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Behavioral Dynamics > Eating Disorders* > Flashcards

Eating Disorders* Flashcards

1
Q

Perception that a person has of their physical self and the thoughts and feelings as a result
Influenced by individual and environmental factors

A

body image

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2
Q

What factors make up body image?

A

perception “how we see ourselves”
affective “how we feel about how we look”
cognitive “our thoughts and beliefs about our body” behavioral “what we do in relation to how we look”

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3
Q

Chronic negative perception of one’s body is strongly tied to ____

A

body dissatisfaction

developed countris emphasize thin body type for females, lean/muscular types for men
Bigger issue in high-income countries: US, european countries, australia/new zealand

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4
Q

What makes body dissatisfaction different from an eating disorder?

A

Morbid fear of weight gain
Idea that one cannot be too thin that overrides all other interests and affairs

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5
Q

What are risk factors for body dissatisfaction (10)?

A

Age (late childhood/adolescence)
Female
Low self esteem
Perfectionism, high achiever, anxiety, black and white world views
Appearance teasing
Activities with emphasis on thinness (ballet, modeling, athletics)
Frequent dieting for weight loss or high body image concerns expressed around patient
Larger body size
Homosexuality in males
Acculturation in Western Society

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6
Q

What are biological risk factors for body dissatisfaction?

A

Possible genetic link

Anorexia = disturbances in serotonin, dopamine, and norepinephrine

bulimia = differences in serotonin

difficulty recognizing hunger and satiety

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7
Q

what are commonly associated psychological problems with body dissatisfaction (7)

A

obsessive-compulsive
anxiety/social anxiety disorder
depression
low self-esteem
phobias
body dissatifaction
body dysmorphic disorder

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8
Q

what are family factors involved in body dissatisfaction (5)?

A

enmeshed parenting
conflict-avoidant families
inflexibility
push for success
family members with body dissatisfaction or poor eating habits

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9
Q

rigid, controlling, organized family typically fits with which eating disorder

A

Anorexic

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10
Q

chaotic, critical, conflicted family fits with which disorder

A

bulimic/BED

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11
Q

what are sociocultural risk factors for body dissatisfaction?

A

western society ideals
Social feedback based on physical traits–> positive or negative adjustment of self-image

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12
Q

How are eating disorders related to parenting other than modeling?

A

Ineffective parents don’t respond appropriately to child’s needs ie feeding during anxiety vs hunger which interferes with self-ability to accurately identify hunger vs emotions

Eventually causes abnormal eating habits

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13
Q

what are cognitive risk factors for eating disorders?

A
  • thought that only thing that matters is body image
  • feelings that if not thin reflects on personal traits
  • mistrust for comparisons of appearance
  • often ignore or have difficulty accepting objective evidence of body state
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14
Q

How do you determine normal vs abnormal eating?

A

Patient’s weight
Health status
Body perception

Up to 80% of the population is dieting at any given time
40% of 9 year old girls have dieted

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15
Q

What are screening tools for eating disorders?

A

SCOFF questionnaire, ESP questionnaire, EAT form, PHQ form

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16
Q

When does avoidant/restrictive food intake disorder typically begin?

A

Infancy or early childhood and may persist into adulthood

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17
Q

Classic presentation of avoidant/restrictive food intake disorder?

A

Underweight child (average BMI-16)
decreased bone mineral density
comorbid anxiety (60%)
comorbid general medical disorder (50%)

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18
Q

What criteria must a patient have in order to be diagnosed with avoidant/restrictive food intake disorder?

A

Avoiding or restricting food intake
* due to lack of interest or sensory characteristics, or aversive experience

Persistent failure to meet nutritional or energy needs, as manifested by at least 1 of the following:
* clinical significant weight loss, poor growth or failure to achieve expected weight gain
* Nutritional deficiency
* oral supplements or enteral feeding required to achieve adequate nutrition
* impaired psychosocial functioning

Not due to lack of food or culturally restrictive practice, not due to general medical condition

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19
Q

What is epidemiology of anorexia nervosa?

A

Lifetime .6%
More common in women
Bimodal peak onset: early adolescence (12-15)
Late adolescence/early adulthood (17-21)
Average age at onset 18 y/o

Classic patient: adolescent white female

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20
Q

What are clinical findings of anorexia nervosa?

