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Flashcards in 1: Eating Disorders Deck (31)

epidemiology of eating disorders

-anorexia: 1% of women
-bulimia: 1-3% of women
-binge-eating: 2% of women, 1% of men

female to male ratio 10:1 for anorexics


factors in the multifactorial pathogenesis

-genetic: higher in monozygotic twins
-psych: means of coping
-biological: chemical changes occur w/ starvation
-family: higher incidence in 1st degree relatives
-env't: higher in cultures that value thinness
-social: teasing


7 risk factors for developing an eating disorders

-female gender
-early pubertal development
-low self-esteem
-sense of personal ineffectiveness
-difficulties w/ communication, conflict resolution, and separation from family
-drive to excel in sports


diagnostic criteria for anorexia

-restriction of energy intake -> significantly low body weight
-intense fear of gaining weight/becoming fat
-disturbance in the way in which one's body weight or shape is experiences/lack of recognition of the seriousness of the problem

weight usually below 85% of normal for age/gender


restricting subtype of anorexia

weight loss achieved by dieting, fasting, and/or excessive exercise


binge eating/purging subtype of anorexia

weight loss achieved by self-induced vomiting, misuse of laxatives/diuretics/enemas, diet pills, stimulants


anorexia levels of severity: mild, moderate, severe, extreme

mild: BMI 17-18.5kg/m2
moderate: BMI 16-16.99 kg/m2
severe: BMI 15-15.99 kg/m2
extreme: BMI


diagnostic criteria for bulimia

-recurrent episodes of binge eating (eating in a discrete period a larger than normal amt or sense of lack of control over eating during episode)
-recurrent inappropriate compensatory behaviors to prevent weight gain at least 1/week for 3 mo.
-self eval is unduly influenced by body shape/weight
-disturbance doesn't occur during anorexic episodes


bulimia levels of severity: mild, moderate, severe, extreme

mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week


diagnostic criteria for binge-eating disorder

-recurrent episodes of binge eating
-episodes associated with 3 or more of the following:
-eating too rapidly
-eating until feeling uncomfortably full
-eating large amts of food when not feeling hungry
-eating alone b/c of embarrassment
-feeling disgusted w/ oneself, depressed, or guilty after
-marked distress regarding binge eating
-at least 1/week for 3 mo
-not associated with inappropriate compensatory behavior


binge-eating levels of severity: mild, moderate, severe, extreme

mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week


presenting symptoms of eating disorders

-amenorrhea or menstrual irregularities
-abdominal pain and bloating
-cold intolerance
-dry skin
-GERD (from vomiting)


physical findings in anorexia

-acrocyanosis (blue fingers/toes)
-hypotension (especially orthostatic hypotension)
-lanugo (fine hair)
-cold extremities
-atrophic breasts
-edema of extremities
-flat affect
-alopecia (lose hair)
-salivary gland enlargement (from starvation)


physical findings in bulimia

-salivary gland enlargement (from vomiting), inflammation of parotid duct
-calluses on knuckles (Russell's sign)
-mouth sores
-dental enamel erosions
-hypotension (especially orthostatic)
-edema of extremities (more due to compensatory methods, like diuretics)
-Mallory-Weiss tear (vomit forcefully and tear esophageal mucosa - usually present w/ bloody vomit)


lab abnormalities in anorexia

-mild normochromic, normocytic anemia with moderate leukopenia
-low blood sugar
-elevated serum cholesterol
-hyponatremia may be present from water loading
-elevated liver enzymes from refeeding or apoptosis from starvation


lab abnormalities in bulimia

-hypokalemia, hypochloremia with metabolic acidosis secondary to vomiting
-hypokalemia with metabolic acidosis from laxative abuse
-elevated serum amylase (from salivary gland)


important questions to ask

-weight: highest, lowest, desired?
-feelings about current weight?
-has anyone commented on weight?
-type of diet? vegetarian common
-rituals such as chewing certain number of times?
-restricting foods they used to eat?
-any purging of food?
-any binging of food?
-medications taken ?
-menstrual history?


suicide risk for eating disorders

-elevated in both anorexia and bulimia


co-morbidities with bulimia

-sexual promiscuity
-substance abuse


lab tests for a suspected eating disorder

-CBC and ESR
-comprehensive metabolic profile (K+, Cl-)
-UA (specific gravity to see if water loaded)
-thyroid function tests
-bone densitometry (osteopenic)


additional labs to consider based on H&P

-urine B-hCG
-serum amylase (to confirm purging)
-FSH, LH, estradiol, testosterone, prolactin (for menorrheal issues)
-stool for blood
-GI endoscopy, CXR, head CT


differential diagnosis options for weight loss (9)

-intentional dieting and exercise
-CNS tumors (hypothalamic, pituitary)
-endocrine disorders (hyperthyroid, T1DM, addison's)
-GI disorders (IBS)
-chronic infection (AIDS, TB)
-CT disorders (SLE)
-malignancy (lymphoma)
-other psych disorders (MDD)


4 principles of successful care of eating disorders

1. early restoration of normal state
2. establishment of trust
3. involvement of family in treatment
4. team approach - medical, nutritional, psychological


levels of care for eating disorders

-hospital inpatient
-partial hospitalization (12 h for 5d/week)
-intensive outpatient program (IOP) - 8h for 3d/week
-residential - one or two month stay
-regular visits with health care provider, psychotherapist
and nutritionist while maintaining activities of daily life


medical criteria for hospitalization

severe metabolic disturbances


psychiatric criteria for hospitalization

-severe depression
-family crises
-failure to comply with eating disorder contract


what drug is approved for bulimia treatment?

-in higher doses than for depression -> 60 mg/day


pharm treatment for anorexia

-olanzapine/zyprexa may be helpful: promotes weight gain, decreases obsessive thinking
-avoid meds that prolong QT interval


what drug is contraindicated in treating eating disorders and why?

buproprion/wellbutrin/zyban - b/c increased incidence of seizures


definition of refeeding syndrome

clinical complications that occur as a result of fluid and electrolyte shifts during nutritional rehab of malnourished patients
-stores of phosphate depleted during AN/starvation
-feeding -> release insulin -> cell uptake of phosphate, K+, Mg2+ and increase production of ATP
-lack of phosphorylated intermediates causes tissue hypoxia and resultant myocardial dysfunction and resp failure


clinical components of refeeding syndrome (6)

-vitamin and trace mineral deficiencies
-volume overload