Lecture 60: Eating Disorders Flashcards
What are the diagnostic criteria for anorexia nervosa?
- Restriction of food intake relative leading to maintenance of body weight LESS THAN 85% of expected
-failure to make weight gain during period of growth leading to body weight of LESS THAN 85% of that expected - Intense fear of gaining weight or becoming fat, even though underweight, or persistent behavior to avoid weight gain.
- Disturbance in the way in which one’s body weight or shape is experienced
-undue influence of body weight or shape on self-evaluation
-LACK of recognition of seriousness of current low body weight - Absence of 3 menstrual cycles
Bad criteria because happens in men, in women prior to menstrual cycle, and birth control
-not going to be there for DSM 5
What are the eating and feeding disorders?
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
Feeding Disorders: - Avoidant/Restrictive food intake disorder (ARFID)
- PICA
- Rumination
- Feeding or Eating Disorders Not elsewhere classified (FED-NEC)
-Purging disorder
-Night Eating syndrome
-atypical anorexia
-subthreshold AN or BN
What is the etiology of anorexia?
Serotonin may play a role in anorexia
-serotonin modulates feeding, mood and impulse
-anorexia patients have less 5-HIAA in CSF
-however cannot be treated with SSRI
Parents are NOT part of etiology
What are the comorbidities with anorexia?
- Ammonorrhea (100%)
- dry skin
- Bradycardia
- Hypotension
- Hypothermia
- paradoxical excess energy
- Co-morbid depression
6-10% MORTALITY
-from CV and suicide
What are the psychological treatment for anorexia?
- Intensive PSYCHOTHERAPY to address
- weight phobia
- maturational conflict
- family function
- Family based therapy for younger patients “Maudsley Family Therapy”
- Individual therapy for adults (CBT)
What is the most effective psychological treatment for anorexia?
The “Maudsley” Family therapy for adolescents
-puts PARENTS in charge of the refeeding process
-in contrast to traditional parentectomy
-psycheducation for parents, support
-then focuses on general issues of adolsecence
AND
CBT for adults
What are the psychiatric medications for anorexia?
Nothing is effective
-antipsychotics could be useful but still needs more control data
What are the diagnostic criteria of Bulimia Nervosa?
- Recurrent episodes of BINGE EATING
i. eating in a discrete period of time
ii. Sense of lack of control - Recurrent, inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting
- Binge/compensation both occur, an average of once per week for 3 months
- Self evaluation unduly influenced by weight and shape
- but more cognizant of own disorder
- Does not occur during an episode of anorexia
What is different between anorexia and bulimia?
Weight
-people who are anorexic have less than 85% of their body weights!
Bulimic patients have normal weight
What are the neurological deficits associated with bulimia nervosa?
Bulimia patients have LESS self regulation
Fail to activate frontostriatal circuits in the left inferolateral prefrontal cortex, bilateral inferior frontal gyrus, and anterior cingulate cortex
What is the significance of vomiting?
Vomiting provides method of reducing anxiety in response to overeating
- negatively reinforced to increase frequency of vomiting
- patients CANNOT handle stress well
What is the etiology of bulimia?
Less serotonin leads to loss of feeding regulation
What are the co-morbidities of bulimia?
- HYPOkalemia and erosion of dental enamel, both resulting from vomiting
-so dentists spot this first - Electrolyte imbalance can be associated with weakness, lethargy
-rarely cardiac arrhythmias or death - Parotid gland enlargement with elevated amylast levels
Chipmunk cheeks - Depression
What is the therapy of choice for bulimia?
CBT remains treatment of choice
-superior at end of treatment
-superior at follow-up
Interpersonal psychotherapy (IPT) also used
What meds can be given to bulimic patient?
SSRIs (anti-depressant medications)
i. desipramine ii. fluoxetine - used after behavior therapy
Why do we want to use antidepressants for bulimia?
Comorbidity for depression
Serotonin leads to satiety
What are the diagnostic criteria for Binge Eating Disorder?
- Recurrent Episode episode of binge eating
- Bing eating episodes associated with over 3 of following
- eating more rapidly than norma
- eating until feeling uncomfortably full
- eating large amounts when not hungry
- eating alone because of embarrassment
- feeling disgusted with oneself, depressed, guilty
- Marked distress
- Occurs over 1 per week for 3 months
- Anorexia and bulimia trump BED
What is the lifetime prevalence of BED? Who’s at risk?
3.5% in women 9-30% in obesity clinics? Up to 25% in type 2 diabetics Up to 47% in bariatric surgery candidates -Seen in fat people
What is the etiology of BED?
Food addiction
Patients with BED have more dopamine release in response to food cues
-similar to what a cue would do for a cocaine abuser
What are the psychological treatments used for BED? Significance?
- CBT
- Behavioral Weight control (BWC)
BWC is seen as BETTER because while both are efficacious in overcoming psychological challenges, BWC actually makes CBT lose weight
What are the downsides of CBT in BED treatment?
Patients don’t lose weight
What are the benefits of BWC?
1200-1500 kcal/d diet
Exercise for 1000 kcal/wk
Allows patients to lose weight
What medications can be used for BED?
Most antidepressants have been shown to work well
Example: Sertraline and Fluoxetine
What is FED-NEC?
Feeding and eating disorders not elsewhere classified
What’s difference between bulimia and PD?
There is no binge eating in purging disorder
What is Night Eating Disorder (NED)?
A. 25% of daily food intake is consumed after evening meal or
Or at least 2 eating episodes per week upon awakening at night
B. Awareness and recall of evening and nocturnal eating episodes
C. Lack of desire to eat in the morning (no breakfast)
-belief that one must eat in order to sleep
-mood worsens in evening
D. Associated with distress and impairment of function
E. Occurs for 3 months and is not secondary to anything else
What is atypical anorexia nervosa?
All criteria are met EXCEPT for significantly low weight criteria
An obese person being anorexic but still failing to meet weight requirement of 85%
What is subthreshold bulimia?
All criteria for bulimia are met except binge purge episodes occur less than once a week
