Eating disorders Flashcards
essential features of eating disorder
- Significant (more than 25% of ideal body weight) weight loss – progressive.
2) Disturbance of body image
3) Intense fear of becoming obese
4) Absolute refusal to maintain minimal normal body weight
5) No known physical disease to account for weight loss
age of onset
early or late adolescence
sex ratio
predominately female (95%)
prevalence
1 in 250 females –> 12-18 yr age group
weight loss methods
- Accomplished by reduction in food intake, reduction in carbohydrate and fat-containing food
- Use of self-induced vomiting
- Laxative or diuretic abuse
- Diet pill or amphetamine abuse
- Extensive exercise
Does anorexia include a loss of appetite?
no true loss of appetite, purely self-control.
strong preoccupation w/ body side, food, preparing food for others (w/ denial of difficulties)
anorexia physical features
- Emaciated appearance, slow movements, weakness (may be denied)
- Low body temperature, pulse, BP at extreme: Death can occur through CV collapse or electrolyte abnormalities (vomiters)
- Thin hair, hair over body, appearance of being chronically ill.
- Cold when others are warm (use of sweaters, etc)
- amenorrhea (direct interference with hypothalamic and pituitary hormones)
- muscle wasting, GI disturbances, liver failure.
- Changes in thinking/sensorium due to malnutrition
- In general, remainder of physical exam and laboratory studies is normal.
Do appetite suppressants tx anorexia or bulimia?
NO
anorexia is treated by treating symptoms like anxiety, depression…
Signs of Medical Instability seen in eating disorders
Heart rate <45 or >100, BP >120/80
Abnormal electrolytes or liver function tests
Significant orthostatic BP changes (>35 points)
Weight less than 75% of IBW
Psychosis
Rapid acute weight loss >3-5 lbs per week
Significant health concerns that present with anorexia
Osteoporosis Refeeding syndrome (inc calories too fast --> cardiac failure) Purging Substance abuse Suicide
Behavioral features of anorexia
- Bizarre eating habits – compulsive, hoarding
- eating binges
- Compulsive exercising
- Retention of school or work attendance and performance – at times compulsive homework adherence (for teenagers)
- Progressive social isolation, no dating, etc.
- Sullen, resistant, or fearful behavior at home
- When with peers is on periphery
- Relationships are shallow, dependent and easily ruptured
- Marked concern for parents and their wellbeing
Psychological features of anorexia
- denial - while markedly self-absorbed
- pervasive sense of helplessness and incapacity
- poor self-esteem to point of appearing significantly depressed (differentiating feature is distorted body image in anorectics)
- marked non-assertiveness
- avoidance of conflict
- inability to make choices
- perfectionistic, may be highly “moral”
- sense of specialness, mastery and control –> reinforced through weight loss. Approaches “spoiled.”
- power and control occur through resistance and refusal
subtypes of anorexia nervosa
- restricters
2. bulimic anorectics
restricters anorectics
- weight loss by dietary restriction
- obsessive behavior style
- usually younger
- binging and purging rear no use of laxatives
- socially withdrawn
- impulse disorder (drug use, sexual promiscuity) rare
bulimic anorectics
- periods of starvation fluctuate with binging and purging, which may be excessive
- significant impulse disorder may be present (drug and alcohol abuse, sexual promiscuity)
- usually older age of onset
- significant difficulties with relationships – easily intense and easily ruptured
- suicidal ideation and attempts may be present
- wider fluctuations in weight during periods of weight gain or weight loss
