Psych - Eating Disorders Flashcards
Anorexia nervosa: definition and diagnostic criteria
-People restrict what they eat, compulsively exercise to maintain an excessively low body weight
Diagnostic criteria:
- Morbid fear of fatness, even though are underweight
- Restriction of energy intake relative to requirements leading to a significant low body weight in the context of age, sex, developmental trajectory and physical health
- Distorted body image/denial of the seriousness of current low body weight
Anorexia: epidemiology
- Onset age typically between 13-20 (men later)
- Prevalence: 1-2% of schoolgirls and female students
- Sex ratio F:M = 3:1
Anorexia: differential diagnosis
- Psychosis: schizophrenia (delusions about food)
- Organic: DM (which may coexist with anorexia)
- More unlikely causes: addison’s, malabsorption, malignancy
Anorexia nervosa: clinical manifestations
-Emaciation
-Dry/yellow skin
-Fine lanugo hair on face/trunk
-Bradycardia/hypotension
alkalosis, pitted teeth, parotid swelling, Russell’s sign (scarring of dorsum of hand)
Anorexia nervosa: what physiological abnormalities occur?
- Hypokalaemia
- Anaemia and/or leukopenia
- Low FSH, LH, oestrogens and testosterone
- Raised cortisol and growth hormone
- Impaired glucose tolerance
- Hypercholesterolaemia
- Hypercarotinaemia
- Low T3
Anorexia nervosa: what are the criteria for hospitalisation?
- Severe or rapid weight loss or BMI <13.5 - patients are at high risk of arrhythmia or hypoglycaemia
- Significant suicide risk
- Physical sequelae from starvation/purging
Bulimia nervosa: definition and criteria
- Morbid fear of fatness, distorted body image
- Cravings for food and uncontrolled binge-eating (>2000kcal in 1 session)
- Sense of lack of control during over eating during binge episodes
- Recurrent behaviours to prevent weight gain: purging/vomiting/laxative abuse
- Binge eating and compensatory behaviours both occur, on average, at least/week for 3 months
- Fluctuating (normal or excessive) weight
- Weight disturbance does not occur exclusively during episodes of anorexia nervosa
Bulimia: epidemiology
- Onset usually at age 15-30
- Prevalence: 1-3%
- Sex ratio F:M = 3:1
Bulimia: differential diagnosis
- Anorexia nervosa
- Kleine-Levin: rare sleep disorder where patients can experience hyperphagia
- Kluver-Bucy: syndrome resulting from bilateral lesions to medial temporal lobe - can present with compulsive eating
- Prader-Willi syndrome: overeating
Bulimia nervosa: management
- Referral for specialist care
- Dietitian input
- Adults: bulimia nervosa focused guided self help, if ineffective after 4/52, eating disorder focused CBT
- Children: bulimia nervosa focused family therapy
- Pharmacological tx: limited role, high dose Fluoxetine is currently licensed for bulimia but long-term data is lacking
What is eating disorder not otherwise specified
-Patient has a mix of sx: purging, binging and periods of anorexia
Andrea is nervosa: outline the Mx
Adults with anorexia
- Individual eating-disorder focused CBT, IPT, focal psychodynamic therapy and family therapy
- Maudsley anorexia nervosa treatment pathway
- Specialised supportive clinical management
Children and young people
- Anorexia focused family therapy
- CBT
