eating/feeding disorders (2) Flashcards
which ED has the highest mortality rate?
anorexia nervosa
what is the relapse rate of anorexia at 1 year
50%
which disorder has an extreme fear of obesity/weight gain even though they are severely underweight
anorexia
which disorder has a severe distortion of body image
anorexia
describe restricting type of anorexia
-does not engage in binge eating or purging
-diet and fast rigorous exercise
describe binge/purge anorexia
primarily only restricts but does binge/purge occasionally
when is someone with anorexia in full remission
at a regular BMI
BMI levels of mild, moderate, severe, and extreme anorexia
mild= >17
mod= 16-16.99
severe= 15-15.99
extreme= <15
heart complications of anorexia
prolonged QT and ST-T wave (CAN LEAD TO DEATH)
bradycardia
vtac/vfib
how is BP effected by anorexia
hypotension/ortho
comorbidity with anorexia
depression/anxiety
compulsive behavior/OCD
when does bulimia occur?
late adolescence/early adulthood
what condition is repeated, episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time. FOLLOWED by inappropriate compensatory behaviors to rid body of excess calories
bulimia
how long does episodes of bulimia need to occur to be diagnosed
once a week for 3 months
compensatory mechanisms used in binging
-self-induced vomiting
-misuse of laxatives, diuretics, enemas
-fasting
-excessive exercise
describe frequency of episodes that classifies mild, mod, severe, and extreme bulimia (also the same for binge eating disorder)
mild= 1-3 eps/week
mod= 4-7 eps/week
severe= 8-13 eps/week
extreme= 14 or more eps/week
comorbidities with bulimia
MDD/bipolar, anxiety, borderline/histrionic personality, substance abuse
describe weight fluctuation in bulimia
weight fluctuation common, but likely stays in normal range
what can lead to death in bulimia
dehydration/electrolyte imbalances, EKG changes/arrythmias
effects of vomiting frequently (bulimia)
tooth enamel erosion, dental carries, loss of dental arch, tears in esophagus
risk factors for anorexia/bulimia?
UNKNOWN
-linked to chromosomes 1, 2, abd 13
-neuro-endocrine abnormalities
what part of the brain is effected in eating disorders
hypothalamus
what does the hypothalamus do in relation to eating disorders
-recognize when hungry
-nit hungry
-when sated
which neurotransmitter is impaired in anorexia
dopamine, triggers anxiety
which neurotransmitters are altered in bulimia
serotonin and norepinephrine
which amino acid is essential to serotonin synthesis and is only available through diet
tryptophan
brain differences in bulimia
-increased grey matter
-more likely to have ADHD
psychodynamic influences on bulimia/anorexia
-mother-infant disturbances
-parent responds to emotional need with food
-enmeshed boundaries
-conflict avoidance
-POWER/CONTROL OF BODY
-passive father/domineering mother
which kind of gain are where they get to avoid something
primary
which kind of gain are where they get attention
secondary
which kind of gain are where their areas of conflict are shifted
tertiary
personality traits linked with EDs
perfectionism, avoidant, interceptive awareness, anxirty, intolerance of uncertainty, obsession, thought sticking, impulsive/compulsive, competitive
which ED is repeated episodes of uncontrolled binge eating with significant distress, do not use compensatory mechanisms
binge eating disorder
psychological/environment factors for binge eating disorder
-low self esteem / body dissatisfication
-reduced coping
-ACE
which feeding disorder is the persistent eating of substances with no nutritional value (dirt, paint, paper clips)
pica
why is pica dangerous
undigested objects can cause intestinal blocking
which feeding disorder is where undigested food is returned to the mouth, re-chewed, re-swallowed, or spit out
rumination disorder
what is rumination disorder associated with
intellectual development disorders and neglect
which eating disorder is when someone with DM1 restricts insulin to lose weight
diabulimia (ED-DMT1)
treatment of eating disorders
restore nutritional status - weight restoration program
what is an imbalance of electrolytes / fluid shifts that can occur when a malnourished pt begins to eat normally (rapid discharge of insulin & ↓ phosphorus)
refeeding syndrome
what increases the risk of refeeding syndrome
-rapid weight loss
-abnormal EKG/low phos
-diuretic, laxative, or insulin misuse
s/sx of refeeding syndrome
weakness, leg swelling, difficult breathing, altered mental status, seizures, heart failure
how must people with refeeding syndrome be fed?
refed slowly and supplement electrolytes
descrube behavior modification treatment for ED
must perceive control of treatment, contract for privleges based on weight gain
which practice of ED recovery uses concepts of CBT and eastern mindfulness practices
dialectical behavior therapy
what are the goals of family therapy for ED
-educate
-don’t comment on body
-support for feelings of guilt and stigma
-support gorups
-stop tertiary gains
when should individual therapy be used for EDs
not normally used, only when there is an underlying psych problem
how can “fear foods” be handled?
pair challenging food with non-challenging food
meds with anorexia
no approved meds, no evidence of meds being beneficial for treatment
