Feeding and Eating Disorders

Question 1

Satiety

Answer 1

Serotonin has long been a focus of attention for its possible role in disrupted satiety.

Question 2

the intestinally derived anorexigen
that elicits satiety, appears to be dysregulated in individuals with
AN and BN, but not in those with BED.

(5-HT, serotonin) functioning contributes to dysregulated appetite, mood, and impulse control in EDs and that such alteration persists after recovery from AN and BN, possibly reflecting premorbid vulnerability.

Answer 2

altered Peptide tyrosine (PYY)

Question 3

Appetite

Answer 3

The orexigenic peptide ghrelin is of interest in EDs because it is the only known GI hormone that stimulates appetite and promotes food intake.

Question 4

influences secretion of growth hormone, induces adiposity, and is implicated in signaling the hypothalamic nuclei involved in energy homeostasis.

Answer 4

Ghrelin

Question 5

Energy Storage

Answer 5

Leptin and adiponectin are hormonal signals associated with longer-term regulation of body fat stores.

Question 6

___is also directly implicated in satiety through its binding to the ventral medial nucleus of the hypothalamus, an area termed the satiety center.

Answer 6

Leptin

Question 7

Leptin and adiponectin

Answer 7

Leptin and adiponectin are both altered in patients with EDs.

Question 8

Anorexia Nervosa

Answer 8

significantly low weight (the weight that is less than minimally normal), fear of gaining weight (despite being thin), and a disturbance in the way body shape or weight is perceived (e.g., a denial of the medical seriousness of being under- weight or feeling fat despite emaciation)

Question 9

Behaviors Used to Compensate for Excessive Food Intake or to Prevent Weight Gain

Answer 9

PURGING BEHAVIORS
Diuretic abuse
Laxative and/or enema abuse
Self-induced vomiting (including syrup of ipecac abuse)

NON-PURGING BEHAVIORS
Excessive physical activity
Fasting, skipping meals, restrictive-eating pattern
Inappropriate withholding or under-dosing of insulin (among individuals with diabetes mellitus)
Stimulant abuse (e.g., caffeine, ephedra, methylphenidate,
cocaine)

Question 10

AN is further divided into 2 subtypes:

Answer 10

restricting type (those who primarily control their weight through dieting, fasting, or exercising)

binge-eating/purging type (those who routinely purge calories to control weight and/or routinely binge eat).

in middle-aged and older women new-onset AN may present in conjunction with difficulty making life transitions and fear of aging.

Question 11

recurrent binge eating accompanied by inappropriate compensatory behaviors to control weight or to purge calories consumed during a binge

Answer 11

Bulimia Nervosa

these behaviors must occur once each week for at least 3 months to meet diagnostic criteria

Question 12

binge eating

Answer 12

is consumption of an unusually large amount of food during a “discrete period of time” (i.e., not overeating or “grazing” all day), accompanied by the feeling that the eating cannot be controlled.

Question 13

Binge-Eating Disorder

Answer 13

recurrent and persistent binge eating.

To meet diagnostic criteria, binge episodes should occur at least weekly, on average, over a duration of 3 or more months.

Question 14

NES Night-eating syndrome

Answer 14

is characterized by recurrent bouts of evening or nocturnal overeating—but not necessarily bingeing— without associated inappropriate compensatory behaviors to prevent weight gain.

investigators have proposed morning anorexia, evening hyperphagia (e.g., consuming a disproportionately large number of calories in the evening or after dinner), and sleep disturbance (operationalized in various ways including difficulty falling or staying asleep).

Question 15

Purging disorder PD, another OSFED variant,

Answer 15

is characterized by recurrent purging symptoms in the absence of clinically significant binge- pattern eating.

PD is more common among women

peak onset (at age 20) appears to be later than for BN.

Question 16

Avoidant/Restrictive Food Intake Disorder

Answer 16

ARFID can be co-morbid with neuro-developmental disorders, such as intellectual dis-
ability and autism spectrum disorder; for the latter co-morbidities,

ARFID is more common among males compared with those who
have AN or BN.

Question 17

a disorder characterized by recurrent and persistent ingestion of non-food substances like chalk, paper, paint chips, or laundry starch.

Answer 17

Pica

Question 18

The hallmark of ___disorder is repeated and persistent (over at least 1 month) effortless, voluntary regurgitation that is not solely attributable to a medical condition.

Gastric contents that are brought up are sometimes spit out, but alternatively may be re-chewed and/or swallowed.

Regurgitation is sometimes used for self-soothing or self-stimulation.

Answer 18

Rumination Disorder

Question 19

(patient weight/ expected weight for height and gender) × 100 %

Answer 19

Expected body weight ( % )

Question 20

For underweight patients without this degree of compromise, the primary goals of nutritional management

Answer 20

are increasing caloric requirements to regain weight, ensuring adequate intake and balance of macro- and micronutrients, and reestablishing a dietary pattern of 3 meals and 1 to 3 snacks daily.

Question 21

Superior mesenteric artery (SMA) syndrome

Answer 21

is a rare disorder
that can complicate AN.

It results from severe weight loss with
resultant collapse of the angle at which the SMA arises from the
aorta and through which the duodenum passes;

reduction of the
angle results in compression of the third part of the duodenum by
the SMA

Question 22

Constipation in AN and BN

Answer 22

is thought to be the result of poor nutrition, decreased gut motility, dehydration, and hypokalemia due to purging behavior such as vomiting or laxative abuse.

Question 23

Medications and Dietary Supplements

Answer 23

Laxative abuse remains common among
patients with EDs, particularly among those with BN

The most frequently abused group of laxatives is the stimulant class; side effects and toxicity include constipation, cathartic colon, GI bleeding, rectal prolapse, dehydration, and electrolyte abnormalities.

Ipecac is an emetic that is used to induce vomiting