Henren- Eating disorders Flashcards
What are the 4 major eating disorders?
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
- Avoidant/restrictive food intake disorder (ARFID)
Which is the most dangerous eating disorder in which 9% of those affected die?
Anorexia Nervosa
What are 5 things that can influence an eating disorder, the main theme being shape desireability?
– Preferred body shape
– New “freedoms”
– Media
– Culture
– High risk populations and settings
What are 5 major psychological factors associated with eating disorders?
– Difficulty identifying feelings
– External locus of control
– Low self-esteem
– Maturation fears
– Psychodynamics = changes in our body overtime, the conscious and unconscious struggle that determine motivation and personality
When are 2 different ages where eating disorders peak?
Beginning of adolescence (puberty, secondary sex characteristics)
Later adolescence (18+, moving out)
What are 3 psychosocial issuses that explain etiology of eating disorders?
- Assumptions and distortions
- Family influence and conflict
- Premorbid perfectionism and negative selfevaluation
• There is some evidence for a basis (GWAS, twin studies)
genetic
What is the fMRI evidence as related to after and eating disorder has started?
abnormal function in corticolimbic circuits involved in appetite (anterior insula)
fMRI evidence of abnormal function in circuits involved in appetite (anterior insula)
corticolimbic
Some/multiple neurotransmitter systems implicated after an eating disorder develops
multiple
Eating disorder influences of nutrition, metabolism, and vulnerability can be associated with the following factors:
– Set Point
– hypothalamus
– Fat cells
– deficiency
– Leptin and and CNS
– Lack of exercise
VMN
Dopamine
ghrelin
What is our bodie’s set point?
Our bodies have a preset weight baseline hardwired into our DNA
Can lack of exercise effect our set point?
yes
Below are the criteria for Anorexia Nervosa
–Refusal to maintain body weight – generally defined as BMI < for adults
– Intense of weight or fat
– body image
– Amenorrhea
– Restricting and Binge/Purging Types
18.5
fear
Distorted
The severity of Anorexia Nervosa is classified by what standard?
weight
What is the lifetime prevalence of Anorexia Nervosa?
0.6%
Onset of AN typically occurs during what age?
late adolescence
AN more common in men/women
women
AN is highly comorbid with depression, panic, , and other anxiety disorders
OCD
Please review the list of physical exam findings and symptoms of anorexia nervosa:
What is xerosis and what eating disorder is it associated with?
dry, rough skin
associated with Anorexia Nervosa
What can happen to the CNS of someone with Anorexia Nervosa?
What is the first thing to tackle for treatment of Anorexia Nervosa?
weight restoration, reestablish normal eating
What multidisciplinary team members should be involved in treatment of Anorexia Nervosa?
- Medical
- Psychological
- Nutritional
What is the preferred therapy for Anorexia Nervosa?
family therapy
(some evidence for CBT)
What are the 5 things included for treatment of AN?
• Hospitalization
• Multidisciplinary Team
- Medical - Psychological - Nutritional
• #1 Weight restoration, reestablish normal eating
• ID Precipitants- what causes one to eat or throw up
• Psychotherapy (family therapy, some evidence for CBT)
• Minimal evidence for medications
Are medications indicated for the treatment of anorexia nervosa?
minimal evidence for medications
(olanzapine can help with weight gain)
As concerning AN, Patients often have or superficial insight into the severity of their illness
poor
As concerning AN:
Toxic online cultures may perpetuate ideas about the disease
There may be pathways for involuntary treatment in some jurisdictions and situations
– restoration is key, and this may sometimes necessitate placement of an NG tube
unrealistic
Weight
As concerning AN:
- Patients with severe anorexia nervosa generally have some degree of impairment
- When treating patients with eating disorders, interdisciplinary is crucial
- If you have a patient who’s in recovery from an eating disorder, ask them how you can work with them to prevent and avoid interventions that may unknowingly exacerbate their illness
cognitive
collaboration
relapse
What are the 5 critieria used to diagnos Bulimia Nervosa?
– Recurrent binge eating and lack of control
– Inappropriate compensatory behaviors
– Self-evaluation and body shape
– Not Anorexia Nervosa
– Purging and Non-Purging Types
What are some of the innapropriate compensatory behaviors used in order to prevent weight gain with bulimia nervosa?
vomiting, laxatives, diuretics, fasting, excessive exercise, medications
How is the severity of bulimia nervosa measured and by what standard:
innappropriate compensatory behaviors per week
BN is more/less lethal than AN?
less
Which medications can be used to treat BN and which type of therapy?
SSRIs
CBT
Review the medical sequelae of BN:
What are some metabolic consequences of BN?
Hypokalemia
hypochloremia
metabolic acidosis
What are 4 GI issues that can occur due to BN?
Pancreatitis
GERD
consipation
Mallory-Weiss tears (tear in lower esophagus)
What esophageal tear can occur with Bulimia Nervosa?
Mallory-Weiss tears (tear of tissue of the lower esophagus)
Prognosis of AN
- 40% recover; 30% improve; % no improvement
- Overall mortality is 5-18%
- All-cause mortality in anorexia is 4-14x higher than the general population
- ~60% due causes
- ~25% due to
- Anorexia is among the most deadly of all disorders
20
cardiovascular
suicide
psychiatric
Prognosis of Bulimia Nervosa:
- Overall better than AN
- 50-90%
- % continue long term
improve
30
An episode of binge eating is characterized by which 2 characteristics?
- Eating far more than others in a discrete amount of time
- A sense of lack of control during episode
Review the other criteria for binge eating (without compensatory techniques):
How is binge eating (without compensatory techniques) specified by severity?
of binge eating episodes per week
What is the most common eating disorder?
Binge eating (without compensatory behaviors)
What % of patients who seek medical care for obesity have a binge eating disorder?
25%
Binge eating is more common in men/women?
women
What is the medication of choice for binge eating and what is the best type of therapy?
SSRIs
CBT
What is ARFID?
avoidant/restrictive food intake disorder (ARFID)
ARFID is an eating or feeding disturbance associated with which 4 criteria:
ARFID is/is not better explained by lack of food or cultural practices
is not
ARFID does not occur exclusively with which 2 eating disorders?
anorexia nervosa
bulimia nervosa
In ARFID, there is/ is no disturbance in the way in which one’s body weight or shape is experienced
is no
In ARFID, the eating disturbance is/ is not attributable to a concurrent medical condition or not better explained by another mental health disorder, or with another disorder (ASD) warrants additional clinical attention
is not
Clinically, patients of ARFID are often underweight/overweight?
underweight
What is the simple 5 question questionnaire that screens for eating disorders?
SCOFF
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Does the patient have a BMI <18.5? Differentiating between which 2 eating disorders?
Anorexia Nervosa or ARFID (avoidant/restrictive food intake disorder)
How do we differentiate between AN and ARFID if patient has BMI less than 18.5?
Does the patient also have negative body cognitions? = AN
How to distinguish between BN and Binge eating disorder if BMI over 18.5?
– Is the patient purging? —> Probably BN
Review the question and correct and incorrect answers regarding AN?
- As you gather further history, which symptoms would support the diagnosis of anorexia nervosa?
Review the question and correct and incorrect answers regarding AN?
- The most appropriate steps in the management of the patient once the diagnosis of anorexia nervosa is confirmed includes:
most importantly = restore weight
