🤯Psychiatry🤯 - Eating disorders

Question 1

What is the 5:2 diet?

Answer 1

Intermittent caloric restriction method
5 days of normal eating, 2 days of calorie restriction (500-600kcal)

Question 2

What is the difference between binge eating and bulimia?

Answer 2

Bing eating is where you consume an excessive amount of food - no compensation - most common eating disorder especially in higher weight individuals
Bulimia is consuming an excessive amount of food - followed by compensation (e.g. purging/excessive caloric restriction)

Question 3

Why are men statistically less likely to be advised to lose weight?

Answer 3

Doesn’t experience same levels of distress or shame/guilt
Less internalised stigma

Question 4

What is the definition of an eating disorder?

Answer 4

A persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning
Driven by “fear of fatness” or extreme distress about eating

Question 5

What categories can disturbances of eating behaviour be found in?

Answer 5

Binge eating
Restricted eating
-Quantity
-Range

Question 6

What are some common weight controlling behaviours?

Answer 6

Restricted eating (fasting)
Self induced vomiting
Excessive exercise - element of compulsion, distressed when unable to
Laxative, diuretic and other energy burning or appetite suppressing medications (e.g. caffeine, smoking)

Question 7

What physical health impairments can result from out of control eating disorders?

Answer 7

Impacts growth and development
Stop periods
Effects on the brain
Results in osteoporosis
High mortality

Question 8

What psychosocial consequences can out of control eating disorders result in?

Answer 8

Functional impairment
-Impacts work
-Relationships (family, peers, intimate)
-Daily living
Distress

Question 9

List the main eating disorders

Answer 9

Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Other Specified Feeding and Eating Disorders (OSFED)
Avoidant/Restrictive Food Intake Disorder (ARFID)
Rumination Disorder/Syndrome
Pica

Question 10

What is the most common eating disorder?

Answer 10

Anorexia nervosa
Always top differential if showing signs of malnutrition

Question 11

What is pica?

Answer 11

Eating non-nutritious substances

Question 12

Which 2 eating disorders are generally not seen in routine clinical practice?

Answer 12

Rumination disorder/syndrome
Pica

Question 13

What is anorexia nervosa?

Answer 13

Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health
Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain
Often body dysmorphia
Restricting – exercising is main weight management strategy

Question 14

What is bulimia nervosa?

Answer 14

Over eating episodes:
Large amount of food in discrete time period - sense of lack of control
Inappropriate compensatory mechanisms
Body image disturbance
Occur at least 1x week for 4 weeks or more

Question 15

What is binge eating disorder?

Answer 15

Episodes of over eating at least once a week for 4 weeks or more
No or minimal compensation
Hence, frequently overweight

Question 16

Briefly outline anorexia, bulimia and binge eating in terms of the key characteristics

Answer 16

Question 17

What is purging disorder?

Answer 17

Defined by recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications including insulin) in the absence of binge eating.
Weight is in the normal range

Question 18

What is ARFID?

Answer 18

Replaces and extends Feeding Disorders of Infancy and Early Childhood (FdoIEC)
Feeding/Eating disturbance:
-significant weight loss
-significant nutritional deficiency
-dependence on enteral -feeding/nutritional supplements
-marked interference with psychosocial functioning
No weight/shape concerns

Question 18

What are the subtypes of ARFID?

Answer 18

Three main subtypes and a mixed group:
Individuals who do not eat enough/show little interest in feeding (25.1%)
Individuals who only accept a limited diet in relation to sensory features (29.5%)
Individuals whose food refusal is related to aversive experience (7.2%)
Combined subtype (38.2%)

Question 19

Give a more brief definition of ARFID

Answer 19

Umbrella term to describe eating behaviours that weren’t driven by weight and shape concerns
Has to be clinically significant

Question 20

What are the key epidemiological points for eating disorders?

Answer 20

ED are relatively common in childhood and adolescence
-around 40% of adolescent girls show ED behaviours by age 16, 11% diagnosable
Incidence of AN and BN are stable – around 1-2% of adolescents
Incidence of OSFED & BED may be increasing – lifetime prev. around 2.3%
AN is still most common disorder in ED clinics

Question 21

What acts as the strongest predictor of EDs?

Answer 21

EDs run in families

Question 22

What are the psychosocial risk factors for EDs?

Answer 22

Psychological:
Temperament/personality
Neurocognition
Self-esteem
Psychopathology
Behaviour
Sociocultural:
Family
School/peers
Wider social influences
General:
Life events
Trauma
Life events/trauma - a risk factor for any mental disorder

Question 23

What personality traits have a correlation with ED development?

Answer 23

Perfectionism (especially fasting and purging)
High self esteem - protective for AN; low self esteem - risk factor for bulimic and compulsive eating

Question 24

Which psychological conditions can increase the risk of an ED?

Answer 24

anxiety disorders (i.e. OCD) - increased risk of AN
externalising disorders (i.e. ADHD), history of depression - increased risk of BN,

Question 25

Which trauma/life events leave people more susceptible to certain EDs?

Answer 25

Sexual abuse (binge-purge type disorders)
Life events (non-specific)

Question 26

What sociocultural factors put someone at risk of developing an ED?

Answer 26

Some evidence of increase in developing countries of incidence/prevalence (mass media exposure)
Bullying, teasing by peers, social pressure to be thin
Exposure to social network media