Eating Disorders

Question 1

What is the core diagnostic feature of anorexia nervosa?

Answer 1

intentional Persistent restriction of caloric intake, leading to significantly low body weight
❗ Distorted perception of body weight and shape
Feels “fat” even when emaciated
Rigid food rules and fear of gaining weight

Question 2

What are the key physical signs characteristic of anorexia nervosa?

Answer 2

hypothermia, hypotension, bradycardia, secondary amenorrhea (due to hypothalamic suppression), osteoporosis, hair loss, lanugo

Question 3

At what age is anorexia nervosa most likely to begin? ⏳

Answer 3

Most common onset: early teens

Question 4

What are the two subtypes of anorexia nervosa, and how do they differ? ⚖️

Answer 4

Question 5

What methods are used for purging in the binge/purge subtype of anorexia nervosa? 🧪

Answer 5

A:
✔️ Most often: Self-induced vomiting
✔️ Frequently: Laxative abuse
✔️ Less frequently: Diuretic use
✔️ Occasionally: Use of emetics

Question 6

What unusual behavior may occur in patients with anorexia nervosa related to food? 🍲📸

Answer 6

A:
✔️ Collecting recipes
✔️ Preparing elaborate meals for others (without eating them)

Question 7

How can you clinically differentiate between the restrictive vs. purging subtype in anorexia nervosa? 🔍

Answer 7

A:
✔️ Restrictive type: No evidence of bingeing/purging; only strict dietary limitation
✔️ Purging type: Presence of bingeing and/or compensatory purging (vomiting, laxatives)

Question 8

Q: What defines bulimia nervosa

Answer 8

Feature

✔️ Recurrent episodes of binge eating
✔️ Followed by compensatory behaviors:

Vomiting
Laxative use
Excessive exercise
✔️ Body image distortion may be present but less severe
✔️ Body weight is often normal or near normal

Question 9

Answer 9

Question 11

What characterizes bulimia nervosa, and is vomiting always present?

Answer 11

:
✔️ Characterized by recurrent, frequent binge eating
✔️ May occur with or without vomiting
✔️ Purging methods can include vomiting, laxatives, diuretics, or enemas

Question 12

What is the most appropriate next step in evaluating a patient with suspected weight loss when the complaint is subjective or conflicting?

Answer 12

📌 Step 1: Calculate BMI

✔️ Conflicting reports (e.g. from patient and parent) require objective data.
✔️ BMI is the first and most basic tool in assessing suspected weight loss.
❌ Avoid jumping to lab tests before confirming actual weight loss.

Question 13

Does a normal BMI exclude an eating disorder such as bulimia nervosa?

Answer 13

❌ No — Normal BMI ≠ No Eating Disorder

📌 Bulimia nervosa often presents with normal BMI.
✔️ Requires additional questioning about:
Binge-eating
Purging
Compensatory behaviors

Question 14

What laboratory investigations are indicated if a patient’s BMI is found to be low (<18)?

Answer 14

BMI

✔️ (1) Complete blood count (CBC)
✔️ (2) Blood chemistry
✔️ (3) Serum potassium level (🧪 check for hypokalemia → vomiting/purging)
✔️ (4) Thyroid function tests (to assess for hyper/hypothyroidism)

Question 15

What are the main medical complications seen in restrictive-type anorexia nervosa?

Answer 15

A:
✔️ Vital signs: bradycardia, orthostatic hypotension, hypothermia (with lanugo hair)
✔️ CNS: generalized brain atrophy, enlarged ventricles, seizures, abnormal EEG
✔️ Cardiovascular: peripheral edema, reduced cardiac size, thinning of left ventricular wall, superior mesenteric artery syndrome
✔️ Renal: pre-renal azotemia
✔️ Hematological: anemia, leukopenia
✔️ Metabolic: elevated liver enzymes, hypercholesterolemia, hypoglycemia

Question 16

Why are prolactin levels elevated in anorexia nervosa?

Answer 16

A:
✔️ Decreased thyroid function → increased TRH → stimulation of prolactin secretion

Question 17

What are the common laboratory abnormalities seen in anorexia nervosa (restricting type and Burging type)?

