306 Personality, eating, and anxiety disorders

Question 1

What does EUPD stand for?

Answer 1

Emotionally unstable personality disorder

Question 2

What is EUPD?

Answer 2

Emotional instability/affective dysregulation – very intense, changeable and uncontrollable emotions

Disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions

Impulsive behaviour

Intense but unstable relationships with others

Attachment seeking behaviour
-may harm themselves in attempts to get their needs met

Question 3

What is schizophrenia?

Answer 3

A loss of connection to reality so they don’t have much insight

Question 4

Where in the brain do people with EUPD show neurological changes?

Answer 4

-Orbitofrontal cortex (planning, decision making)
-Amygdala (intensity and reactivity of emotions)
-Hippocampus (behavioural regulation)
-Neurotransmitter abnormalities (especially serotonin)

Question 5

What is the most common type of personality disorder?

Answer 5

Antisocial personality disorder

Question 6

What are the features of antisocial personality disorder?

Answer 6

-Exploits, manipulates other for personal gain
-Lacks concern for other people/their distress
-Disregards normal social behaviour
-Anger outbursts
-Trouble sustaining long term relationships
-Lacks guilt
-Blames others for problems in their lives
-Repeatedly breaks the law

Question 7

What are some different types of personality disorder?

Answer 7

Paranoid – suspiciousness, misconstrue friendly or neutral actions of others as hostile, tenacious sense of personal rights, preoccupation with unsubstantiated “conspiracies”

Schizoid – withdrawal from social contacts with preference for solitary activities, fantasy. Limited capacity to express feelings and feel pleasure

Anankastic (Obsessive Compulsive) – feelings of doubt, perfectionism, excessive conscientiousness, rigidity, and preoccupation with details

Dependent – pervasive passive reliance on others to make one’s life decisions. Feelings of helplessness and incompetence. Fear of abandonment

Avoidant – extreme shyness, social inhibition, feelings of inadequacy, sensitivity to rejection and criticism from others.

Histrionic – shallow, labile affect, self-dramatization, theatricality, exaggerated expression of emotion, lack of consideration for others, easily hurt feelings

Question 8

What are some features of PTSD?

Answer 8

Flashbacks - re-experiencing phenomena

Avoidance of anything that may be triggering

Hypervigilance due to anxiety

Question 9

What is depersonalisations?

Answer 9

Feeling like your not real

Question 10

What is derealisation?

Answer 10

Feeling like things around you aren’t real

Question 11

Name some continuous anxiety disorders

Answer 11

Generalised Anxiety Disorder (GAD)
PTSD

Question 12

Name some episodic anxiety disorders

Answer 12

Panic Disorder
Specific Phobia
Social Phobia
Agoraphobia
OCD
BDD
Acute Stress Reaction

Question 13

What are some organic causes of anxiety?

Answer 13

-Phaeochromocytoma
-Hyperthyroidism
-Hypoparathyroidism
-Caffeine
-Substance use
Acute intoxication (eg stimulants) and withdrawal (eg alcohol, benzos)
-Medication
Eg. Asthma drugs (Salbutamol, Theophylline) and steroids

Question 14

What is Agoraphobia?

Answer 14

Fear of situation in which escape might be difficult or help might not be available

Examples:
Fear of entering shops
Public places (shops, cinemas, theatres)
Using public transport
Being in crowds
Being outside the home alone

Question 15

What is EMDR?

Answer 15

Eye Movement Desensitization and Reprocessing

Used to treat PTSD

Question 16

What is the SCOFF questionnaire?

Answer 16

A group of questions used to screen for an eating disorder

Sick: ‘Do you ever make yourself sick because you feel uncomfortably full?’
Control: ‘Do you worry that you have lost control over how much you eat?’
One: ‘Have you recently lost more than one stone in a 3-month period?’
Fat: ‘Do you believe yourself to be fat when others say you are too thin?’
Food ‘Would you say that food dominates your life?’

Question 17

What does the SUSS test measure?

