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Behavioral Med > Feeding/Eating Disorder > Flashcards

Feeding/Eating Disorder Flashcards

0
Q

What are the 3 common dx in childhood?

A

PICA
Rumination disorder
Avoidant/Restrictive food intake disorder

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1
Q

What is eating disorder?

A

extreme attitudes and behaviors about wt and food –> create serious emotional and physical probs with LIFE THREATENING consequences

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2
Q

What is PICA?

A

childhood dx
NON nutritive substances for 1 mo
mental retardation

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3
Q

Rumination disorder?

A

childhood
regurgitation and rechewing food for 1 mo
mental retardation

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4
Q

Avoidant/Restrictive food intake disorder?

A

disinterest in eating d/t o aversive consequences (pesticides, etc)
childhood dz

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5
Q

3 primary feeding and eating disorders (FEDs)?

A

1) anorexia nervosa
2) bulimia nervosa
3) binge-eating disorder

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6
Q

Anorexia nervosa and bulimia nervosa?

A

extreme fear and apprehension about wt gain

strong sociocultural origins - traumatic event –> control what you eat

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7
Q

Binge-eating disorder?

A

lack of control feelings and distress

shame and feeling out control

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8
Q

Spectrum of anorexia, bulimia, and binge eating?

A

Anorexia —> bulimia —> binge eating

control —> less control –> NO CONTROL

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9
Q

Anorexia and Bulimia nervosa - onset and duration?

A

onset:
- happens in younger and younger populations (86%: 20yo)
- social phenomenon
duration:
- LIFE LONG DISEASE

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10
Q

FEDs - incidence and tx cost?

A

FEDs tx is NOT included in Affordable Care Act

many are dx but NOT tx - can be costly (inpt vs outpt)

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11
Q

Anorexia nervosa - 2 subtypes?

A

1) restricting type

2) binge-eating/purging type

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12
Q

Anorexia nervosa?

A

restriction of ENERGY INTAKE w/ significantly LOW WT (unlike bulimia)
intense FEAR of gaining wt (anger/irritability)
disturbance in perception of body size and DENIAL of thinness

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13
Q

Restricting type?

A

subtype of anorexia nervosa

NO binge/purging in 3 mo (dieting, fasting , exercise)

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14
Q

Binge-eating/purging type?

A

subtype of anorexia nervosa

positive binge eating/purging/BOTH in 3 mo (vomiting, laxatives, diuretics, enemas)

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15
Q

Anorexia nervosa BMI?

A

mild: >17
mod: 16-17
severe: 15-16
extreme: hospitalization

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16
Q

Anorexia vs bulimia?

A

anorexia is more chronic and resistant to tx than bulimia

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17
Q

Anorexia - gender?

A

female to male: 10:1

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18
Q

Anorexia - timeline?

A

around age 13/early adolescence:

-puberty and development of secondary sex traits

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19
Q

Anorexia - PE?

A 
lanugo (fine unpigmented hair - like baby hair)
loss of muscle mass
loss of hair
tooth and bone decay
emotional instability
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20
Q

Anorexia - sx?

A 
insomnia
anemia
diarrhea
bradycardia
ulcers
delayed gastric emptying (body is trying to suck nutrients out of everything and anything)
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21
Q

Bulimia nervosa?

A

1) recurrent episodes of binging:
- eating in discrete time period of EXCESSIVE AMOUNT OF FOOD
- sense of lack of control
2) binge eat –> compensatory behavior*** (using laxatives, enemas)
3) occurs 1x/wk for 3 mo
4) self-evaluation excessively based on BODY SHAPE and wt

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22
Q

Bulimia nervosa - subtypes?

A

1) purging

2) non purging

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23
Q

Bulimia nervosa - purging?

A

subtype of bulimia

self-induced vomiting OR misuse of: laxatives, diuretics, enema

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24
Q

Bulimia nervosa - nonpurging?

A

exercise and eating

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25
Q

Bulimia nervosa - frequency of episodes?