A
  • Restricted energy intake –> low body weight
  • Intense fear of weight gain, or persistent behavior preventing weight gain
  • Distorted perception of weight, undue influence of weight on self-worth, or denial of the medical seriousness of low weight
  • Abnormal food behaviors
  • Behavioral disturbances
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21
Q

How is severity of anorexia nervosa designated?

what is the BMI for each category?

A

Mild: BMI >17
Moderate: BMI 16-16.99
Severe: 15-15.99
Extreme: <15

22
Q

what are subtypes of anorexia nervosa?

A

Binge-eating
Restrictive

23
Q

What are abnormal food behaviors in anorexia nervosa?

A
  • reduction in total food intake
  • exclusion of high caloric foods
  • distaste for food or epigastric pain
  • food-related obsessions
24
Q

What are other common behavioral disturbances in anorexia nervosa?

A
  • distorted perception of part or all of body weight
  • may admit to being high avhiever or perfectionist
  • can have limited social activities
25
Q

what are observed findings with anorexia nervosa?
Psych, ____, ____, GI, Derm

A
  • psych: depression, irritability, fatigue, weakness
    bone pain
  • amenorrhea
  • GI: constipation, abdominal pain
  • derm: hair loss, brittle nails, russell’s sign
26
Q

What are severe starvation findings?

A
  • General: emaciation, hypothermia
  • derm: dry and flaky skin, lanugo, petechiae on extremities, sallow complexion
  • cardiovascular: significant hypotension, bradycardia, peripheral edema
  • bone: dental enamel erosion, osteoporosis
27
Q

What are big complications of anorexia nervosa to be aware of?

A

Cardiovascular complications: electrolyte abnormalities, arrhythmias
Pulmonary
Neuro

Basically body starts to shut down without nutrition it needs

28
Q

Death in anorexia nervosa patients most commonly results from what?

A

consequences of starvation, suicide, or electrolyte imbalance

29
Q

Why would you admit a anorexia nervosa patient?

A

signs of:
* unstable vitals or hypothermia
* end-organ complications: seizures, organ failure
* cardiac complications: low HR (<30 or <40 with hypotension or dizziness), cardiac dysrhythmias
* psych complications: suicidal ideation with high lethality plan or suicide attempt, acute food refusal, poor compliance, or acute psych emergency
* nutritional complications: weight <70% ideal body weight, marked dehydration, refeeding syndrome

30
Q

what is the main goal of anorexia nervosa treatment?

A
  • medical stability and management of complications
  • weigth stabilization and return to healthy weight
  • healthy nutrition and eating patterns
  • treat psychopathology
  • prevent relapse
31
Q

What are considerations for medication management of AN?

A

not first line treamtent
2nd gen antipsychotic (olanzapine), anxiolytic may help patients not gaining weight
SSRI may help if comorbid anxiety/depression

don’t want to pick escitalopram due to cardiac side effects
venlafaxine

usually pick prozac or paxil, prozac at higher doses can prevent relapse once weight is restored

32
Q

what is prognosis of anorexia nervosa?

A

50% good outcomes
25% intermediate outcomes
25% poor outcomes

35-55% eventually relapse

All cause mortality is 6x higher (medical complications 50% of deaths, suicide 25%)

33
Q

What is the epidemiology of bulimia nervosa?

A

1%
More common in women
Age of onset 18-20

classic patient: adolescent white female

34
Q

what are clinical findings in bulimia nervosa?

A
  • recurrent binge eating and inappropriate compensatory behaviors at least once a week for 3 months:

commonly vomiting, can be laxatives, enemas, diuretics, fasting

self evaluation is unduly influenced by body weight

35
Q

what are subtypes of bulimia nervosa?

A

purging and nonpurging

purging: self-induced vomiting or misuse of laxatives, diuretics, enemas

nonpurging: other inappropriate compensatory behaviors ie fasting, excessive exercise

36
Q

What is the typical pattern of bulimia nervosa?

A
  • caloric restriction
  • binge: consumption of large quantities of foods often in secret
  • compensatory mechanisms: often with guilt and depression

more control over timing of behaviors

37
Q

What are physical clinical findings of bulimia nervosa?

