Week 1 - F - Eating disorders - Anorexia nervosa, Bulimia nervosa, Binge eating disorders - Diagnostic features, Risk assessment, Treatment Flashcards
Anorexia Nervosa “nervous absence of appetite” Anorexia is defined differnelty dependent on whether using the ICD-10 classification or the DSM V As europe mainly uses the ICD-10, lets consider this classification system
What are the 4 different diagnostic criteria of anorexia nervosa?
* A - weight loss, or lack of weight gain in children, leading to a body weight of at least 15% below the normal predicted for their age and height
* B - the weight loss is self induced by avoidance of fattening foods
* C - there is a self perception of being too fat with an intrusive dread of fatness which leads to a self imposed low weight threshold
* D - A widespread endocrine disorder involving the Hypothalamic, piuitary gonadal axis
Anorexia nervosa * Wight loss, lack of weight gain in children, putting patient at least 15% below the predicted for their age and height * Self induced weight loss due to avoiding fatty foods * Self perception of being too fat, with an intrusive dread of fatness leading to a self-imposed low weight threshold
How does the widespread endocrine disorder involving the hypothalamic-pituitary gonoadal axis present in boys/girls?
In females, the disorder presents typically as amenorrhea and in males the disorder presents as loss of sexual interest and potency
IN females the widespread endocrine disorder presents as amenorrhea. When is there the execption to this case?
The exception to the amenorrhea in females is the persistence of vaginal bleeds in anorexic women who are on hormone replacement - most commonly females taking the contraceptive pilll
What is the main way of causing weight loss in anorexia nervosa? What are other ways?
Weight loss by avoidance of fatty foods
Also can happen by vomiting or excessive exercise
State again the criteria or diagnosing anorexia nervosa?
- Weight loss of lack of weight gain in children, that leads to a body 15% below the predicted body weight for age and height
- Weight loss-self induced by avoidance of fatty foods
- Self perception of being too fat with intrusive dread of fatness, leads to a self-imposed low weight threshold
- Widespread endocrine disorder involving the hypothalamic -pituitary-gonodal axis - manifests as amenorrhea in female, loss of sexual interest & potency in males
If the onset of anorexia is prepubertal then how does it present? (girls and boys) What gender is anorexia nervosa more common in?
If the onset is prepubertal, in both sexes the sequence of pubertal events is delayed or even arrested
In females - breasts do not develop and there is a primary amenorrhea
In boys the genitals remain juvenile
Anorexi is more common in females about 4 times more common
If a patients puberty has ceased with anorexia nervosa, but it is treated, does the puberty still occur?
The puberty tends to reoccur normally but the menarche comes late
Bulimia nervosa also has diagnostic criteria under the ICD-10 and the DSM-V but as Europe mainly uses the ICD-10, so shall we What is the criteria for bulimia nervosa?
Recurrent episodes of binge eating- at least two times per week for a period of three months, in which large amounts of food are consumed in short periods of times ie over 2 hours
Persistent preoccupation with eating and a strong desire or sense of compulsion to eat
Patient attepmts to counteract the fattening effects of food by: Self induced vomiting Self induced purging Aleternating periods of starvation - can use drugs
Self perception of being too fat, with intrusive dread of fatness
How often do the recurrent episodes of binge eating need to occur in bulimia nervosa? What is the strong desire or sense of compulsion to eat known as? What are the ways the patient attempts to counteract the fattening effects of food?
The recurrent epidoses of binge eating need to occur at least twice per week for 3 months
The strong desire or sense of compulsion to eat is known as cravings
The ways the patient attempts to counteract the fattening effects of food:
- * Self induced vomiting * Self induced purging * Alternating periods of starvation
Binge eating disorders also has different classifications Based on, what characterises an episode of binge eating, what they binge eating is associated with, how often it occurs and what it is not associated with What characterizes an episode of binge eating?
Recurrent episodes of binge eating is characterised by both of the following
* Eating in a discrete period ie 2hours, more food than most people would eat during a similar time period
* A sense of lack of control over eating during the episode - cant stop yourself
What are the binge eating episodes associated with?
Eating much more rapidly than normal
* Eating until feeling uncomfortably full
* Eating large amounts of food when not physically hungry
* Eating alone because of feeling embarrassed over how much one is eating
* Feeling disgusted with oneself, depressed or very guilty afterwards
Marked distress regarding binge eating is also present
How often does the binge eating occur in binge eating disorders?
Binge eating occurs at least once a week every week for three months
What is binge eating disorders not associated with? (in relevance to bulimia and anorexia)
It is not not associated with recurrent use of compensatory behaviors such as in bulimia nervosa and does not occur exclusively during the course of bulimia or anorexia nervosa
What other health risks does bulimia nervosa carry?
It is associated with enamel erosion in the teeth due to the gastric acid eroding it away during episodes of self-induced vomiting
It is associated with callous formation on the knuckles due to sticking hands down throats to induce vomiting - RUSSELS SIGN
Do patients tend to be overweight or underweight in anorexia vs bulimia nervosa?
Patients with anorexia nervosa are underweight - typically BMI is <17.5
Patient with bulimia nervosa are usually of normal weight or are infact overweight
What effect does starvation have on the brain?
There is the loss of both grey and why matter
There is increased compulsive behavior
There is reduced social skills
Increased focus on fod
Poor concentration and decision making
New learning stunted
What is the different treatments for each of the disorders? (adult and childhood)
The treatment of bulimia and anorexia nervosa in childhood would be family therapy
Many children and young people with anorexia find it helpful to have a talking therapy that family members or carers can take part in too.
This is known as family therapy
Congitive behavioural therapy is the mainstay of treatment for the eating disorders in adults and if family therapy doesnt work in children
