Eating Disorders Flashcards
Anorexia Nervosa
Significantly low body weight; fear of being fat
Cognitive distortions
- experience weight/shape differently
- weight strongly influences self-eval & esteem
- lack of recognition for seriousness of low weight
Types of Anorexia Nervosa
Restricting type – 50%
- comorbid with anxiety
- caloric intake is 300-500 daily
Binge/purge type
- comorbid with depression
- vomitting, laxatives, diuretics
- ritualistic exercise
Specify as mild, mod, severe based on BMI
What is considered severe anorexia nervosa based on BMI?
< 15
Comorbid Psych Diagnoses associated with Anorexia
MDD – 65%
Anxiety & Seasonal Depression – 35%
OCD – 25%
Phobia or Panic Disorder
Anorexia Nervosa Epidemiology
10-20x more likely in females
often begins in teen years (14-18 yo)
Some evidence indicates strained relationship with parents, chaos at home – restricting calories may be seen as a form of control by patient
Perfectionism & obsessive-compusive features
Mortality rate of AN?
5-9%
most lethal psychiatric disorder
Physical Exam findings / Lab values AN
- bradycardia
- hypotension
- hypothermia
- muscle atrophy
- dehydration
Lanugo – fine hair all over body
Hypokalemia Low estrogen, FSH, LH --> amenorrhea HYPERcholesterolemia HYPOglycemia Elevated cortisol
Anorexia Treatment
Hospitalize if BMI is 15-20% below IBW
Slow refeeding! 300-500 calories above their current daily intake…split into 5-6 smaller meals
Correct dehydration / electrolyte problems
Morning weigh ins
-want to be gaining 0.25 lbs
Psychotherapy – CBT + family therapy
Drugs for associated symptoms (depression, anxiety, OCD)
-Prozac
Periactin = drug to increase appetite
Anorexia Favorable vs, Poor outcome facts
Favorable outcomes
- Pt admits hunger
- improved self-esteem
- 25% will recover completely
Poor Outcomes
- childhood neuroticism (anxious since childhood)
- parental conflict
- purging behaviors
50% will improve and become functionally normal
Bulemia Nervosa Definition
Binging followed by compensatory behaviors designed to prevent weight gain
- vomiting
- laxatives
- diuretics
- fasting
- excessive exercise
Behaviors occur on average 1x/week x3 months
Pts don’t necessarily look thin or have low BMI
Bulemia Nervosa Epidemiology
Females…tend to be high achievers
-more outgoing and impulsive compared to AN
**suicide rate is 7.5x higher than general pop
Associated with self harm behaviors like cutting
High prevalence of sexual abuse hx
Physical Exam Bulemia Nervosa
Dental caries, tooth enamel loss
Parotitis, gland swelling
Gastritis, esophagitis, Mallory Weis tears
Russel’s sign –> abrasions on back of fingers
HYPO K+, Cl-, Mg+
Abnormal menses
Bulemia treatment
Typically don’t need inpatient treatment
Self monitoring intake
- food diaries
- meal pattern normalization
CBT therapy + pharmacology (SSRI)
Avoid Bupropion!!! – risk of seizures
Bulemia prognosis
higher rates of partial and complete recovery when compared to AN
Mortality rate is 2% per decade
Binge-Eating Disorder
- *MOST common eating disorder**
- 25% are seeking care for obesity
- 5% of general population
Binging but NO purging or compensatory acts
Eating large amounts of food in private, often densely caloric foods
