Feeding or Eating Disorders

Question 1

What is anorexia nervosa?

Answer 1

patient who refuses to eat due to fear of being overweight

• intense fear of becoming fat, even though underweight, frequent weight checks and denial of emaciated state
• weight <85% of ideal body weight
• anorexia nervosa can be distinguished from bulimia nervosa by body mass index <17 or bodyweight <85% of ideal body weight
• the highest suicide rate of eating disorders

Question 2

What are the two types of anorexia nervosa?

Answer 2

Binging/purging 
-laxatives/diuretics abuse 
-excessive exercise 
Restricting 
-eat very little 
-exercise to excess

Question 3

What is the tx of anorexia nervosa?

Answer 3

• restore nutritional state
• hospitalization - if weight is <75% expected body weight
• psychotherapy - behavioral therapy
• pharmacologic - SSRIs
• have added benefit of causing weight gain
• have not been proven to be effective in anorexia nervosa
• have some efficacy in bulimia nervosa

Question 4

What is bulimia nervosa?

Answer 4

patient who has episodes of mass eating followed by self-induced vomiting or intense exercise

• frequent binge eating with or without purging
• purging commonly performed by self-induced vomiting resulting in - metabolic alkalosis, urinary chloride < 20 mEq, and volume depletion
• may abuse laxatives/diuretics
• may exercise excessively
• patients are disturbed by their behavior
• binging and compensatory behaviors occur at least once a week for 3 months
• on the exam look for these classic physical findings: scar on knuckles, swollen parotid glands + dental erosions + normal weight + hypokalemia

Question 5

What is the tx for bulimia nervosa?

Answer 5

• first, you must restore the nutritional state
• fluoxetine 60 mg PO once/day is recommended (this does is higher than that typically used for depression)
• SSRIs used alone often reduce the frequency of binge eating and vomiting
• second-line medications: TCAs and MAOIs
• behavioral/family/group therapy