Trastornos de conducta alimentaria Flashcards
13.1.
A 14-year-old female reports not eating during the day
because she feels too anxious to eat at school and doesn’t like
the school lunch. Her parents report she refuses snacks when
coming home from school and exercises for 2 hours daily.
Parents report she then eats a big dinner and snacks
constantly until 7
PM
, and then won’t eat anything further. She
denied any body image concerns though her parents reported
she is going to the bathroom more frequently and has reported
nausea and vomiting. Her periods stopped and she lost weight
and she is now at 105 lb at a height of 5′5″. She reported
wanting to gain weight. Which of the following disorders are
most likely?
A. Anorexia nervosa, binge/purge subtype
B. Bulimia nervosa
C. Night eating syndrome
D. Other specified feeding or eating disorder
E. Purging disorder
13.1. A. Anorexia nervosa, binge/purge subtype
Though reporting wanting to gain weight, the girl described in the
vignette above has behaviors consistent with restricting and she lost
a large amount of weight and is currently underweight, and has lost
her periods. The increased frequency of going to the bathroom and
excessively eating large quantities of food after the restricting is
suspicious for a binge/purge subtype of anorexia nervosa. With the
other disorders listed (bulimia nervosa, night eating syndromes, and
purging disorder) the weight would be stable. Purging and night
eating disorders do not include restricting and binging. Other
specific feeding or eating disorders (OSFEDs) can include night
eating and purging disorder, along with atypical anorexia nervosa,
which would have similar features to anorexia nervosa, including
weight loss, but the weight would appear normal or overweight even
after the weight loss.
13.2.
A 13-year-old female presents with increased isolation and is
skipping meals. Her parents report concern of weight loss
though noted it is difficult to tell since she wears baggy
clothing and is refusing to be weighed. They reported she is
exercising multiple times daily and when they see her eat, she
cuts her food up until little pieces. Medical evaluation would
most likely show which of the following findings (choose
three).
A. Bradycardia
B. Hypercholesterolemia
C. Hyperthermia
D. Hypertension
E. Increased gastric emptying
F. Lanugo
G. Leukocytosis
13.2. A. Bradycardia, B. Hypercholesterolemia, and F.
Lanugo
The patient described meets criteria for classic anorexia nervosa,
restricting subtype. Common medical complications include
bradycardia, hypotension, and arrhythmias and these patients are at
increased risk of death, mainly from cardiac complications.
Hypothermia, decreased gastric emptying, and leukopenia are other
associated findings with malnutrition. Despite decreased cholesterol
intake, due to liver damage from the malnutrition, cholesterol is
typically increased.
13.3.
Which of the following endocrine findings can be seen in
patients with anorexia nervosa?
A. Decreased cortisol
B. Decreased reverse triiodothyronine
C. Elevated growth hormone
D. Increased thyroxine
E. Lower levels of prolactin
13.3. C. Elevated growth hormone
Often patients with anorexia nervosa lose their menses due to low
levels of luteinizing hormone, follicle-stimulating hormone, and low
estrogen. Testosterone is suppressed in males with anorexia. Growth
hormone increases to help the body compensate. Cortisol, a marker
of stress, is also increased. Elevated prolactin is also found. Thyroid
hormone changes include low, or a normal thyroxine level, and low
triiodothyronine, along with increased reverse triiodothyronine
13.4.
Which feature is unique to anorexia versus bulimia nervosa?
A. Absence of menses
B. Body image concerns
C. Excessive exercising
D. Severely low weight
E. Vomiting
13.4. D. Severely low weight
In both anorexia and bulimia nervosa, body image concerns are
present, and the binge/purge subtype of anorexia can look like
bulimia nervosa except for that those with anorexia nervosa are of a
severely low weight, whereas typically those with bulimia nervosa are
of normal weight (though some may be under- or overweight).
Excessive exercising is considered a type of compensatory behavior
that would go under purging. The absence of menses is a nonspecific
sign and was eliminated in changing from the DSM-IV to DSM-5
criteria for anorexia nervosa.
13.5.
Which of the symptoms below would be more indicative of a
binge rather than overeating?