Answer 17

✔️ Elevated: Cholesterol, liver enzymes, cortisol, GH, prolactin
✔️ Decreased: LH, FSH, estrogen/testosterone, T3 / glucose
✔️ Fluid/electrolyte: Prerenal azotemia, dehydration
✔️ GI: Low lipase/lactase

Question 18

What are the key metabolic complications of bulimia nervosa and binge/purge type anorexia nervosa?

Answer 18

A:
✔️ Hypokalemic alkalosis or acidosis
✔️ Hypochloremia
✔️ Dehydration

Question 19

How does repeated vomiting in purging-type anorexia nervosa lead to hypokalemic hypochloremic metabolic alkalosis?

Answer 19

A:
✔️ Repeated vomiting causes loss of hydrogen (H⁺) and chloride (Cl⁻) ions, leading to metabolic alkalosis.
✔️ In the kidneys’ distal tubule, hydrogen ions are reabsorbed in exchange for potassium secretion into urine.
✔️ This process results in hypokalemia and hypochloremia alongside metabolic alkalosis—known as hypokalemic hypochloremic metabolic alkalosis.
✔️ This lab finding supports purging-type anorexia nervosa, as restrictive-type does not include vomiting.

Question 20

What are the additional lab findings seen in purging-type anorexia nervosa?

Answer 20

Mnemonic: “PUKE’S BAD”

P – Parotid gland swelling (later finding)
U – Urine issues (dehydration, renal failure)
K – K+ loss → Hypokalemia
E – Electrolyte imbalance (hypochloremia, acidosis ( rare )/alkalosis(common) )
S – Serum amylase ⬆️ (from vomiting/stress on pancreas)
B – Bicarbonate ↑ (if alkalosis)
A – Ammonia may be mildly ↑ (from renal impairment)
D – Dehydration 🥵

Question 21

What cardiovascular complication is commonly associated with purging behaviors in eating disorders? ❤️⚠️

Answer 21

Arrhythmias (due to electrolyte imbalances like hypokalemia)

Question 22

What dental finding is typically seen in purging-type eating disorders? 😬🦷

Answer 22

Loss of enamel on the lingual surfaces of the teeth (due to repeated vomiting)

Question 23

What are the classic gastrointestinal complications found in bulimia nervosa and binge/purge anorexia? 🧪😮‍💨

Answer 23

A: ✔️ Swollen parotid glands ✔️ Elevated serum amylase levels

Question 24

How do the metabolic and dental findings help differentiate between restrictive and purging types of anorexia nervosa? 🔍

Answer 24

A: ✔️ Findings like hypokalemia, enamel loss, and swollen parotids strongly suggest purging subtype ✔️ These are absent in restrictive type

Question 25

What changes occur in the thyroid hormone profile of a patient with anorexia nervosa?

Answer 25

Nervosa ✔️ T3 (Triiodothyronine) – ⬇️ Decreased Due to reduced peripheral conversion of T4 → T3 >> Helps slow metabolism during starvation ✔️ T4 (Thyroxine) – Normal or ⬇️ Low ✔️ Reverse T3 (rT3) – ⬆️ Increased Inactive form of T3 Elevated as a metabolic adaptation to conserve energy ✔️ TSH (Thyroid Stimulating Hormone) – Low

Question 26

What electrolyte and acid–base abnormalities are commonly associated with bulimia nervosa (especially purging)?

Answer 26

: ✔️ Hypokalemia (↓ K⁺) ✔️ Hypochloremia (↓ Cl⁻) ✔️ Metabolic alkalosis most common (especially with vomiting) ✔️ Metabolic acidosis (possible with laxative abuse) ✔️ Dehydration from fluid loss

Question 27

True or False — Hypokalemic alkalosis is a possible metabolic complication of vomiting in bulimia nervosa.

Answer 27

Why? ✔️ Vomiting → loss of H⁺ and Cl⁻ → metabolic alkalosis ✔️ Accompanied by hypokalemia due to renal compensation

Question 30

What is the most common cause of death in patients with anorexia nervosa?

