Eating Disorders

Question 1

What characterizes eating disorders (EDs)?

Answer 1

Body dissatisfaction related to overvaluation of a thin body ideal, dysfunctional patterns of cognition, and weight control behaviors leading to biologic, psychologic, and social complications.

Question 2

Who can develop eating disorders?

Answer 2

Individuals of any age, gender, sexual orientation, ethnicity, or cultural background.

Question 3

What improves the outcome in eating disorders?

Answer 3

Early intervention.

Question 4

What are the key features of anorexia nervosa (AN)?

Answer 4

Significant overestimation of body size, relentless pursuit of thinness, and behaviors like dieting and compulsive exercising.

Question 5

What distinguishes the binge-purge subtype of anorexia nervosa?

Answer 5

Intermittent overeating followed by attempts to rid calories through vomiting or laxatives.

Question 6

What characterizes bulimia nervosa (BN)?

Answer 6

Episodes of eating large amounts of food followed by compensatory behaviors like vomiting, laxative use, exercise, or fasting.

Question 7

What is Other Specified Feeding and Eating Disorders (OSFED)?

Answer 7

A subcategory for individuals not meeting full AN or BN criteria, requiring close monitoring over time.

Question 8

What is avoidant/restrictive food intake disorder (ARFID)?

Answer 8

Limiting food intake based on subjective qualities without concern about body image, leading to unintended weight loss or nutritional deficiencies.

Question 9

What is binge eating disorder (BED)?

Answer 9

Binge eating episodes without regular compensatory behaviors.

Question 10

What are the DSM-5 criteria for anorexia nervosa (AN)?

Answer 10

Restriction of energy intake, intense fear of gaining weight, and disturbance in body weight perception.

Question 11

How is the severity of anorexia nervosa classified?

Answer 11

Based on BMI: Mild (≥17), Moderate (16-16.99), Severe (15-15.99), and Extreme (<15).

Question 12

What are the DSM-5 criteria for bulimia nervosa (BN)?

Answer 12

Recurrent binge eating, inappropriate compensatory behaviors, and self-evaluation influenced by body shape and weight.

Question 13

What is the minimum frequency for compensatory behaviors in bulimia nervosa?

Answer 13

At least once a week for 3 months.

Question 14

How is the severity of bulimia nervosa classified?

Answer 14

By frequency of compensatory behaviors: Mild (1-3/week), Moderate (4-7/week), Severe (8-13/week), Extreme (≥14/week).

Question 15

What is the classic presentation of anorexia nervosa?

Answer 15

Early to middle adolescent female, above-average intelligence, conflict-avoidant, risk-aversive perfectionist.

Question 16

What is the classic presentation of bulimia nervosa?

Answer 16

Emerges in later adolescence, sometimes evolving from AN, associated with impulsivity and depression.

Question 17

What are the common comorbidities of avoidant/restrictive food intake disorder (ARFID)?

Answer 17

Anxiety disorders and autism spectrum disorder.

Question 18

What influences the gender disparity in eating disorders?

Answer 18

Stronger relationship between body image and self-evaluation in females and societal thin body ideals.

Question 19

What are common triggers for eating disorders?

Answer 19

Peer teasing, family interactions, and societal messages.

Question 20

What is the role of genetics in eating disorders?

Answer 20

Genetic predisposition to anxiety, depression, or obsessive-compulsive traits.

Question 21

What reinforces disordered eating behaviors in patients with EDs?

Answer 21

Biologic effects of malnutrition and positive reinforcement from reduced anxiety or emotional reactivity.

Question 22

What neurotransmitters are altered in eating disorders?

Answer 22

Serotonin and dopamine.

Question 23

What are the physical manifestations of anorexia nervosa?

Answer 23

Hypothermia, acrocyanosis, bradycardia, orthostasis, and muscle mass loss.

Question 24

What differentiates ARFID from other eating disorders?

