Anorexia/Bulimia/eating disorders Flashcards
(74 cards)
1
Q
Categories of eating disorders according to DSM-5
A
- anorexia
- Bulimia
- binge-eating disorder
- avoidant/restrictive food intake disorder {ARFID}
2
Q
Common features of anorexia and bulimia
A
- dysfunctional eating patterns
- underlying psychosocial issues
- low self-esteem
- depression
- family dynamics
- body image disturbance
- weight changes/fluctuations
3
Q
DSM-5 criteria for anorexia
A
- restriction of energy intake
- intense fear of weight gain even though underweight
- distortion in body weight/shape experience
- removed amenorrhea and below 85% threshold of expected body weight
4
Q
DSM-5 criteria for bulimia
A
- cycles of binge eating
- recurrent inappropriate compensatory behaviors to prevent weight gain
- frequency of episodes: at least one time per week
5
Q
Eating disorders variants
A
anorexia and bulimia on one extreme also includes binge eating, frequent dieters/obsessive dieters
6
Q
Mild variants of eating disorders can threaten
A
growth and development
7
Q
mild variants of eating disorders can progress into
A
full-blown eating disorders or remain static
8
Q
mild variants of eating disorders need to be
A
monitored
9
Q
who is more likely to develop eating disorders
A
severe dieters
10
Q
Significance of primary care in eating disorders
A
- often delay between onset and treatment
- unrecognized in clinical setting up to 50% of time
11
Q
Eating disorders affects
A
5 million Americans yearly
12
Q
what is the 3rd most common chronic adolescent illness
A
eating disorders
13
Q
occurrence of eating disorders
A
- predominantly in females
- often onset at age 15-19;
- increased risk in athletes, diabetics, and obese adolescents
- most common among caucasians
14
Q
Peak onset of anorexia
A
between 15 and 19 years
15
Q
peak onset of bulimia
A
between 18 and 23 years;
- bulimia may arise out of anorexia
16
Q
Risk factors for eating disorders
A
- family history of obesity, affective disorders
- biologic contributors such as serotonin dysfunction and onset of puberty
17
Q
Psychological risk factors of eating disorders
A
- psychiatric diagnoses
- concerns about self-control, low self-esteem, or self- efficacy;
- stress from developmental tasks
- history of abuse
18
Q
Social risk factors of eating disorders
A
- obesity
- media impact on body image norms
- modeling or specific sports
- family hx of disordered eating or alcoholism
19
Q
etiology of eating disorders
A
- dieting is common entry point
20
Q
Hypothesis of etiology of eating disorders
A
- genetic: familial transmission
- biochemical factors
- family functioning
- avoidance of sexual pressure
21
Q
physiological disturbances of anorexia
A
- speculation that anorexia is biological condition for example investigations into disruptions in pituitary, hypothalamus, neurotransmitters;
- many conditions resolved with normalized body weight but probably not prime cause
22
Q
Serotonin and eating disorders
A
- plays role in mood, stress response, eating behaviors
- major serotonin metabolite low in anorexics is 5-hydroxyindoleacetic acid
23
Q
Leptin and eating disorders
A
- hormone produced in fat cells
- closely involved with satiety signaling
- one hypothesis: anorexics have abnormality in leptin receptors but current research disproves this
24
Q
Assessment for eating disorders
A
- look for clues
- ask questions
- screen
25
SCOFF Screening
- do you make yourself sick because you feel uncomfortably full?
- do you worry you have lost control over how much you eat?
- have you recently lost more than 14# in 3 months
- do you believe yourself to be fat when others say you are thin?
- would you say food dominates your life?