A

mild: 1-3/wk
mod: 4-7/wk
severe: 8-13/wk
extreme: 14+/wk

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26
Q

Bulimia nervosa - population?

A

16-19yo
female > male
5-10% college women

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27
Q

Bulimia nervosa- prognosis?

A

untreated: chronic

50-75% can fully recover

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28
Q

Vomiting sx?

A

Low K
high bicarbonate
arrhythmia
acid-base imbalance

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29
Q

Laxative abuse?

A 
low K
low HCO3
renal injury
arrhythmia
constipation
acid base imbalance
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30
Q

Russell’s sign?

A

signs of vomiting

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31
Q

Oral complications of bulminia?

A 
teeth become translucent 
enamel loss
teeth are shortened
pulp exposed 
palatal hematoma
32
Q

Buliminia nervosa - PE?

A

oral complications
sialadenosis
russell’s signs

33
Q

Sialadenosis?

A

PE of bulimina

bilateral parotid gland enlargement

34
Q

Compensatory strategies - Buliminia?

A 
exercise
strict diet
diet pills
fasting
vomiting
diuretics
laxatives
35
Q

How does culture play a role in eating disorders?

A

past: not able to afford food –> fat? RICH
now: TOO MUCH FOOD –> thin? RICH and self control

36
Q

Binge eating disorder?

A

NEW - DSM5
recurrent episodes of binging characterized by:
-eating in discrete time period an excessive amount of food (like Buliminia but NOT purging)
-sense of lack of control

37
Q

Binge eating disorder - dx?

A 
at least 3; 1x/wk for 3 mo:
more rapid eating
eating until uncomfortably full
eat large amounts when not hungry
eat alone b/c they feel embarrassment 
feel gross w/ self, depressed, very guilty
38
Q

Binge eating - cx?

A

emotions dysregulation (sadness, stress, worry)

39
Q

Binge eating - aftermath?

A

feelings/mood alteration

emotions in response to consuming large amount of food

40
Q

Binge eating - episodes?

A

mild: 1-3/wk
mod: 4-7/wk
severe: 7-13/wk
extreme: 14+/wk

41
Q

Binge eating cycle?

A

crave food –> strict rigid diet –> shame dperessed –> guiilt, self loathing –> “ive failed, fck it all” –> break rules and eat –> crave food, etc

42
Q

Other specified feeding or eating disorders (5)?

A

1) atypical anorexia nervosa
2) bulimia nervosa of low freq and/or limited duration
3) binge eating disorder of low freq and/or limited duration
4) purging disorder
5) night eating syndrome

43
Q

Other specified feeding or eating disorders-Atypical anorexia nervosa?

A

ALL anorexia criterai EXCEPT wt is normal

44
Q

Other specified feeding or eating disorders-Bulimia nervosa?

A

ALL bulimia critera EXCEPT binge/purg <3 mo

45
Q

Other specified feeding or eating disorders-Binge eating disorder?

A

all BED criteria except binge <3mo

46
Q

Other specified feeding or eating disorders-Purging disorder?

A

recurrent purging for wt or shape w/o binge eating

47
Q

Other specified feeding or eating disorders-Night eating syndrome?

A

recurrent eating after waking or excessive eating after evening meal w/ awareness and recall of eating dinner

48
Q

Unspecified feeding or eating disorder?

A

sx of FED but does NOT meet criteria for anything
can be used to “shift”/bridging to another dz
clinician cannot get a clear hx of the pt - ie) ER

49
Q

DDx and Comorbid dx?

A 
Superior mesenteric artery sx 
MDD
OCD
BDD (body dysmorphic disorder) 
somatoform disorder
50
Q

Body dysmorphic disorder (BDD)?

A

ALWAYS includes debilitating or excessive fear of judgment by others
social anxiety
social phobia
preoccupation w/ PERCEIVED DEFECT or flaws in physical appearance
repetitive behaviors or mental acts at some point d/t concern
ANXIETY DISORDER

51
Q

Somatoform disorder?