A. Compensatory exercising after the episode
B. Consuming more than 1,000 kcals during the episode
C. Eating excessively after hunger from restricting
D. Eating an excessive amount of food in under 2 hours
E. Excessive eating episodes occurring twice a month
13.5. D. Eating an excessive amount of food in under 2
hours
Often, patients with anorexia will report subjective binges of
overeating after periods of restriction and feeling out of control
though calorie wise and timing wise, these episodes do not
necessarily count as actual binges. A true binge per DSM-5 is defined
as eating a large quantity of food (i.e., more than 2,000 kcals) in
under 2 hours and a feeling of a loss of control during these episodes,
along with at least three of the following criteria: eating quicker than
normal, eating until uncomfortably full, eating in spite of not feeling
hungry, eating alone to avoid embarrassment, and feeling guilty or
disgusted afterward. These episodes need to occur at least once a
week for 3 months in order to meet criteria.
13.6.
In general, which symptom is more consistent with a
depressive disorder compared to anorexia nervosa?
A. Low energy
B. Difficulty focusing
C. Reports of decreased appetite
D. Ritualistic hyperactivity
E. Weight loss
13.6. C. Reports of decreased appetite
While those with depression could potentially have increased
appetite, often decreased appetite is commonly reported and it can
help distinguish between depression versus anorexia nervosa since in
anorexia nervosa, a normal appetite or hunger are commonly
reported. With anorexia nervosa, behaviors to curb the hunger are
noted, along with a preoccupation with food, recipes, cooking, etc.
Psychomotor retardation or hyperactivity can be seen in both
depression and anorexia, though in anorexia, the hyperactivity is
typically planned and ritualistic and the focus is on weight loss and
there is an intense fear of weight gain and body image disturbance.
With both malnutrition and depression, focusing issues can be seen
13.7.
A 16-year-old female has a long history of depressive
symptoms and suicidality, along with a preoccupation with her
weight and will skip breakfast and lunch most days and then
eat thousands of calories at night and feeling out of control,
will vomit after. She engages in this pattern a few times per
week and has also started taking diet pills daily. Her weight
has remained stable around 130 lb at a height of 5′6″. Which
personality disorder is most commonly comorbid with this
eating disorder?
A. Avoidant
B. Borderline
C. Obsessive–compulsive
D. Narcissistic
E. Schizotypal
13.7. B. Borderline
The patient described above has bulimia nervosa, characterized by
binging and purging at least once a week for 3 months, along with a
focus on body/shape/weight concerns and unlike anorexia nervosa,
binge/purge subtype, for bulimia, the weight is typically normal.
Patients with bulimia often engage in impulsive behaviors other than
purging including substance use, compulsive shopping,
self-harm,
etc. They often meet criteria for borderline personality disorder and
at times can also meet criteria for bipolar II disorder.
13.8.
Which of the following symptoms can distinguish night eating
syndrome from bulimia nervosa?
A. Being overweight
B. Consumption of thousands of calories during an episode
C. Eating nonfood items
D. Lack of concern about body image and weight
E. Skipping meals during the day and only eating at night
13.8. D. Lack of concern about body image and weight
With many eating disorders, such as anorexia and bulimia nervosa,
body image, along with weight and shape concerns are a key feature.
While eating large quantities of food can occur in both bulimia and
night eating syndrome, those with night eating syndrome do not
have body image concerns or a fear of weight gain. Another
distinguishing feature is that the binges in bulimia typically involve a
higher number of calories consumed compared to night eating
syndrome. Timing differs in that for night eating syndrome, these
involuntary episodes typically occur after the patient has gone to
sleep, and the eating can occur even when asleep or unconscious.
Eating nonfood items can happen in night eating syndrome as well as
other eating disorders.
13.9.
Anorexia nervosa is associated with which of the following
comorbid psychiatric disorders in approximately half of the
patients?
A. Depression
B. Obsessive–compulsive disorder
C. Panic disorder
D. Social phobia
E. Substance use
13.9. A. Depression
Anorexia nervosa is highly comorbid with other psychiatric
disorders, with depression being the most common at 50%. Social
phobia is also commonly comorbid at around 22% and comorbidity
with obsessive–compulsive disorder is around 35%.
13.10.
The prevalence of posttraumatic stress disorder (PTSD) is
most often found to be comorbid with which of the following
eating disorders?
A. Anorexia nervosa
B. Avoidant restrictive food intake disorder
C. Binge eating disorder
D. Bulimia nervosa
E. Night eating syndrome
13.10. D. Bulimia nervosa
Patients with bulimia nervosa have higher histories of sexual abuse
and PTSD. It is thought that over 26% of those with bulimia have a
comorbid PTSD, compared to over 8% for anorexia, and over 13% for
binge eating disorder
13.11.