26
screening questions for eating disorders
1. how much would you like to weigh
2. how do you feel about your present weight
3. do you or anyone else have concerns about your eating
27
evaluation for eating disorders
- previous weight and height
- maximum/minimum weight
- history of cycling
- current and desired weight
- BMI
- body image concerns and fears
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what BMI is considered anorexic
below 17.5
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what BMI is considered underweight
17.5-20
30
what BMI is considered normal weight
20-25
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what BMI is considered overweight
25-30
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what BMI is considered obese
over 30
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what BMI is considered morbidly obese
over 35
34
Differential diagnosis for eating disorders
- intentional weight loss
- depression
- central nervous system lesions
- new-onset diabetes
- GI conditions
- infection
- malignancy
- adrenal insufficiency
35
Nutritional history for eating disorders
- be careful, direct, nonjudgmental
- detailed info on weight changes
- ideal weight
- target weight
- food restrictions/history
- parental observations
- eating rituals
- exercise history
- social/family history
- menstrual history
- medications
36
Review of systems for eating disorders
- dizziness, blackout, weakness
- pallor, easy bruising
- cold intolerance
- hair loss, dry skin
- vomiting, diarrhea, bloating, abdominal pain
- muscle cramps, joint pains, chest pains
- menstrual irregularities
- s/s of differentials in question
37
Initial psychological assessment for eating disorders
- level of obsession with food/weight loss
- willingness to receive help
- home/school functioning
- comorbidities/psychological illness
- parental evaluation/reaction
38
Clues for anorexia
- rapid/severe weight loss
- dieting, taboo foods, calorie counting
- excessive exercise
- focus on body image
- symptoms such as weakness or fatigue
39
physical assessment for eating disorders
- vital signs
- skin/extremities
- cardiac exam
- abdominal exam
- neurological exam
- evaluate for other causes of weight loss
40
Cardiac complications from eating disorders
- bradycardia
- hypotension
- EKG abnormalities
- Syncope
- mitral valve prolapse
41
GI complications from eating disorders
- hypomotility/constipation
- abdominal pain
- elevated liver enzymes
42
Metabolic/endocrine complications from eating disorders
- cold intolerance
- hypothermia
- amenorrhea
- delayed puberty
- hypoglycemia
43
Musculoskeletal complications from eating disorders
- muscle wasting
- loss of sub-Q fat tissues
- low weight
- low body mass index and low bone density
- pathologic/stress fractures
44
Neurological complications from eating disorders
- seizures
- cognitive and memory dysfunction
- depression
- anxiety
- abnormal EEG
45
Hematologic complications from eating disorders
- easy bruising
- leukopenia
- anemia
- thrombocytopenia
46
Lab testing for eating disorders
- dx is clinical and doesn't require labs
- baseline needed
- can be affected by state of nutrition and weight-control behaviors
- routine tests:
1. CBC with differential
2. sed rate
3. electrolytes
4. urine, serum protein, and albumin
47
Other labs to differentiate eating disorder from other causes
1. T2 and TSH
2. stool
3. HIV
4. pregnancy
5. PPD
6. EKG
7. chest X-ray
8. bone density
48
Findings for eating disorders
- falsely elevated hemoglobin
- elevated or low BUN
- hypokalemia
- acidosis
- electrolytes normal when purging stops
- hypoglycemia
- increased cholesterol
49
What is the main characteristic of bulimia
binge eating
50
Essential diagnostic features of bulimia
- binging and purging
| - inappropriate methods used to prevent weight gain
51
Definition of binging
in a dicrete period of time, eating an amount of food that is definitely larger than most individuals would eat under similar circumstances
52
Length of time that binge eating usually occurs
less than 2 hours
53
binge eating usually involves what types of food
food that is very caloric and high in carbohydrates
54
Binge eating often occurs
in secrecy
55
binge eating is triggered by
dysphoric mood states or lack of control
56
Manifestations of bulimia
- weight cycles (gain/loss)
- trips to bathroom after meals
- vomiting, laxatives, enemas, and excesive exercise
57
Physical signs and symptoms of bulimia
- Russell's sign - calluses or scars on backs of hands
- parotid swelling bilateral
- loss of dental enamel
- GERD
- constipation
- bruises/lacerations of palate and post-pharynx
- cardiomyopathy if using ipecac for vomiting
- esophageal rupture (emergency)
58
Presentation of patient with bulimia
- often normal weight
59
mean duration of bulimia before diagnosis
6 years
60
Psychiatric signs and symptoms of bulimia
- suicidal ideation
- depression
- anxiety
61
Physical findings of bulimia
- Electrolyte imbalances on labs
- EKG abnormalities (QTc prolongation);
-
62
complications of bulimia
- pancreatitis
- constipation
- loss of gag reflex (GERD)
- seizures
- cognitive and memory problems
- depression
- anxiety
63
The majority of bulimics meet criteria for what comorbidites
at least one of the following personality disorder
- obsessive compulsive disorder
- borderline personality disorder
- depression
64
Comorbidites found in bulimics
- hx of highesubstance abuse rate
- hx of sexual conflicts
- hx of impulsive behaviors;
- promiscuity
- self-mutilation
65
Lab studies performed for bulimia
- electrolytes;
- hypocalcemia
- hyponatremia
- hypochloremia
- metabolic acidosis from loss of stomach acid from vomiting
66
Detection of bulimia
- serum electrolyte screen +
- exam of teeth, hands, and salivary glands
* *together can detect 85% of bulimia with normal weight
67
Mortality rate of anorexia
4%
68
What % of anroexia will become chronic
10-31%
69
What % of anorexic patients will develop bulimia
50%
70
Mortality rate of bulimic patients
3.9%
71
50 % of bulimic patients will have full recovery within _____
2 years
72
55% of pts with bulimia will develop
mood disorders
73
Prevention of eating disorders
1. be sensitive to weight issues
2. use nonjudgmental tone
3. focus on education in community and office for pt and family
4. watch for key warning signs
5. implement regular screening
74
Challenges for diagnosing eating disorders
- late presentation (often missed in primary care)
- denial, secretive, and manipulative behaviors
- noncompliance of pt and family
- difficulty with insurance reimbursement
