SM_119b: Eating Disorders

Question 1

Anorexia nervosa is subdivided into the ____ and ____ types

Answer 1

Anorexia nervosa is subdivided into the restricting and binge eating / purging types

Question 2

Describe DSM-5 criteria for anorexia nervosa

Answer 2

Anorexia nervosa DSM-5 criteria

• Restriction of energy intake relative to requirements, leading to significantly low body weight (less than minimally normal/expected)
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 3

Anorexia affects ____

Answer 3

Anorexia affects the whole body

Question 4

Describe risk factors for anorexia nervosa

Answer 4

Anorexia nervosa risk factors

• Puberty
• Perfectionistic personality
• FMHx of eating disorder
• OCD
• Anxiety
• Impaired family interactions
• Stressful life event

Question 5

Describe warning signs of anorexia nervosa

Answer 5

Anorexia nervosa warning signs

• Excessive weight loss
• Odd food rituals
• Lack of menstrual cycles
• Fine hair on face, arms, or torso (lanugo)
• Wearing baggy clothing
• Vigorous exercise at odd hours
• Paleness, dizziness, fainting spells

Question 6

Workup for anorexia nervosa involves ____, ____, ____, and ____

Answer 6

Workup for anorexia nervosa involves vitals, physical exam, electrolytes, and EKG

Question 7

Clinical management of anorexia nervosa includes ____, ____, and ____

Answer 7

Clinical management of anorexia nervosa includes weight restoration, modifying distorted earing behavior, and addressing psychological / family issues through psychotherapy

Question 8

____ is the best medication for anorexia nervosa

Answer 8

Food is the best medication for anorexia nervosa

(standard meds not effective)

Question 10

Describe DSM-5 criteria for bulimia nervosa

Answer 10

Bulimia nervosa DSM-5 criteria

• Recurrent episodes of binge eating: eating a lot in a discrete period of time, sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behaviors to prevent weight gain
• Binge eating and inappropriate compensatory behaviors both occur on average at least 1x/week for 3 months
• Self-evaluation is unduly influenced by body shape and weoght
• Disturbance does not exclusively occur during episodes of anorexia nervosa

Question 11

Describe risk factors for bulimia nervosa

Answer 11

Bulimia nervosa risk factors

• Dieting
• Puberty
• Life transitions
• Various jobs (athletes, actors, models)
• Anorexia
• Impulsivity
• Anxiety

Question 12

_____ is the classic sign for bulimia nervosa

Answer 12

Russell’s sign is the classic sign for bulimia nervosa

• Calluses on the back of knuckles or back of hand due to repeated self-induced vomiting over long periods of time

Question 13

Workup for bulimia nervosa involves ____, ____, and ____

Answer 13

Workup for bulimia nervosa involves vitals, physical exam, and labs

Question 14

Describe symptoms of bulimia nervosa

Answer 14

Bulimia nervsa symptoms

Question 15

Describe warning signs for bulimia nervosa

Answer 15

Bulimia nervosa warning signs

• Fluctuating weight: 10-15 lbs
• Missing food / secretive eating
• Cuts / scrapes on back of hand from purging
• Tooth decay
• Uses bathroom after meals
• Diet pills / laxative abuse
• Self-disparagement related to food intake
• Swollen glands, puffy cheeks, broken blood vessels under the eye

Question 16

Bulimia nervosa is primarily managed ____ and ____ is the mainstay of treatment

Answer 16

Bulimia nervosa is primarily managed outpatient and psychotherapy is the mainstay of treatment

(SSRIs also approved, bupropion contraindicated)

Question 17

Describe DSM-5 criteria for binge eating disorder

Answer 17

Binge eating disorder DSM-5 criteria

• Recurrent episodes of binge eating as characterized by both of the following: eating in a discrete period of time an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, sense of laack of control over eating during the episode
• Binge eating is associated with ≥ 3 of: eating much more rapidly than normal, until feeling uncomfortably full, large amounts of food when not being physically hungry, alone because of feeling embarrassed by how much one is eating, and feeling disgusted / depressed / guilty

Question 18

Binge eating disorder is associated with ____, requires workup including ____, and is treated with ____ or ____

Answer 18

Binge eating disorder is associated with skeletal / muscular problems, requires workup including labs, and is treated with CBT or lisdexamfetamine

Question 19

____ is an eating disorder involving apparent lack of interest in eating or food, avoidance based on sensory characteristics, concern about aversiveness of food, and an inability to meet appropriate nutritional needs

Answer 19

Avoidant / restrictive food intake disorder is an eating disorder involving apparent lack of interest in eating or food, avoidance based on sensory characteristics, concern about aversiveness of food, and an inability to meet appropriate nutritional needs

Question 20

Eating disorders have typical age of onset in ____ and are more prevalent among people of ____ SES

Answer 20

Eating disorders have typical age of onset in adolescence / young adulthood and are more prevalent among people of higher SES

Question 21

Describe etiology of eating disorders

Answer 21

Eating disorders etiology

• Hypothalamus dysregulated: increased corticotropin releasing factor in CSF
• Central neurotransmitter system dysregulation affecting 5HT, dopamine, and NE (reduced NE activity)
• Genetics

Question 22

____ has the highest mortality rate of any psychiatric disorder

Answer 22

Anorexia nervosa has the highest mortality rate of any psychiatric disorder

(bulimia has a better outcome)

Question 23

BMI ___ is mild anorexia nervosa

Answer 23

BMI ≥ 17 is mild anorexia nervosa