Feeding & Eating Disorder

Question 1

Anorexia Nervosa

Answer 1

• Definition:
  
  • failure to maintain a normal body weight; fear & preoccupation with body image
• Etiology:
  
  • genetic, trauma (50%), family dynamic *False misconception that it is a disease of privilege in wealthy white women
• Epidemiology:
  
  • deadliest illness in psychiatry, peak incidence 13-18yo (but growing risk in group 8-12yo), 0.4% F population, 10:1 F:M; chronic illness with remission for many
• S/sxs:
  
  • -Thin (usually)
  • -Relentless pursuit of thinness as a method of control
  • -Intense fear of becoming fat
  • -significantly underweight
  • -severe caloric restriction & new diets (vegetarianism)
  • -Ritualistic eating behaviors & habits
  • -Preoccupied with food (recipes, hoarding)
  • -May involve purging behaviors, vomiting, laxative abuse, exercise
• DSM-V Criteria
  
  • A) Restriction of energy intake relative to requirements leading to significantly low body weight
  • B) Intense fear of gaining weight or becoming fat, even though underweight
  • C) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body shape or weight on self-evaluation, or denial of the seriousness of current low body weight.
• Dx:
  
  • -UA
  • -Electrolyte panel
  • -CBC, TSH, ESR
  • -LFTs, Amylase
  • -EKG
  • -B-hcg, LH, FSH, prolactin, estradiol
  • -Bone density
  • ** In pts who only restrict it is common that all lab tests are NORMAL
• Tx:
  
  • Mortality of 5-7% (as high as 18% in some studies)
  • Want to restore/maintain weight, normalize eating, normalize psychological & family functioning
  • Family based therapy & nutrition rehab (1st line):
    
    • Maudsley approach → families assume responsibility for healthy eating
  • Meds are not effective, other than treating sxs → Can try SSRIs or benzos
  • Inpatient indications: severe malnutrition, physiologic instability (brady 50, hypotensive 80/50, hypothermic 96F, cardiac dysrhythmia, arrested growth, failure of outpatient tx, acute food refusal)

Question 2

What are the indications for admitting someone with anorexia nervosa for inpatient tx?

Answer 2

severe malnutrition, physiologic instability (brady 50, hypotensive 80/50, hypothermic 96F, cardiac dysrhythmia, arrested growth, failure of outpatient tx, acute food refusal)

Question 3

Complications of Anorexia Nervosa

Answer 3

starvation, suicide, electrolyte imbalance, amenorrhea, osteoporosis, bradycardia, hypotension, constipation, acid-base imbalance, pedal edema, hypokalemia

Question 4

Bulimia Nervosa

Answer 4

• Definition:
  
  • eating disorder characterized by frequent binge eating combined with compensatory behavior to prevent weight gain
• Comorbidities:
  
  • depression, anxiety, substance abuse, borderline personality disorder, PTSD
• Epidemiology:
  
  • 0.9-3% of population, 40% of college-aged women have disordered eating, onset later at 13-18yo
• S/sxs:
  
  • Normal weight (usually)
  • -recurrent episodes of binge eating
  • -Recurrent inappropriate compensatory behaviors: purging (90%), laxative abuse (33%), diuretics, abnormal amounts of exercise
  • -Self-eval focused on body shape & weight
• PE:
  
  • parotid gland enlargement
  • -Russel’s Sign: calluses on dorsum of hand from self-induced vomiting
• DSM-V Criteria
  
  • A) Recurrent episodes of binge eating
  • B) Recurrent inappropriate compensatory behavior to prevent weight gain
  • C) At least 1x/week for 3 months
  • D) Self-evaluation is unduly influenced by body shape/weight
  • E) This disturbance does not occur exclusively during episodes of AN
• Tx:
  
  • Psychotherapy
  • Fluoxetine (Prozac): only FDA-approved med

Question 5

Complications of Bulimia Nervosa

Answer 5

hypokalemia, suicide/suicidal ideation, gastric esophageal, bowel abnormalities, erosion of dental enamel, parotid enlargement

Question 6

Eating Disorder Not Otherwise Specified

Answer 6

• Definition:
  
  • sxs that cause clinical distress and/or impairment in social, occupational, or other important areas of functioning, but do not meet full criteria for other eating disorders.
• Dx:
  
  • Insufficient information to make a more specific diagnosis
• Tx:
  
  • Psychotherapy, CBT = best
  • Dependent on sxs–antidepressants may be helpful