Eating disorders

Question 1

Two subtypes of anorexia nervosa

Answer 1

Restricting type or binge-eating/purging type

Question 2

Diagnostic criteria for anorexia nervosa

Answer 2

Restriction of energy intake relative to requirements, leading to significant low body weight
Intense fear of gaining weight or becoming fat, or persistent behaviors that prevent weight gain
Disturbed body image, undue influence of weight or shape on self-evaluation, or denial of low body weight

Question 3

Physical manifestations of anorexia (there are many)

Answer 3

Amenorrhea, cold intolerance, hypotension, bradycardia, arrhythmia, ACS, cardiomyopathy, mitral valve prolapse, constipation, alopecia, seizures, etc.

Question 4

Lab findings in anorexia

Answer 4

Hyponatremia, hypocholremic hypokalemic metabolic alkalosis 2/2 vomiting, arrhythmia, high cholesterol, high LFTs, leukopenia, anemia, high BUN, ………….many

Question 5

Medical Ddx for anorexia

Answer 5

Endocrine: hypothalamic disease, DM, hyperthyroid
GI: Malabsorption, IBD
Genetic: Turner syndrome, Gaucher disease
Cancer
AIDS

Question 6

Psych Ddx for anorexia

Answer 6

MDD, bulimia, other

Question 7

Management of anorexia

Answer 7

Food, hospitalize if >20-25% below ideal body weight, CBT or other therapy (Maudsley method of family therapy), treat comorbid anxiety and depression

Question 8

What distinguishes bulimia nervosa from anorexia nervosa?

Answer 8

Patients usually maintain a normal weight or are overweight

Question 9

Diagnostic criteria for bulimia nervosa

Answer 9

Recurrent episodes of binge eating
Recurrent, inappropriate attempts to compensate for overeating and prevent weight gain (laxatives, vomiting, diuretics, fasting, exercise)
Binging/compensatory behaviors at least 1x/wk for 3 mos
Perception of self-worth excessively influenced by body weight and shape

Question 10

Physical exam findings in bulimia

Answer 10

Salivary gland enlargement, dental erosions, callouses/erosions on dorsum of hands, petechiae, edema

Question 11

Lab findings in bulimia

Answer 11

Hypochloremic hypokalemic metabolic alkalosis 2/2 vomiting, hypernatremia, high BUN, high amylase, esophagitis (not a lab…?)

Question 12

Course and prognosis of anorexia and bulimia

Answer 12

Chronic and relapsing illness
Bulimia = better prognosis
Anorexia =5% mortality per decade of life (starvation, suicide, or cardiac failure)

Question 13

Management of bulimia

Answer 13

SSRIs + therapy (CBT, interpersonal, family, group)
Fluoxetine is FDA approved
Avoid buproprion due to seizure risk

Question 14

Features of binge eating disorder

Answer 14

Patients have distress about their binge-eating, but do not try to control their weight with compensatory measures

Question 15

Diagnostic criteria for binge-eating disorder

Answer 15

Recurrent episodes of bingeing with at least 3 of: eating too fast, too full, too much, when not hungry, feeling disgusted/depressed after eating, eating alone due to embarrassment
Severe distress about binge eating
Occurs at least 1x/wk for 3 months
No compensatory behaviors

Question 16

Physical exam findings of binge-eating disorder

Answer 16

Usually obese, with related medical problems

Question 17

Course and prognosis of binge-eating disorder

Answer 17

Usually begins in adolescence or young adulthood

Persistent, but better chance of remission compared to other eating disorders

Question 18

Management of binge-eating disorder

Answer 18

Individual psychotherapy (CBT, interpersonal) + strict diet and exercise program
Treat comorbid mood or anxiety disorders
MAYBE drugs for weight loss: stimulants, topiramate zonisimide, orlistat (inhibits pancreatic lipase –> decreased fat absorption)

Question 19

Diagnostic criteria for pica

Answer 19

Consumes nonnutritive substances on a persistent basis for at least 1 month
Inappropriate to the developmental level of the individual
Eating behavior is not culturally supported or socially normal
If it occurs in the context of another mental disorder, it is severe enough to warrant additional clinical attention

Question 20

Treatment for pica

Answer 20

No specific therapy

Behavior therapy that rewards appropriate eating behavior

Question 21

What is geophagy?

Answer 21

Eating dirt or clay. A common cultural activity, particulary in central Africa and Southern USA, and Pomo people of Northern California. Takes place during pregnancy, religious ceremonies, as part of a normal diet, or as a remedy for disease

Question 22

What is rumination disorder?

Answer 22

Repeated regurgitation of food

Question 23

Diagnostic criteria for rumination disorder

Answer 23

Repeated regurgitation of food for at least 1 month
Not related to an underlying GI problem or other medical condition
Not due to another eating disorder
If it occurs in the context of another mental disorder, it is severe enough to warrant additional clinical attention

Question 24

Treatment for rumination disorder

Answer 24

No specific therapy

Reward non-rumination

Question 25

Diagnostic criteria for avoidant/restrictive food intake disorder

Answer 25

-Eating/feeding disturbance manifested by persistent failure to meet appropriate nutritional/energy needs associated with at least one of:
–Significant weight loss
–Significant nutritional deficiency
–Dependence on enteral feeding/oral supplements
–Interference with psychosocial functioning
Not better explained by lack of available of food or by culturally sanctioned practice
Not related to anorexia or bulimia, and no disturbance in body image
Not related to another medical condition