Lecture 6 - Eating and Feeding Disorders Flashcards
What are the most lethal of psychiatric conditions?
Eating Disorders (20% mortality rate)
Eating disorders are a maladaptive coping mechanism to exercise….
Control.
What is the difference between an eating and a feeding disorder?
Eating
–> Socially acceptable coping mechanism gone wrong
Feeding
–> More of a direct result of food preferences and perceived intolerances
What is the formula for BMI?
Kg/ M^2
Is BMI an accurate reading of a person’s nutritional status?
No - it does not consider fitness level, muscle mass, body fat, or dietary habits.
BMI itself means nothing and must be considered as a measure to help understand the whole picture.
Factors that contribute to the development of an eating disorder include…
Genetics, family, stressors and coping style, personality, and social and cultural factors.
What is anorexia nervosa? How is severity determined?
Restriction of energy intake and intense fear of gaining weight. Accompanied by a disturbance in body image perception.
Severity of AN is based on BMI
What are the subtypes of anorexia nervosa?
Restrictive (AN-R)
–> In last three months, individual has not engaged in episodes of binge eating or purging
Bing-eating/Purging (AN-P)
–> In the last three months, in the individual has engaged in recurrent episodes of binge eating or purging.
What is lanugo?
soft, fine hair that an indicate poor nutritional status. Seen in AN and BN.
What does the nurse need to assess when suspecting AN?
Physical: Lytes, weight, integ + hair, pulse + BP + temp
Lifestyle: Hx of eating habits and dieting. Methods used to achieve ideal weight and value attached to weight.
MSE: Focus on mood, cognition, insight, anxiety, suicidal ideation.
What are the goals during the acute care phase of AN?
Immediate medical stabilization if electrolyte imbalance or below 85% ideal body weight.
–> Inpatient management when nutrition is initiated d/t refeeding syndrome
–> Develop therapeutic relationship and monitor client for suicidal ideation
What pharmacological treatment can be helpful for AN?
SSRIS to help reduce obsessive-compulsive behaviour
–> May not be effective until patient reaches 90% of goal weight
Antipsychotics
–> Chlorpromazine for delusion or psychomotor agitation
–> Olanzapine for mood & obsessive behaviours
What nutritional therapy might be needed for someone with AN?
Increased caloric, protein, and fat intake
–> NG tube and supplements might be necessary.
What psychotherapy might be helpful to someone with AN?
Motivational Interviewing - normalize eating habit
CBT - resolve cognitive distortions like overgeneralizing, all-or-nothing thinking
Family therapy - families might feel powerless
What psychosocial interventions could help someone with AN?
Weight-restoration program for incremental weight gain + Milieu therapy for structures mealtimes, weigh-ins, monitoring.
Distraction, diversional activities, and therapeutic alliances can also help.
What is refeeding syndrome? What are some risk factors for it? How long does it last?
Rapid refeeding following long periods of fasting switches body from catabolic to anabolic states and can cause serious electrolyte imbalances.
–> Usually presents in first 4 days, but can be present for up to two weeks.
Risk factors: Chronic malnutrition, anorexia nervosa, prolonged fasting.
What are some S/S of refeeding syndrome?
Resp depression, arrythmias, confusion, seizure, coma, death.
High BP
Hypo phosphatemia, K, Mg
How can we prevent refeeding syndome?
Gradual refeeding and electrolyte monitoring
–> Multidisciplinary approach
What is bulimia nervosa?
Characterized by recurrent episodes of binge eating and inappropriate compensatory mechanisms to prevent weight gain
What is considered mild, moderate, and severe AN?
BMI used
Mild: >17
Moderate: 16-16.99
Severe: 15-15.99
Extreme <15
What is considered mild, moderate, severe, and extreme bulimia nervosa?
Based on number of inappropriate compensatory behaviour per week.
Mild: 1-3 episodes
Moderate: 4-7 episodes
Severe: 8-13
Extreme: >14
What is considered a binge?
Eating in a discrete amount of time (2 hours) an amount that is definitely larger than most would during a similar period of time and under similar circumstances.
What might be seen in a physical assessment of BN?
Dental erosion + cavities, esophageal tears, abd pain, callus on knuckles.
Dehydration + electrolyte imbalance
What psychological findings would be present for someone with BN?
Hx of AN, signs of depression and anxiety, poor self esteem
Difficulties with social relationships, substance use, presence of impulsive behaviours.
