OnlineMedEd: Psychiatry - Eating Disorders

Question 1

Restriction is more characteristic of anorexia. What two forms does it often take?

Answer 1

• Decreasing caloric intake

* Increasing caloric expenditure

Question 2

Purging is a feature of bulimia. What two ways do people typically purge?

Answer 2

• Emesis

* Diarrhea

Question 3

List three physical exam signs and two laboratory values often seen in a person with bulimia who vomits.

Answer 3

PE:
•Dental caries
•Parotid gland swelling
•Dorsal hand scars (from self-induced emesis)

Lab values:
•Hypokalemia (from the loss of potassium with vomit)
• Metabolic alkalosis (the alkaline tide)

Question 4

Compare and contrast anorexia and bulimia in terms of these categories: 
•Body weight
•Body image
•Anxiety
•Method
•Signs and symptoms
•Hospitalization
•Treatment
•Follow-up

Answer 4

Anorexia:
•Body weight: underweight (BMI less than 18.5)
•Body image: woefully bad; they think they’re fat even when they’re underweight)
•Anxiety: toward being or becoming fat
•Method: restriction
•Signs and symptoms: malnutrition (like “hypothyroid but thin”): lanugo, cold intolerance, emaciated, and amenorrhea
•Hospitalization: for any signs of extreme malnutrition (BMI less than 16; electrolyte abnormalities, tachycardia, hypotension)
•Treatment and follow-up: restore electrolytes to normal values; treat outpatient with antipsychotics and CBT

Bulimia: 
•Body weight: normal
•Body image: normal
•Anxiety: the anxiety is due to purging on food
•Method: binge-purge
•Signs and symptoms: normal patient
•Hospitalization: usually not needed 
• Treatment and follow-up: SSRIs/SNRIs and CBT

Question 5

How is binge-eating disorder distinct from bulimia?

Answer 5

In binge-eating disorder, there is no purge.