Eating Disorders x2

Question 1

What are different causes of disordered eating / weight change? [+]

Answer 1

Primary eating disorders
- AN
- BN

Medical causes:
- Dental
- Endocrine
- Genetic
- GI
- Infection
- Cancer

Psychiatric:
- Pyschosis
- Mood disorders
- Substance disorders
- ASD

Other:
- Dieting
- Iatrogenic
- Obesity

Question 2

What are the two subtypes of AN? [2]

Answer 2

Restricting subtype (diet restriction (often combined with XS exercise)

Binge-purge subtypes

Question 3

How can you severity criteria for AN in adults [1] and children? [1]

Answer 3

Adults:
- Based off BMI

Children:
- Based off % weight expected for height based on centile charts

Question 4

What defines BN? [4]

Answer 4

Recurrent binge eating
* Clearly excessive amounts, defined period, loss of control, negative affect

AND

Inappropriate compensatory behaviours
* E.g. purging, excessive exercise, fasting
NELFT

at least weekly over last 3 months

AND

Not just during AN

Question 5

What is the difference with BED and BN? [1]

Answer 5

Recurrent binges without compensatory behaviours - often obese

Question 6

What is meant by other specified feeding or eating disorder (OSFED)? [1]

Answer 6

Any presentation that doesn’t fit neatly into other categories - could be a mixed picture
- e.g. symptoms haven’t gone on long enough for 3 months
- Or anorexic like behaviour, but started on large weight so aren’t at low weight yet

Question 7

What is meant by avoidant restrictive food intake disorder? [1]

Answer 7

Marked dietary restriction WITHOUT weight and shape concern

Question 8

What is important to note about how people transition between eating disorders? [1]

Answer 8

Often transition away from AN to other eating disorders
- Move is away from low weight presentations, but often will continue purging etc.

Question 9

If taking a Hx from ?ED patient, what do you speficially need to ask? [+]

Answer 9

Exploring ED symptoms:

Diet history
- Meals & snacks, fluid intake, foods avoided, calorie restriction, rules

Binges

Compensatory behaviours
- Purging
- Exercise
- Restriction
- Medication (e.g. appetite suppression)

Weight concerns
- Comfort at current weight
- Body dissatisfaction
- Salience in self-evalation

Weighing and checking behaviours

Current weight, recent and longer term trends
- Ask about max/min weight
- If women - has if periods have ever stopped
- Ask if ever had treatment

Motivation for change

Question 10

What are possible comorbidities of EDs? [+]

Answer 10

Anxiety disorders
Mood disorders
Personality disorders
Substance misuse
Neurodiversity
Diabetes
Obesity

Question 11

Which electrolyte imbalance is key in AN? [1]

Answer 11

Hypokalaemia can cause cardiac arrest

Question 12

What are the key features of refeeding syndrome and why do they occur? [2]

Answer 12

Refeeding syndrome:
- falls in phosphate and magnesium (used to make ATP)

Causes:
- Peripheral oedema - potentially fatal

Question 13

Which foods should you encourage with refeeding? [1]

Answer 13

Diary - full of phosphates

Question 14

Describe how you would perform a physical risk assessment in a malnourished patient [5+]

Answer 14

Appearance:
- Often look well

BMI
- < 13kg/m2 / 70% WH or rapid weight loss (>1 kg per week) high risk

Physical examination:
- Vital signs, muscle power and SUSS (Sit-Up Squat-Stand)

Blood tests:
- FBC, U&Es, glu, PO4, Mg, LFTs,

ECG

Question 15

What is the tx for BN in adults and young children? [2]

Answer 15

Adults: BN focused guided self-help (GSH-BN)
CYP: BN focused Family Therapy