Answer 30

A: ✔️ Medical complications related to severe malnutrition and low body weight are the leading cause of mortality in anorexia nervosa.

Question 31

How does the mortality risk in anorexia nervosa compare to the general population, and what are the main causes of death?

Answer 31

A: ✔️ Individuals with anorexia nervosa are up to six times more likely to die compared to the general population. ✔️ The majority of deaths are due to medical complications related to low weight and malnutrition. ✔️ A smaller but significant portion (~20%) of deaths result from suicide.

Question 32

Which personality disorder is most commonly associated with bulimia nervosa?

Answer 32

Borderline Personality Disorder (BPD)

Question 33

what are the key features of binge -eating disorder?

Answer 33

individuals. ✔️ Characterized by recurrent binge episodes involving large amounts of food eaten rapidly. ✔️ Unlike bulimia nervosa, no compensatory behaviors (e.g., vomiting, laxatives) follow binge episodes. ✔️ Binge episodes usually occur in private and involve calorie-dense foods. ✔️ Patients feel a loss of control over their eating during binges.

Question 34

What is the core feature shared by binge-eating disorder and bulimia nervosa?

Answer 34

Both disorders involve recurrent binge eating episodes.

Question 35

How does binge-eating disorder differ from bulimia nervosa regarding compensatory behaviors?

Answer 35

A: ✔️ Binge-eating disorder does not involve compensatory behaviors such as vomiting, laxative abuse, or excessive dieting. ✔️ Bulimia nervosa includes recurrent compensatory behaviors after binge episodes.

Question 36

How common is a prior history of anorexia nervosa among patients diagnosed with bulimia nervosa?

Answer 36

Approximately 50% of bulimia nervosa patients have experienced a prior episode of anorexia nervosa.

Question 37

What characterizes purging disorder, and how is it different from bulimia nervosa?

Answer 37

A: ✔️ Purging disorder involves recurrent purging behaviors without binge eating. ✔️ Patients are generally of average weight but have a distorted body image. ✔️ Purging behaviors include vomiting, laxative abuse, enemas, and diuretics.

Question 38

What defines night-eating syndrome?

Answer 38

A: ✔️ Characterized by large food consumption after the evening meal. ✔️ Patients typically have little appetite during the day. ✔️ Often associated with insomnia.

Question 39

What is considered the benchmark, first-line treatment for bulimia nervosa, and what does it involve?

Answer 39

A: ✔️ Cognitive Behavioral Therapy (CBT) is the first-line treatment. ✔️ It involves about 18 to 20 manual-guided sessions over 5 to 6 months. ✔️ CBT targets:  1. Interrupting the cycle of bingeing and dieting  2. Altering dysfunctional beliefs about food, weight, body image

Question 40

Which medications have evidence supporting their use in bulimia nervosa?

Answer 40

A: ✔️ Fluoxetine (SSRI) is the most supported antidepressant. ✔️ Topiramate may reduce binge episodes but is not first-line. ✔️ Caution with some SSRIs (e.g., citalopram) due to QT prolongation risks at higher doses.

Question 41

What is the most common eating disorder, and what are its key features?

Answer 41

: ✔️ Binge-eating disorder is the most common eating disorder. ✔️ Lifetime prevalence in the U.S.:  * Women: ~3.6%  * Men: ~2.1% (least gender-divided among eating disorders) ✔️ More prevalent among overweight and obese individuals.

Question 42

What is the general prognosis and mortality rate of anorexia nervosa?

Answer 42

A: ✔️ Prognosis is generally poor. ✔️ Mortality rates range from 5% to 18%. ✔️ Favorable outcome indicators:  - Admission of hunger  - Lessening of denial and immaturity  - Improved self-esteem

Question 43

Which subtype of anorexia nervosa is associated with a higher suicide risk?

Answer 43

A: ✔️ Binge eating-purging type has a higher suicide rate compared to restricting type.

Question 44

What are the challenges in using dynamic expressive-supportive psychotherapy for anorexia nervosa?

Answer 44

A: ✔️ Patients often resist therapy, making the process difficult and painstaking. ✔️ This therapy is sometimes used, but adherence can be limited.