Answer 24

Disturbance in neurosensory processes related to eating, not weight loss or body image concerns.

Question 25

What conditions mimic anorexia nervosa?

Answer 25

Hyperthyroidism, malignancy, celiac disease, Addison disease, and type 1 diabetes mellitus.

Question 26

What CNS conditions mimic eating disorders?

Answer 26

Craniopharyngiomas, Rathke pouch tumors, and mitochondrial neurogastrointestinal encephalomyopathy.

Question 27

What is the treatment significance of early satiety in EDs?

Answer 27

Linked to gastric atony in AN, not malabsorption.

Question 28

How does purging behavior reinforce bulimia nervosa?

Answer 28

Reduces anxiety and improves mood through neurotransmitter changes.

Question 29

What is the basis for diagnosing an eating disorder (ED)?

Answer 29

The diagnosis of an ED is made clinically and not through confirmatory laboratory tests.

Question 30

What routine lab tests are typically included when screening for ED?

Answer 30

Complete blood count, erythrocyte sedimentation rate, and a biochemical profile.

Question 31

What electrolyte imbalance is associated with severe vomiting in ED?

Answer 31

Hypokalemic, hypochloremic metabolic alkalosis.

Question 32

What ECG findings may be present in ED patients?

Answer 32

Low voltage, nonspecific ST or T-wave changes, and sometimes prolonged QTc.

Question 33

What are the most concerning organ targets of medical complications in ED?

Answer 33

The heart, brain, gonads, and bones.

Question 34

What is refeeding syndrome, and what does it cause?

Answer 34

Refeeding syndrome results from a rapid drop in serum phosphorus, magnesium, and potassium with excessive reintroduction of calories, causing acute tachycardia, heart failure, and neurologic symptoms.

Question 35

What are common reversible brain changes seen in anorexia nervosa (AN)?

Answer 35

Increased ventricular and sulcal volumes that normalize with weight restoration.

Question 36

What hormonal changes contribute to amenorrhea in AN?

Answer 36

Reduced gonadotropins due to hypothalamic dysfunction and physical/emotional stress.

Question 37

What is the significance of decreased bone mineral density (BMD) in ED?

Answer 37

It leads to osteopenia or osteoporosis, more pronounced in AN than in bulimia nervosa (BN).

Question 38

What dietary adjustments are recommended early in treating AN?

Answer 38

Gradually increasing caloric intake by 100-200 kcal increments every few days to support weight gain.

Question 39

What cognitive pattern is typical in patients with AN?

Answer 39

All-or-none thinking, overgeneralization, and catastrophic conclusions.

Question 40

How does refeeding in AN patients minimize the risk of refeeding syndrome?

Answer 40

By proceeding carefully, especially if weight is below 80% of the expected weight for height.

Question 41

What is the role of family-based treatment in adolescent AN?

Answer 41

It involves parents actively supporting healthy eating and weight restoration while professionals provide guidance.

Question 42

What is the first-line treatment for depressive symptoms in AN?

Answer 42

Food and weight restoration, as SSRIs are ineffective in underweight patients.

Question 43

What therapy is most effective for BN patients?

Answer 43

Cognitive-behavioral therapy, often combined with SSRIs.

Question 44

What are potential indications for inpatient hospitalization of AN patients?

Answer 44

Heart rate <50 beats/min, blood pressure <80/50 mm Hg, hypokalemia, hypoglycemia, body weight <80% of healthy weight.

Question 45

How do eating disorder partial hospital programs function?

Answer 45

They provide outpatient services for 4-5 days a week, focusing on meals, group therapy, and real-life challenges.

Question 46

What is the prognosis for AN with early diagnosis and effective treatment?

Answer 46

≥80% recover with normal eating and weight control habits and resumed menses.

Question 47

What prevention strategies for EDs are recommended?

Answer 47

Targeted interventions for high-risk groups, avoiding programs that normalize or glamorize EDs.