A
  • lethargy, irregular menses
  • cardiac: hypotension, tachycardia, peripheral edema
  • GI: constipation, abdominal pain, bloating, if vomiting eroded enamel and puffy cheeks
  • derm: hair loss, russell’s sign
  • body weight typically within or above the normal range

depends on type of compensatory mechanism

38
Q

what are complications of bulimia nervosa?

A
  • cardiac: rare, tachycardia, palpitations, edema, dysrhythmias
  • endocrine: menstrual irregularities, infertility, osteoporosis, DM
  • GI: salivary gland hypertrophy, loss of gag reflex, GI tract dysmotility, GERD, esophageal tears or rupture, malabsorption, diarrhea, constipation, pancreatitis
  • renal/electrolytes: dehydration, hypokalemia, hyponatremia, hypophosphatemia
  • pulmonary: aspiration pneumonitis
  • derm: xerosis, hair loss
39
Q

How is bulimia nervosa worked up?

A
  • UA and serum labs: BUN/Cr, electrolytes, LFTs, CBC with diff
  • If severely ill: ECG and serum calcium, magnesium and phosphorus
40
Q

Why would you admit a patient with bulimia nervosa?

A
  • unstable medical condition
  • suicidal ideation or other severe psychiatric decomensation
  • refusal of treatment with potential to become unstable
41
Q

how is BN managed?

A
  • Multimodal: nutritional rehab, psychotherapy, pharmacotherapy
  • CBT has advantage (not true in anorexia)
  • Antidepressants: SSRIs-fluoxetine 1st line
  • May try TCA if no improvement on SSRIs

BUPROPION IS CONTRAINDICATED in BN and anorexia(can cause seizures)

42
Q

what is the prognosis of BN?

A
  • 2x increase in all-cause mortality
  • High comorbidity with anxiety, depressive disorders, personality disorders, PTSD, and substance use
  • Higher risk of suicide attempt (25-40% patients)
  • 50-70% have short-term reduction of symptoms
  • 60% recover
  • 28% relapse
43
Q

what is the epidemiology of BED?

A

2.6% lifetime prevalence
more common in women
median age of onset-23 years

Less researched despite higher prevalence

44
Q

What are clinical findings of BED?

A
  • recurrent binge eating without compensatory behaviors
  • Severity depends on frequency per week
  • Food is coping or comfort
  • Continue eating after feel full
  • may eat very quickly
  • feelings of shame, guilt, and hopelessness
  • often try to hide part or all of their eating habits
45
Q

What are comorbidities with BED?

A
  • Overweight or obese
  • Impaired functioning
  • frequent comorbid psychological disorders: anxiety, ADHD, depression, PTSD, alcohol use, personality disorders, history of abuse
46
Q

What are complications of BED?

A
  • general: sleep changes, higher risk of cancer
  • MSK: muscle and joint pain, limited mobility
  • CV: heart disease, atherosclerosis, HTN, HF, CVA
  • Pulm: dyspnea on exertion, sleep apnea
  • Metabolic: development or worsening of obesity, DM and/or HLD
  • GI: abdoinal pain, GI upset
  • Psych: development or worsening of comorbid psych disorders
47
Q

Body dissatisfaction is a _____ in Western Societies

A

Cultural norm

48
Q

What labs should be ordered for all suspected anorexia patients?

A

ECG for cardiac dysrhythmias
UA for specific gravity

Serum labs
* CMP-electrolytes, kidney and liver function, protein, glucose
* Phosphorus
* Magnesium
* INR
* CBC with diff

49
Q

What is first line treatment for anorexia nervosa?

A

Multimodal approach with nutritional rehabilitation, psychotherapy, medical management

50
Q

What is the most common compensation in bulimia nervosa?

A

Vomiting

51
Q

What are severe clinical findings of bulimia nervosa?

A
  • Dehydration
  • Hypokalemia
  • Hypochloremia
  • Metabolic alkalosis
52
Q

How is BED managed?

A
  • Psychotherapy = first-line
  • Behavioral weight loss therapy

May try pharmacotherapy
* SSRIs = first-line
* Antiepileptic (topiramate, zonisamide)
* Lisdexamfetamine
* Antiobesity drugs not recommended due to SE and limited efficacy

Behavioral Dynamics (6 decks)

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