Week 4 - Eating Disorders Flashcards
disordered eating occurs in __% of women
80% Low calorie intake Excessive exercise Vegetarianism* Fat restriction Carbohydrate restriction Candida diets, wheat free, dairy free*
Men comprise what percentage of individuals with ED in clinical settings?
5-10%
with significantly more gay and bisexual men suffering from these disorders compared with heterosexual men .
However, there is evidence that more men in the general population have ED and that ED in men are under-diagnosed and under-treated. Men may not seek treatment due to experiencing fewer severe symptoms or because they may not consider themselves at risk for eating disorders (Woodside).
Describe the spectrum of eating disorders
- anorexia nervosa; restrictive; binge-eating, purging
- bulimia nervosa
- binge eating disorder
- eating disorders not otherwise specified; female athlete triad; anything else (e.g. orthorexia)
Diagnostic criteria for anorexia nervosa
Body weight <85% expected weight
Intense fear (pathological) of becoming fat
Inaccurate perception of own body size, weight or shape
Excessive dieting leading to severe weight loss
Criterion removed:
Amenorrhea of at least 3 consecutive mos.
(in girls or women after menarche)
Mortality rates for AN: __% at 10 years; __% at 20 years
Mortality rates: 10% at 10 years; 20% at 20 years
More than __% of patients with AN become chronically ill over 10 years
More than 30% of patients with AN become chronically ill over 10 years
What is the profile of high risk for death that causes AN to have the highest mortality rate of any psychiatric disorder?
Profile of high risk for death:
Chronic illness (> 2yr)
Very low weight (BMI <19) – irrespective of dx.
History of suicidal behaviour or self harm
Presence of affective disorders
Alcohol misuse
History of hospitalization for mental health problems
Daily vomiting; Daily bingeing
Laxative misuse &/or Diuretic misuse
Ipecac use; Stimulant use (cocaine, ephedrine)
14 signs of AN
Emaciation Hyperactivity Bradycardia Tachycardia Hypotension Dry skin Brittle hair Hair loss on scalp "Yellow” skin especially on palms Lanugo - very fine, soft, and usually unpigmented, downy hair as can be found on the body of a fetus or newborn baby; d/t malnutrition Peripheral cyanosis Raynaud’s phenomenon Edema: ankle, periorbital Sialadenosis - Enlargement of the salivary glands, usually the parotids, often seen in conditions such as alcoholism and malnutrition.
16 symptoms of AN
Weight loss Amenorrhea Irritability Sleep disturbances Fatigue Headache Dizziness Food sensitivities/allergies Faintness Constipation Nonfocal abdominal pain or bloating Feeling of “fullness” Polyuria Cold intolerance Leg pains Infertility
Temperament of person with AN
Cautious Inhibited Controlled thinking Restricted Rigid Fearful of intimacy < New experience Extremely persistent Fear Decreased self directedness Perfectionist Anxious (even as child) Struggle with identity Low self esteem Hyperactivity (cycle) (zinc defic, malnutrition)
8 physiological sequelae of AN
Electrolyte imbalance (K+, Cl-, Na+) Cardiac insufficiency Reproductive stunting/imbalance Gastrointestinal dysfunction Osteoporosis Immune stress - infections Organ failure (heart, liver, kidney) Death – due to physiological shut down or suicide
Symptoms of electrolyte imbalance
Weakness Muscle twitches Constipation Hypotension Dizziness Polyuria Depression Polydipsia Fatigue Paraesthesia Leg (muscle) pain
Cardiac complications found in eating disorders
Fatigue bradycardia small HT, EKG changes (AN) Syncope orthostatic/systolic hypotension (AN, BN, EDNOS) Acrocyanosis poor peripheral circulation (AN) Palpitations abnormal EKG (AN, BN, EDNOS) Chest pain mid-systolic click MVP & TVP (AN) Calf pain hypokalemia * (AN, BN)
Dyspnea rapid respiratory rate (AN)
Factors For Increased Cardiac Risk In Person With AN
Severe and/or rapid weight loss Purge frequency Ipecac use Co-morbid physiological disorder Underlying cardiac disease Older age
Red Flags (physical aspect) of AN
Very low weight
High frequency of binge/vomiting
Low vitals – HR & BP
Arrhythmia
Appearance – weak, peripheral edema
Abnormal lab- electrolytes, liver enzymes
Patient complains of chest pain, leg cramps
History – alcohol misuse; self harm/suicide, hospitalization, chronic illness, etc
Effects on Reproductive System in Anorexia Nervosa
Normally, pulsatile GnRH release induces LH-FSH
In AN, LH-FSH pulses diminish with reversion to prepubertal pattern
60% women with oligomenorrhea or amenorrhea seen at infertility clinics have eating disorders
Amenorrhea not likely due to starvation alone
Study: Nutrition (fats) and reproductive hormones:
non-dieters, intense dieters, risk group
–> women who ovulated consumed more energy from fat vs. non-ovulating women
Factors Contributing to the Development of Osteoporosis in Anorexia Nervosa
Estrogen deficiency state –> high turnover bone resorption state –> osteoporosis
Osteoclast-stimulating cytokines:
- IL-1, IL-6, IL-11, TNF
High cortisol implicated also.
Mechanisms of estrogen regulation of bone resorption
- Bone cells contain E receptors
- L-1, IL-6, TNF-α, granulocyte macrophage colony-stimulating factor, macrophage colony-stimulating factor (M-CSF), and prostaglandin-E2 (PGE2). These factors increase bone resorption, mainly by increasing the pool size of pre-OCs in bone marrow (2, 3), and are downregulated by E.
- E upregulates TGF-β, an inhibitor of bone resorption that acts directly on OC to decrease activity and increase apoptosis
Effects of ED on GI system
- gastroparesis
- GERD
- gall stones
- constipation - reflex hypo functioning of colon; cathartic colon syndrome
- abdominal pain
- dysphagia, hoarseness
- stomach rupture via gastric dilation (binges) BN
cathartic colon syndrome
Cathartic colon is the anatomic and physiologic change in the colon that occurs with chronic use of stimulant laxatives (> 3 times per week for at least 1 year). Signs and symptoms of cathartic colon include bloating, a feeling of fullness, abdominal pain, and incomplete fecal evacuation. Radiologic studies show an atonic and redundant colon. Chronic use of stimulant laxatives can lead to serious medical consequences such as fluid and electrolyte imbalance, steatorrhea, protein-losing gastroenteropathy, osteomalacia, and vitamin and mineral deficiencies. When the drug is discontinued, radiographic and functional changes in the colon may only partially return to normal because of drug-induced neuromuscular damage to the colon.
Anthranoid laxatives (aloe, cascara sagrada, and senna) are derived from naturally occurring plants and are considered to be stimulant laxatives. Short-term use of stimulant laxatives is safe, but abuse of these drugs can cause melanosis coli and possibly increases the risk of colonic cancer. Melanosis coli, a benign condition, is characterized by dark pigmentation of the colonic mucosa that usually develops 9 months after initiating the use of these drugs and disappears just as quickly after the drug is discontinued.
Bulimia Nervosa diagnostic criteria
Recurrent binge eating
Recurrent purging, excessive exercise or fasting
Excessive concern about body weight or shape
Absence of anorexia nervosa
Usually normal weight
