Eating Disorders

Question 1

What are the 3 core features in anorexia nervosa

Answer 1

1) restrictive calorie intake
2) fear of weight gain
3) disturbance in self perceived weight

Question 2

Subtypes/specifiers of anorexia nervosa

Answer 2

Restricting during last 3 months
Binge eating/purging during last 3 months

Question 3

Features associated with anorexia nervosa

Answer 3

Depression
Malnutrition
Decreased bone mineral density
Amenorrhoea
Decreased sexual interest
Obsessive compulsive features (preoccupied with thoughts of food)
Public eating concerns

Question 4

When do you admit a patient with anorexia nervosa?

Answer 4

<20% below expected weight for height = inpatient
<30% below expected weight for height = admit to psychiatric hospital for 2-6months
If there are complications of malnutrition = admit (risk of death therefore compulsory admission)

Question 5

What is the inpatient management of an anorexia nervosa patient?

Answer 5

Weight daily in morning after voiding
Monitor for vomiting and check electrolytes (avoid hypokalaemia)
Fluid intake and output monitored
Control vomiting = bathroom inaccessible until 2 hours after meal, someone monitoring bathroom
Constipation - relieved by normal eating/stool softener
Diarrhoea - due to laxative use
Feeds - 1500-2000 calories a day, 6 equal feeds: NB start slow to avoid refeeding syndrome
Liquid formula supplements

Question 6

What metabolic derangement do you get from laxatives?

Answer 6

Metabolic acidosis
>low sodium
>low potassium
>low chloride
>high hydrogen ions

Question 7

What metabolic derangement do you get from vomiting

Answer 7

Metabolic alkalosis
>hyponatraemia
>hypokalaemia
>hypochloraemia
>low hydrogen ions

Question 8

Metabolic derangements in anorexia nervosa?

Answer 8

Low WCC
Low RCC
Low LH
Low FSH
Low Testosterone
Low oestrogen
Increased GH
Increased cholesterol
Dehydration

Question 9

What are the characteristics of bulaemia nervosa?

Answer 9

Maintains normal weight
Episodes of binge eating combined with inappropriate ways of stopping weight gain (purging, laxatives, diuretics, enemas, increased exercise)
Eating terminated by physical discomfort (eg cramps, nausea)
Feelings of self disgust, guilt, depression

Question 10

How do you determine the severity of bulaemia nervosa?

Answer 10

By the extent of the inappropriate compensatory behaviours

Mild: 1-3times/week
Moderate: 4-7episodes/week
Severe: 8-13 episodes/week
Extreme: >/= 14 episodes/week

Question 11

Features associated with bulaemia nervosa

Answer 11

Normal/over weight
Knuckle marks (callouses from purging)
Tooth enamel damaged
Total caloric restriction between binges
Menstrual irregularities
Sexually active
Fluid and electrolyte imbalances
Cardiac and skeletal myopathy
GIT symptoms, rectal prolapse, laxative abuse
Life threatening = oesophageal tears, arrhythmias, gastric rupture

Question 12

When do you hospitalise a patient with bulaemia nervosa?

Answer 12

Electrolyte and metabolic disturbances
Eating binges out of control
Failed out patient treatment
Comorbid psychiatric conditions

NOT REQUIRED TO ADMIT UNCOMPLICATED PATIENT

Question 13

What are the characteristics of binge eating disorder?

Answer 13

The consumption of an abnormally large amount of food in a short space of time with no compensation after binge episode
>binge in private
>feeling of no control over eating, with feelings of guilt after

Question 14

How do you determine the severity of binge eating disorder?

Answer 14

Amount of times they binge eat

Mild: 1-3 episodes/week
Moderate: 4-7 episodes/week
Severe: 8-13 episodes/week
Extreme: >/= 14 episodes/week

Question 15

Psychotherapy in binge eating disorder

Answer 15

CBT
Interpersonal therapy
Group therapy

Question 16

What is the DSM criteria for rumination syndrome?

Answer 16

Criteria A: the repetitive regurgitation and refeeding of food occuring for 1month
Criteria B: is not attributable to GIT or other medical condition
Criteria C: does not exclusively occur during AN, BN, binge eating syndrome or restrictive/avoidant food intake disorder
Criteria D: if sx occur in context of another mental disorder, the symptoms are severe enough to warrant additional clinical attention

Question 17

DSM criteria for avoidant/restrictive food intake disorder

Answer 17

Criteria A: eating/feeding disturbance evidant by inability to meet nutritional/energy (due to sensory characteristic of food, lack of interest) characterised by:
1) significant weight loss or failure to gain weight in children
2) significant nutritional deficiency
3) dependence of enteral feeding or oral nutritional supplementation
4) marked interference with psychosocial functioning

Criteria B: not better explained by lack of food available
Criteria C: does not occur exclusively burning AN, BN (no evidence of disturbed body weight/shape experience)

Criteria D: eating disturbance is not attributable to another mental or medical condition

Question 18

DSM criteria for anorexia nervosa

Answer 18

Criteria A: restriction of energy intake relative to requirements leading to significantly low body weight relative to age, sex, developmental trajectory and physical health
Criteria B: intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain
Criteria C: disturbance in which one’s body weight or shape is experienced, undue influence of body weight and shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight

Question 19

DSM criteria for bulaemia nervosa

Answer 19

Criteria A: recurrent episodes of binge eating (characterised by: 1)increased amount of food consumed in a short period of time <2hrs which is more than another individual would consume in the same scenario and 2) a sense of lack of control of eating during the episode)

Criteria B: recurrent inappropriate compensatory behaviour in order to prevent weight gain
Criteria C: both A and B occur on average once a week for 3 months
Criteria D: self evaluation is unduly evaluated by body weight and shape
Criteria E: the disturbance does not exclusively occur during episodes of anorexia nervosa

Question 20

DSM criteria for binge eating disorder

Answer 20

Criteria A: recurrent episodes of binge eating (increased amount, feeling out of control)
Criteria B: episodes are associated with 3+
1) eating even when not feeling hungry
2) feelings of guilt/depression
3) eating alone because embarrassed of amount
4) eat more rapidly that normal
5) eating until feeling of uncomfortably full

Criteria C: marked distress regarding binge eating
Criteria D: occurs on average once a week for 3 months
Criteria E: binge eating is not associated with recurrent use of inappropriate compensatory behaviour with in anorexia nervosa and bulaemia nervosa.