Feeding/Eating Disorder Flashcards
What are the 3 common dx in childhood?
PICA
Rumination disorder
Avoidant/Restrictive food intake disorder
What is eating disorder?
extreme attitudes and behaviors about wt and food –> create serious emotional and physical probs with LIFE THREATENING consequences
What is PICA?
childhood dx
NON nutritive substances for 1 mo
mental retardation
Rumination disorder?
childhood
regurgitation and rechewing food for 1 mo
mental retardation
Avoidant/Restrictive food intake disorder?
disinterest in eating d/t o aversive consequences (pesticides, etc)
childhood dz
3 primary feeding and eating disorders (FEDs)?
1) anorexia nervosa
2) bulimia nervosa
3) binge-eating disorder
Anorexia nervosa and bulimia nervosa?
extreme fear and apprehension about wt gain
strong sociocultural origins - traumatic event –> control what you eat
Binge-eating disorder?
lack of control feelings and distress
shame and feeling out control
Spectrum of anorexia, bulimia, and binge eating?
Anorexia —> bulimia —> binge eating
control —> less control –> NO CONTROL
Anorexia and Bulimia nervosa - onset and duration?
onset:
- happens in younger and younger populations (86%: 20yo)
- social phenomenon
duration:
- LIFE LONG DISEASE
FEDs - incidence and tx cost?
FEDs tx is NOT included in Affordable Care Act
many are dx but NOT tx - can be costly (inpt vs outpt)
Anorexia nervosa - 2 subtypes?
1) restricting type
2) binge-eating/purging type
Anorexia nervosa?
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
Restricting type?
subtype of anorexia nervosa
NO binge/purging in 3 mo (dieting, fasting , exercise)
Binge-eating/purging type?
subtype of anorexia nervosa
positive binge eating/purging/BOTH in 3 mo (vomiting, laxatives, diuretics, enemas)
Anorexia nervosa BMI?
mild: >17
mod: 16-17
severe: 15-16
extreme: hospitalization
Anorexia vs bulimia?
anorexia is more chronic and resistant to tx than bulimia
Anorexia - gender?
female to male: 10:1
Anorexia - timeline?
around age 13/early adolescence:
-puberty and development of secondary sex traits
Anorexia - PE?
lanugo (fine unpigmented hair - like baby hair) loss of muscle mass loss of hair tooth and bone decay emotional instability
Anorexia - sx?
insomnia anemia diarrhea bradycardia ulcers delayed gastric emptying (body is trying to suck nutrients out of everything and anything)
Bulimia nervosa?
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
Bulimia nervosa - subtypes?
1) purging
2) non purging
Bulimia nervosa - purging?
subtype of bulimia
self-induced vomiting OR misuse of: laxatives, diuretics, enema
Bulimia nervosa - nonpurging?
exercise and eating
Bulimia nervosa - frequency of episodes?
mild: 1-3/wk
mod: 4-7/wk
severe: 8-13/wk
extreme: 14+/wk
Bulimia nervosa - population?
16-19yo
female > male
5-10% college women
Bulimia nervosa- prognosis?
untreated: chronic
50-75% can fully recover
Vomiting sx?
Low K
high bicarbonate
arrhythmia
acid-base imbalance
Laxative abuse?
low K low HCO3 renal injury arrhythmia constipation acid base imbalance
Russell’s sign?
signs of vomiting
Oral complications of bulminia?
teeth become translucent enamel loss teeth are shortened pulp exposed palatal hematoma
Buliminia nervosa - PE?
oral complications
sialadenosis
russell’s signs
Sialadenosis?
PE of bulimina
bilateral parotid gland enlargement
Compensatory strategies - Buliminia?
exercise strict diet diet pills fasting vomiting diuretics laxatives
How does culture play a role in eating disorders?
past: not able to afford food –> fat? RICH
now: TOO MUCH FOOD –> thin? RICH and self control
Binge eating disorder?
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
Binge eating disorder - dx?
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
Binge eating - cx?
emotions dysregulation (sadness, stress, worry)
Binge eating - aftermath?
feelings/mood alteration
emotions in response to consuming large amount of food
Binge eating - episodes?
mild: 1-3/wk
mod: 4-7/wk
severe: 7-13/wk
extreme: 14+/wk
Binge eating cycle?
crave food –> strict rigid diet –> shame dperessed –> guiilt, self loathing –> “ive failed, fck it all” –> break rules and eat –> crave food, etc
Other specified feeding or eating disorders (5)?
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
Other specified feeding or eating disorders-Atypical anorexia nervosa?
ALL anorexia criterai EXCEPT wt is normal
Other specified feeding or eating disorders-Bulimia nervosa?
ALL bulimia critera EXCEPT binge/purg <3 mo
Other specified feeding or eating disorders-Binge eating disorder?
all BED criteria except binge <3mo
Other specified feeding or eating disorders-Purging disorder?
recurrent purging for wt or shape w/o binge eating
Other specified feeding or eating disorders-Night eating syndrome?
recurrent eating after waking or excessive eating after evening meal w/ awareness and recall of eating dinner
Unspecified feeding or eating disorder?
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
DDx and Comorbid dx?
Superior mesenteric artery sx MDD OCD BDD (body dysmorphic disorder) somatoform disorder
Body dysmorphic disorder (BDD)?
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
Somatoform disorder?
food avoidance SECONDARY to GI sx
Diabulimia?
manipulating insulin to lose wt
Diabulimia population?
diabetes
15-30yo
Diabulimia - complication?
vision loss
depression
kidney failure
heart damage
Exercise dependence/addiction?
primary exercise dependence
secondary exercise dependence
Exercise dependence/addiction - primary?
exercise is the primary disorder
NO disordered eating behaviors ID’d
Exercise dependence- secondary?
primary dx is AN, B< ED, NOS
longer hospitalization
predicts QUICKER relapse
Problematic exercise?
rigidity routine
exercise is TOP priority
exercise despite sickness, injury, etc
Problematic exercise - effects?
overuse injuries
social isolation and impaired relationship
anxiety
sleep disturbance
Healthy exericse?
REST DAY
exercise buddy
increase variety
moderation approach
Men and eating disorders?
Anorexia: wt loss and fear of wt gain
Bulimia and binge: binging +/- purging
increased risk for depressions, anxiety, and substance disorders
Men and eating disorder - what to watch out for?
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
Muscle dysmorphia/Bigorexia?
preoccupation w/ appearance, musculature
ignore information that body image i NOT consistent w/reality
cx: depression or feeling of disgust
Muscle dysmorphia/Bigorexia - predisposing factors?
being bullied family disharmony perfectionism -OCD stress culture
Men vs women?
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
Sexual orientation?
lesbian women: don’t care about shape
gay men: care about shape
RF for feeding and eating disorders?
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
Factors to FEDs?
social networking
pro-anorexia groups: dieting tips, thinspiration
At risk groups?
gymnast
dancers
gay/lesbians
business
Potential AN, BN traits?
premorbid –> persistent sx after tx –> behaviors are exaggerated by malnutrition
SCOFF quesionnaire?
-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
Increased risk of additional psychiatric dx?
depression
depression tx
OCD
Tx eating disorder?
CBT DBT addiction model Maudsley method interpersonal psychotherapy meds admit
Checking the mirror? Skin picking?
Body dysmorphic Disorder
BDD - w/ muscle dysmorphia?
muscles are too big/small
BDD dx?
need constant reassurance from others
1+hr daily dedicated to defect
repeated dermatologic or cosmetic referral for correction of the defect
NO lab test
BDD - screening?
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
BDD tx?
medications - SSRI, TCA
have consistent tx w same provider
refer
