Session 06 - Eating Disorders

Question 1

What is an eating disorder?

Answer 1

A group of conditions characterised by a disorganised pattern of food consumption, which causes emotional and physical distress.

Question 2

What are the most common eating disorders?

Answer 2

• anorexia nervosa
• bulimia nervosa

Question 3

What are the biological causes of eating disorders?

Answer 3

Genetics: twin studies have shown eating disorders share a large genetic component.

5-HT: altered brain serotonin contributes to disregulation of appetite, mood and impulsivity.

Question 4

What are the psychological causes of eating disorders?

Answer 4

Personality: higher association with anxious, obsessive-compulsive and depressive traits.

Self-esteem: higher incidence in people with low self-esteem and altered body image.

Question 5

What are the social causes of eating disorders?

Answer 5

Childhood: sexual and emotional abuse, overprotective environment, troubled family.

Media: excessive exposure to media adverts and models encouraging excessive dieting.

Question 6

What are the metabolic symptoms of eating disorders?

Answer 6

Low T3: bradycardia, hypotension and hypothermia.

Hypercholesterolaemia and poor glucose tolerance.

Raised cortisol and growth hormone.

Hypokalaemia.

Low FSH, LH, oestrogen and testosterone.

Question 7

What are the tissue symptoms of eating disorders?

Answer 7

Bone: osteoporosis.

Muscle: breakdown and weakness.

Enlarged salivary glands.

Lanugo hair: soft, unpigmented furry hair.

Russel’s sign: hand callouses (self-vomiting).

Question 8

What is anorexia nervosa?

Answer 8

A disorder characterised by restrictive eating, which is due to a morbid fear of fatness.

Patients lose weight either by dieting, purging (vomiting), laxative/diuretic abuse.

Question 9

Diagnosis of anorexia nervosa.

Answer 9

3 key features:
- low body weight (<85%)
- distorted body image
- morbid fear of fatness

Other symptoms:
- amenorrhoea
- loss of libido

Question 10

Indications of NG feeding in anorexia nervosa.

Answer 10

Acute NG feeding tube if:
- BMI <13
- bradycardic
- K+ <3mmol/L
- clearly dehydrated

Question 11

Chronic management of anorexia nervosa.

Answer 11

Referral for specialist care:

Adults - first line is eating disorder focussed CBT or specialist supportive clinical management (SSCM).

Children - first line is anorexia focused family therapy; second line is CBT.

Question 12

Prognosis of anorexia nervosa.

Answer 12

40% recover.

10% mortality.

Question 13

What is bulimia nervosa?

Answer 13

A disorder characterised by episodes of binge eating followed by intentional purgative behaviours in order to lose weight.

This can include intentional vomiting, excessive exercise and laxative / diuretic abuse.

Question 14

Diagnosis of bulimia nervosa.

Answer 14

5 key features:
- preoccupation with body shape and weight
- recurrent binge eating
- inappropriate compensatory behaviours to stop weight gain
- occur once weekly for at least 3 months
- episodes not occurring during episode of anorexia nervosa

Note weight is typically normal.

Question 15

Acute management of bulimia nervosa.

Answer 15

NG feeding tube if:
- BMI <13
- bradycardic
- K+ <3mmol/L
- clearly dehydrated

Question 16

Chronic management of bulimia nervosa.

Answer 16

Adults: first line is eating-disorder focussed CBT (CBT-ED) or interpersonal therapy (IPT).

Children: first line is bulimia-focussed family therapy; second line is CBT.

Fluoxetine is licensed in bulimia only; not anorexia.

Question 17

Prognosis of bulimia.

Answer 17

With CBT, 40% of patients achieve remission.

Mortality lower than anorexia.

Question 18

What is binge eating disorder?

Answer 18

An eating disorder characterised by recurrent episodes of binge-eating without the purging behaviours.

Question 19

Symptoms of binge-eating disorder.

Answer 19

Characterised by binge eating behaviour - eating much more than normal and with a clear loss of control.

Binge eating still gives emotional distress and anxiety, typically co-occurring with obesity (BMI >30).

Question 20

Management of binge-eating disorder.

Answer 20

First line: self guided help.

Second line: group CBT.

Third line: Individual CBT.

Question 21

What is the cognitive model of abnormality?

Answer 21

Cognitive approach assumes that behaviours are controlled by thoughts and beliefs - irrational thoughts and beliefs cause abnormal behaviours.

Question 22

What is Ellis’s ABC model.

Answer 22

A. Activating event (e.g. failed an exam).

B. Belief about why this happened - they can be rational (e.g. I didn’t prepare well enough) or irrational (e.g. I’m too stupid).

C. Consequence can either be adaptive (e.g. more revision) or maladaptive (e.g. depression).

Question 23

What is the basis of cognitive behavioural therapy (CBT)?

Answer 23

Aims to identify and change the patient’s faulty cognitions.

The idea is that patients learn how to notice negative thoughts when they have them, and test how accurate they are.

Question 24

What happens during CBT?

Answer 24

1) Therapist and client identify the faulty cognitions.

2) The therapist helps the client to see that these cognitions aren’t true.

3) Goals are set to think in more positive or adaptive ways.

4) Treatment focuses on the present situation.

5) Clients can keep a diary to record their thought patterns, feelings and actions.

Question 25

What are the advantages of CBT?

Answer 25

• empowers the patient
• equally as effective as medication
• less likely to relapse versus drug treatment

Question 26

What are the disadvantages of CBT?

Answer 26

• take time
• costly
• may only be effective if the therapist is experienced
• person could begin to feel like he or she is to blame