What treatment can be helpful to people with BN?
Interruption of binge eating and monitoring after mealtimes.
CBT + antidepressants.
What is binge eating disorder?
Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances for at least once a week over 3 months.
–> Episodes marked by feelings of loss of control.
How is severity of BED determined?
By frequency of binging episodes per week.
Mild: 1-3
Mod: 4-7
Severe: 8-13
Extreme 14 or more
What is the difference between overeating and binge-eating?
Overeating: Consuming more food than your body needs at a given time, most people overeat on occasion
Bing-Eating: Marked by psychological distress and must include 3 of the following:
- Eating very quickly
- Regardless of hunger
- Eating until uncomfortably full
- Eating alone d/t embarrassment
- Feelings of self-disgust, guilt, or depression
What is Avoidant/Restrictive Food Intake Disorder and who does it affect most?
Restrictive or inadequate eating not attributed to comorbidity or disturbances in perception of shape and weight.
–> More common in children, can occur in adults
What are the three common clinical presentations of ARFID?
Lack of Interest in Food
–> Of blunted response to physiological hunger
Avoidance d/t Sensory Dislike
–> Only eats narrow range of foods
As a Reaction to Upsetting Event
–> Like choking
What are the manifestations of ARFID?
Significant weight loss or lack of appropriate weight gain
Significant nutritional deficiency + dependence on supplements
Marked interference with psychosocial and or physical functioning
What is PICA?
Persistent eating of nonnutritive substances for at least one month where the behaviour is inappropriate for developmental level and not part of a culturally sanctioned practice.
–> Can be diagnosed with another disorder or condition if it is severe enough
What is rumination disorder? What is it associated with?
Repeat regurgitation of food for at least 1 month, does not occur exclusively in the course of another diagnosed ED.
–> Associated with intellectual development disorder and childhood neglect.
What is anorexia athletica? What are the symptoms?
A profound preoccupation with exercise
S/S:
–> Compulsive need to exercise and prioritizing exercise over other life events
—> Equating self worth to physical performance
–> Rarely satisfied with one’s physical achievements
What is Nocturnal Sleep-Related Eating Disorder?
Problematic eating behaviours that occur in the period between sleep and wakefulness
What is Orthorexia?
A problematic preoccupation wit health and relying on natural products.
–> Finds more pleasure in eating clean than actually enjoying food
–> Emotional satisfaction when sticking to goals and intense despair when they fail
Can be a gateway to AN
What is ego-syntonic?
Ideas and behaviours that are acceptable with one’s values and way of thinking.
–> This can lead to a reluctance to change in maladaptive behaviours such as EDs.
What is the purpose of meal support?
To create a safe environment for patients to consume their meal (fine line between policing vs support)
What are some strategies for effective meal support?
Create a safe space, structure meal plans, and incorporate mindful eating practices.
In which ED is self worth largely influenced by body image and external validation?
Bulimia Nervosa
What are some risk factors for eating disorder development?
Consider factors like sex, age, lifestyle, and previous life experiences.
–> Female, younger age
–> Sexual and physical abuse
–> Participation in easthetic or weight oriented sports
–> Heritability
When do most eating disorders develop?
Early teens to mid-twenties - commonly following puberty.
Bulimia generally occurs later in adolescence with prevalence peaking in young adulthood.
What other disorders tend to present comorbidly with EDs?
Depression, anxiety, OCD.
Cluster C disorders: avoidant, dependent, OC, passive-aggressive.
What is the estimated heritability of AN?
60% (quite high)
Why so SSRIs not work until the individual has reaches 90% optimal weight with AN?
Malnutrition causes tryptophan (aa) deficiency. Tryptophan is necessary for serotonin synthesis.
–> Drops is dietary intake can relieve symptoms of anxiety and dysphoria and reward caloric restriction –> feedback loop.
What kinds of cognitive distortions are common in eating disorders?
Overgeneralizations
All-or-Nothing Thinking
Catastrophizing
Personalization
Emotional Reasoning
What evidence informed approaches are used for treatment of AN, BN, and BED?
AN: none (family therapy appears promising in adolscents)
BN: CBT, antidepressants (fluoxetine), interpersonla therapy
BED: CBT, interpersonal therapy, antidepressants, lisdexamfetamine dimesylate to reduce binge eating and weight gain
