Hovland-Feeding, Eating and Elimination Disorders

Question 1

What is diathesis?

Answer 1

Presdisposition toward disorder

Question 2

What is stress?

Answer 2

The response of an individual to perceived demands that tax or exceed coping abilities

Question 3

What are protective factors?

Answer 3

Influences that modify responses to environmental stressors?

Question 4

What is resilience?

Answer 4

The ability to adapt successfully to difficult stressors w/out becoming seriously ill

Question 5

What is Pica?

Answer 5

• Eating non-nutritious and non-food substances for more than one month.
• Eating is inappropriate developmentally

Question 6

How do you treat Pica?

Answer 6

• Remove the stimulus
• arm splints/face
• reinforce positive behaviors
• correct deficiencies in nutrition

Question 7

What is rumination?

Answer 7

Regurgitating food that is either spit out, chewed or swallowed again.
Must occur for period of at least 1 month.
Occurs in absence of a clinical reason.

Most commonly seen in infants, children or adults under stress or experiencing anxiety.

Question 8

How do you assess rumination?

Answer 8

• rule out other causes for rumination
• check for malnutrition
• note whether behavior is self soothing/ self-stimulating
• assess parent child relationship for signs of attachment

Question 9

How do you treat rumination?

Answer 9

Behavior techniques- aversion training, distraction and diversion
Improve environment
Model good interactions

Question 10

What is avoidant/restrictive food intake disorder?

Answer 10

Avoidance of food or failure to eat an appropriate quantity of food.

children: may look like growth retardation or FTT
adults: significant weight loss, malnutrition, deteriorating psychological funcitoning

Question 11

What two questions do primary care physicians find to be 100% sensitive and 90% specific in identifying specific in identifying patients with bulimia?

Answer 11

Are you satisfied with your eating patterns?

do you ever eat in secret?

Question 12

What is the diagnostic criteria for anorexia nervoasa

Answer 12

• Restriction of energy intake related to requirements leading to low body weight
• intense fear of gaining weight or becoming fat, behavior that interferes with weight gain

Question 13

What is the prevalence and onset of anorexia nervosa?

Answer 13

Female > Male 10:1

Early adolescence/adulthood (17)

Question 14

What are the risk factors for anorexia?

Answer 14

• anxiety disorders, obsessional traits
• cultural values of thinness
• 1st degree relative w/ anorexia
• post industrialized/high income countries

Question 15

What is the prognosis for anorexia?

Answer 15

Death often occurs from too rapid weight gain rather than from starvation. Sudden increase in weight can lead to cardiac failure/hypokalemia.

*AN is more serious though less common than bulimia

Question 16

What is the neurochemistry of Anorexia?

Answer 16

REduction in brain serotonergic activity which is usually part of the normal regulation of satiety.

Question 17

How do you manage anorexia?

Answer 17

Assess suicide risk
Evaluate medical status-cardiac indicators
Correct electrolyte and vitamin deficiencies slowly

Question 18

How do you treat anorexia with psychopharmacology?

Answer 18

Antidepressants-TCA and MAO don’t usually help unless depression is also evident, some may also worsen anorexia because they’re appetite suppressants
Anxiolytics-for fear of eating

Question 19

What percentage of pts w/ anorexia also have bulimia?

Answer 19

40-50%

Those w/ both disorders often have older onset and worse prognosis.

Question 20

What is the diagnostic criteria for bulimia?

Answer 20

1. Recurrent episodes of binge eating.
   - eating an amt of food that is larger than most people would eat during a similar period/lack of control over eating
2. Compensatory behavior to lose weight
3. Bing eating at least once a week for three months

Question 21

What is the prevalence of bulimia and what is the common age of onset?

Answer 21

Female > male 81

Often seen in early adolescence

Question 22

What percent of bulimics are single white college women?

Answer 22

50%

Most wait 4-5 yrs before seeking tx

Question 23

What are comorbidities associated with bulimia for women?

Answer 23

• greater incidence of childhood physical abuse
• alcoholism and kleptomania
• panic disorder, depression, GAD
• weight normal to slightly below normal

Question 24

What are comorbidities associated with bulimia in men?

Answer 24

• higher incidence substance abuse
• family hx of affective disorders
• more common in gay/bisexual men

Question 25

What is the best way to manage bulimia pharmacologically?

Answer 25

Antidepressants:

• TCA- imipramine and desipramine
• MAO inhibitors- phenelzine
• Fluoxetine- helpful but it is also an appetite supressant

Question 26

What is the prognosis for bulimia?

Answer 26

When viewed from a 5 year perspecitve bulimia is an episodic illness characterized by frequent relapses and remissions (uncommon after age 40)