old
prognosis for adolescent onset anorexia
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
what is bulimia nervosa
onset?
prevalence?
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
Biologic reasons for bulimia
Serotonin: linked to satiety
SSRIs decrease binging and purging, and depression
Increased rate of Bulimia in first degree relatives
psychodynamic reasons for bulimia
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”
how is bulimia and the personality type different than anorexia
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”
what are the complications of bulimia
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
how do you treat bulimia
1st intervention
intervention for post binge/purge
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
at 3 months post treatment how many bulimia pt’s reached remission
70 percent
at 10 years post treatment, what are the outcomes of bulimic pt’s
60% Fully Recovered
10% E.D. NOS
30% Still meet diagnostic criteria
binge eating disorder
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
what is the pt profile of binge eating disorder
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)
treatment for binge eating disorder
CBT
SSRIs
Self-help groups (OA)
what percentage of women in the US are dissatisfied with their apperance
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
substance abuse comorbidity percentages with bulimia and anorexia
23-40% with Bulimia
12-18% with Anorexia
sexual abuse percentages with bulimia and anorexia
20-50% both Bulimia and Anorexia
personality disorders seen in bulimia and anorexia
Avoidant Personality D/O
Both Anorexia and Bulimia
Obsessive/Compulsive Personality D/O
Anorexia Nervosa
Borderline Personality D/O
Bulimia Nervosa