Which factor is most predictive of a better prognosis for
patients with anorexia nervosa?
A. Childhood onset
B. Full weight restoration
C. Lack of purging features
D. Having never lost periods
E. Onset later in life
13.11. B. Full weight restoration
Overall, patients with anorexia nervosa have recovery rates of 30% to
50%. Mortality rates for individuals with anorexia are six times
higher than the general population. Adolescents with a shorter
duration of illness tend to have the best prognosis. Individuals who
are fully weight-restored on an inpatient unit, along with weight
maintenance for a month after discharge are positive signs of a good
prognosis, along with those who can have a large variety in their diet
and consume high-kcal items. A lower body mass index (BMI) and
weight loss after discharge are factors associated with a poor longterm
outcome.
13.12.
Which psychotherapeutic approach is most helpful for
treating adolescents with anorexia nervosa?
A. Challenge core beliefs about body image concerns
B. Have parents prepare, plate, and supervise meals
C. Focus on improving interpersonal relationships
D. Motivation to get the patients to change their eating
behavior
E. Teach patients to measure their own food and use an
exchange system
13.12. B. Have parents prepare, plate, and supervise meals
Cognitive and behavioral principles can be helpful in treating
anorexia nervosa, such as monitoring thoughts, feelings, and
emotions and monitoring interpersonal relations, and working on
cognitive restructuring for core beliefs. However, in adolescents
under 18 years old with anorexia nervosa, a family-based treatment
approach (FBT) has been shown to be most helpful. Phase 1 of
treatment involves a focus on restoration of the patient’s physical
health, with the parents making the decisions regarding what the
patient should eat. Psychodynamic therapy might involve building an
alliance with the patient and empathizing with the patient’s point of
view rather than directly trying to get them to change their eating
behavior.
13.13.
Data on the use of atypical antipsychotics for the treatment
of anorexia nervosa in adolescents support which of the
following findings?
A. Aripiprazole is tolerated better than the other atypicals
B. Eating disorder thoughts are improved when used as an
adjunct to selective serotonin reuptake inhibitor (SSRI)
C. Meta-analyses have not supported their use
D. Olanzapine is associated with the most weight gain
E. Risperidone did not show added cardiac risks
13.13. C. Meta-analyses have not supported their use
No pharmacologic treatment has been shown to lead to definitive
improvement for the treatment of anorexia nervosa. Some studies
have looked at atypical antipsychotics, mainly olanzapine, for weight
gain, though meta-analyses and large studies have not supported its
use. Added cardiac and metabolic complications can be found when
using the atypical antipsychotics in this already medically
compromised population.
13.14.
A 15-year-old female has been struggling with skipping
meals and has been vomiting and/or using laxatives three to
five times a week for the past year. Her weight is 110 lb and
her height is 5′3″. Which of the following treatments is first
line for this eating disorder?
A. Cognitive behavioral therapy (CBT)
B. Family-based treatment (FBT)
C. Fluoxetine
D. Olanzapine
E. Topiramate
13.14. A. Cognitive behavioral therapy (CBT)
The patient described above has bulimia nervosa, given the
presentation of binging, purging, and being of a normal weight. CBT
is first-line treatment for bulimia nervosa. FBT and dialectical
behavioral therapy (DBT) might also be effective for bulimia, though
are not as well studied. While fluoxetine is U.S. Food and Drug
Administration (FDA) approved for the treatment of bulimia and
topiramate might have some efficacy in reducing binging episodes,
CBT should be initiated first.
13.15.
Which treatment type has been proven to have the best
results for the treatment of binge eating disorder?
A. Cognitive behavioral therapy (CBT) combined with SSRIs
B. Dialectical behavioral therapy
C. Family-based treatment combined with topiramate
D. Interpersonal psychotherapy (IPT) combined with SSRIs
E. Stimulants
13.15. A. Cognitive behavioral therapy (CBT) combined with
SSRIs
CBT is the most effective treatment for binge eating disorder and
should be considered first-line treatment. When combined with
SSRIs and other medications, studies have shown better results than
CBT alone. Stimulants, such as lisdexamfetamine can help with
weight loss and decrease binging.
Anticonvulsants, such as
topiramate, can help improve binge eating disorder and lead to more
weight loss. Interpersonal psychotherapy and dialectical behavioral
therapy might also be effective in helping to treat binge eating
disorder, though CBT with the addition of an SSRI is thought to be
the most effective.
