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Flashcards in Eating disorder Deck (15):

Anorexia nervosa

characterised by loss of body weight and refusal to eat, Appetite is usually intact


Bulimia nervosa

characterised by recurrent and frequent binge eating with or without vomiting


Being eating disorder

Binge eating disorder is a variant of bulimia nervosa with occasional, once a week, binge eating.



eating of non-nutritional substances


Rumination disorder

repeated regurgitation of food, usually beginning in infancy or childhood


Avoidant/restrictive food intake disorder

disorder is a lack of interest in food or eating resulting failure to thrive.


DSM 5 Anorexia Nervosa

A. intake and weight: restriction of energy intake relative to requirements, leading to a signi cantly low body weight in the context of age, sex, developmental trajectory, and physical health. Signi cantly low weight is de ned as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected
B. fear or behaviour: intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a signi cantly low weight
C. perception: disturbance in the way in which one’s body weight or shape is experienced, undue in uence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight


Mx of anorexia

Psycotherapy - family based for kids, address food and body perception, coping mechanisms, health effects. CBTB
Hospital if <13 BMI, unstable, Suicidal eg hypovolemia for IV fluids, HR less then 40
Refeeding syndrome
SSRI if depression


Cx of anorexia

Refeeding syndrome
Hyper K


Refeeding syndrome

a potentially life-threatening metabolic response to refeeding in severely malnourished patients resulting in severe shi s in uid and electrolyte levels
ƒ complications include hypophosphatemia, congestive heart failure, cardiac arrhythmias, delirium, and death
ƒ prevention: slow refeeding, gradual increase in nutrition, supplemental phosphorus, close monitoring of electrolytes and cardiac status


DSM V for Bulimia

A.recurrent episodes of binge-eating; an episode of binge-eating is characterized by both of the following
ƒ - eating, in a discrete period of time, an amount of food that is de nitely larger than what most individuals would eat during a similar period of time and under similar circumstances
ƒ - a sense of lack of control over eating during the episode
B recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise
C the binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 mo
D self-evaluation is unduly in uenced by body shape and weight
E the disturbance does not occur exclusively during episodes of AN


Clinical features of Bulimia

• fatigue and muscle weakness due to repetitive vomiting and fluid/electrolyte imbalance
• tooth decay
• swollen appearance around angle of jaw and pu ness of eye sockets due to uid retention • reddened knuckles, Russell’s sign (knuckle callus from self-induced vomiting)
• trouble concentrating
• weight uctuation over time


Mx of Bulimia

• admission for signicant electrolyte abnormalities
• biological: treatment of starvation e ects, SSRIs ( uoxetine most evidence) as adjunct
• psychological: develop trusting relationship with therapist to explore personal etiology and
triggers, CBT, family therapy, recognition of health risks
• social: challenge destructive societal views of women, use of hospital environment to provide
external patterning for normative eating behaviour


prognosis of Bulimia

• relapsing/remitting disease
• good prognostic factors: onset before age 15, achieving a healthy weight within 2 yr of treatment • poor prognostic factors: later age of onset, previous hospitalizations, individual and familial
• 60% good treatment outcome, 30% intermediate outcome, 10% poor outcome


Clinical features of anorexia

Fatigue and weakness
Poor concentration
lanugo body hair
orthostatic hypotension
cardiac arrhythmias
shorter stature
eroded dental enamel
scars on dorsum of hand
dependent oedema
Increased fractures