Feeding Or Eating Disorders

Question 1

Anorexia nervosa (AN)

Answer 1

• refusal to maintain a minimally normal body weight
  
  • fueling a relentless desire for thinness with a morbid fear of fatness or gaining weight (even though underweight)
• MC onset= mid teens
• 90% women
• 60% girls age 15-24
• athletes, dancers (conditions requiring thinness)
• 60% incidence of depression

Question 2

AN- symptoms

Answer 2

• exhibit behaviors targeted at maintaining a low weight or certain body image
  
  • excess water intake
  • food-related obsessions (hoarding, collecting)
• restrictive type- reduced calorie intake, dieting, fasting, excessive exercise, diet pills
• purging type- primarily engages in self-induced vomiting, diuretic/laxative/enema abuse

Question 3

AN- diagnosis

Answer 3

• BMI <17.5 or body weight <85% ideal body weight
• PE:
  
  • emaciation
  • hypotension
  • bradycardia
  • skin/hair changes (lanugo)
• labs:
  
  • leukocytosis
  • leukopenia
  • anemia
  • hypokalemia
  • increased BUN (dehydration)
  • hypothyroidism

Question 4

AN- management

Answer 4

• medical stabilization:
  
  • hospitalization:
    
    • <75% expected body weight
    • medical complications
    • electrolyte imbalances- may lead to cardiac abnormalities
• psychotherapy:
  
  • CBT
  • supervised meals
  • weight monitoring
• medication:
  
  • if depressed
    
    • SSRIs
    • atypical antipsychotics (+/ also help weight gain)

Question 5

Bulimia nervosa (BN)

Answer 5

• normal weight or +/ overweight (major difference from AN)
• concerned about body image
• MC in females
• onset= late teens

Question 6

BN- symptoms

Answer 6

• binge eating- recurrent episodes of eating within 2 hour period more than people would in a similar period with lack of control
  
  • at least weekly for 3 months
  • may be triggered by stress/mood changes
• compensatory behavior:
  
  • purging type- primarily self-induced vomiting, diuretic/laxative/enema abuse
  • non-purging type- reduced calorie intake, dieting, fasting, excessive exercise, diet pills

Question 7

BN- findings

Answer 7

• from vomiting:
  
  • teeth pitting or enamel erosion
  • Russell’s sign- calluses on dorsal of hand from induced vomiting
  • parotid gland hypertrophy
  • metabolic alkalosis
• labs:
  
  • +/ hypokalemia
  • +/ hypomagnesemia

Question 8

BN- management

Answer 8

• psychotherapy: CBT
• medication: fluoxetine has been shown to reduce binge-purge cycle
  
  • may have CV SE, especially if electrolyte abnormalities present