A

food avoidance SECONDARY to GI sx

52
Q

Diabulimia?

A

manipulating insulin to lose wt

53
Q

Diabulimia population?

A

diabetes

15-30yo

54
Q

Diabulimia - complication?

A

vision loss
depression
kidney failure
heart damage

55
Q

Exercise dependence/addiction?

A

primary exercise dependence

secondary exercise dependence

56
Q

Exercise dependence/addiction - primary?

A

exercise is the primary disorder

NO disordered eating behaviors ID’d

57
Q

Exercise dependence- secondary?

A

primary dx is AN, B< ED, NOS
longer hospitalization
predicts QUICKER relapse

58
Q

Problematic exercise?

A

rigidity routine
exercise is TOP priority
exercise despite sickness, injury, etc

59
Q

Problematic exercise - effects?

A

overuse injuries
social isolation and impaired relationship
anxiety
sleep disturbance

60
Q

Healthy exericse?

A

REST DAY
exercise buddy
increase variety
moderation approach

61
Q

Men and eating disorders?

A

Anorexia: wt loss and fear of wt gain
Bulimia and binge: binging +/- purging
increased risk for depressions, anxiety, and substance disorders

62
Q

Men and eating disorder - what to watch out for?

A

compensatory strategies
social norms
positive feedback for exercise: don’t eat and just exercise
CULTURE - men are suppose to be macho, not skinny and weak

63
Q

Muscle dysmorphia/Bigorexia?

A

preoccupation w/ appearance, musculature
ignore information that body image i NOT consistent w/reality
cx: depression or feeling of disgust

64
Q

Muscle dysmorphia/Bigorexia - predisposing factors?

A 
being bullied
family disharmony
perfectionism -OCD
stress
culture
65
Q

Men vs women?

A 
men: 
less likely to seek help for emotional prob
delaying tx = reduce tx effectiveness
focus on more muscular shape
compulsive exercise and dieting 
exercise; nonpurging 
more substance abuse
women: 
higher drive for thinness
importance of SHAPE
compensatory behaviors
66
Q

Sexual orientation?

A

lesbian women: don’t care about shape

gay men: care about shape

67
Q

RF for feeding and eating disorders?

A 
early prob eating behaviors 
early pubertal maturation
HIGH % of body fat
poor body image: abuse hx - sexual abuse w/ bulimia NOT anorexia 
**EARLY, EARLY, EARLY
68
Q

Factors to FEDs?

A

social networking

pro-anorexia groups: dieting tips, thinspiration

69
Q

At risk groups?

A

gymnast
dancers
gay/lesbians
business

70
Q

Potential AN, BN traits?

A

premorbid –> persistent sx after tx –> behaviors are exaggerated by malnutrition

71
Q

SCOFF quesionnaire?

A

-do you make yourself SICK
-do you worry you lost CONTROL
-in past 3 mo, have you lost OVER 6.5kg/15lbs
-do you believe ourself to FAT
-would you say FOOD dominates your life
2+ = AN/BN

72
Q

Increased risk of additional psychiatric dx?

A

depression
depression tx
OCD

73
Q

Tx eating disorder?

A 
CBT
DBT
addiction model
Maudsley method
interpersonal psychotherapy
meds
admit
74
Q

Checking the mirror? Skin picking?

A

Body dysmorphic Disorder

75
Q

BDD - w/ muscle dysmorphia?

A

muscles are too big/small

76
Q

BDD dx?

A

need constant reassurance from others
1+hr daily dedicated to defect
repeated dermatologic or cosmetic referral for correction of the defect
NO lab test

77
Q

BDD - screening?

A

MMSE
MOOD: depressed, irritable, anxious
THOUGHT process: perseveration on perceived defect
THOUGH content: thoughts about perceived defect become delusional
EXCEPT for time and energy spent on perceived defet

78
Q

BDD tx?

A

medications - SSRI, TCA
have consistent tx w same provider
refer

Behavioral Med (17 decks)

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