Answer 17

Sit Up, Squat, and Stand Test

Measures muscle strength

0: unstable
1: able only using hands to help
2: able to with noticeable difficulty
3: No difficulty

2 or less is a red flag

Question 18

What are some differentials for weight loss?

Answer 18

GI: coeliac, IBD, peptic ulcer, malignancy
Drug or alcohol
Endocrine/metabolic – Diabetes, hyperthyroidism
Autoimmune

Question 19

What are some differentials of amenorrhoea?

Answer 19

Pregnancy
Polycystic ovary syndrome
Hypothalamic

Question 20

What are some differential mental health conditions for eating disorder?

Answer 20

Depression
Anxiety
OCD
Substance misuse

Question 21

Name some eating disorders

Answer 21

-Anorexia nervosa
-Bulimia nervosa
-Binge eating disorder(BED)
-Other specified feeding or eating disorders (OSFED): almost half of patients with eating disorders will actually have OSFED. This accounts for a variety of eating disorders that don’t quite fit into diagnostic criteria for the disorders above

Question 22

What is diabulimia?

Answer 22

A media coined, not in diagnostic criteria type of eating disorder

A condition associated with type 1 diabetes when a person reduces or stops taking their insulin in order to lose weight

Question 23

What are some clinical features of anorexia nervosa?

Answer 23

-Significantly low BMI
-Persistent pattern of behaviours to prevent restoration of normal weight
-Compensatory behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at increasing energy expenditure (e.g. excessive exercise)
-Intense fear of gaining weight
-Incorrectly perceived weight

Question 24

What are the features of bulimia nervosa?

Answer 24

-Frequent, recurrent episodes of binge eating
-Subjective loss of control of eating
-Repeated inappropriate compensatory behaviours aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise, continuing attempts to restrict intake)
-Preoccupation with weight
-Distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in psychosocial function
-BMI may be normal or above

Question 25

What are some dermatological complications of eating disorders?

Answer 25

-Acrocyanosis
-Jaundice
-lanugo hair
-Dry skin

Question 26

What is Acrocyanosis?

Answer 26

Persistent abnormally cyanotic discoloration of skin over extremities

Question 27

What is Lanugo hair?

Answer 27

Fine hair due to malnourishment

Question 28

What are some dental complications of eating disorders?

Answer 28

-Dental erosions if induced vomiting
-Salivary gland enlargement

Question 29

What are some metabolic/endocrine complications of eating disorders?

Answer 29

Bone loss,
Oedema
euthyroid sick syndrome (low T4)
suppression HPA axis
hypothermia
hypoglycaemia

Question 30

What are some renal complications of eating disorders?

Answer 30

Kidney stones
hypokalaemia
renal impairment

Question 31

What are some obstetric and gynaecological complications of eating disorders?

Answer 31

Amenorrhoea, infertility, miscarriage

Question 32

What are some neurological complications of eating disorders?

Answer 32

Fainting, headaches, fatigue, poor concentration

Question 33

What are some Cardiovascular complications of eating disorders?

Answer 33

Low cardiac output and hypotension
Poor circulation
bradycardia
anaemia
Arrhythmias

Question 34

What are some Gastrointestinal complications of eating disorders?

Answer 34

Constipation
bloating
gastro-oesophageal reflux
slow gastric emptying

Question 35

What are some Musculoskeletal complications of eating disorders?

Answer 35

Muscle weakness
swollen joints
osteoporosis/osteopaenia

Question 36

When would you refer patient to specialist services?

Answer 36

Rapid weight loss (>1kg/week)
BMI <15
Other concerns/medical complications/risk factors
Severe psychiatric comorbidity

Question 37

What is re-feeding syndrome?

Answer 37

A dangerous and potentially fatal complication of eating disorders

Occurs 1-5 days after eating is reinstated following period of starvation

Rapid shifts of electrolytes back into cells from which they had, during starvation, been leached out

Electrolytes affected: phosphate, potassium, magnesium, calcium, thiamine