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Flashcards in Eating Disorders Deck (17):
1

Obesity: etiology

Now a medical disorder;
more than 20% over ideal weight or BMI>30;

1. genetic component (leptin receptor mutation, melanocortin 4 receptor mutation)
2. Iatrogenic (anti-psychotics and/or anti-depressants; block H1 for increased appetite, Achm that can increase your weight, 5HT2c receptors)
3. Lifestyle: sedentary, depends on CARS, increased fat/carb content and processed food

2

Manage and Course of Obesity:

1. Try commercial dieting and weight loss programs, but ineffective maybe for long term
2. Surgery (bariatric and also gastric banding)
3. Pharm: amphetamines (decrease appetite), orlistat (lipase inhibitor and can lead to diarrhea that's foul-smelling), topiramate and zonisamide (anti-convulsants)
4. Realistic diet and exercise

3

Anorexia DSM-5 diagnosis and types

1. refusal to maintain 85% typical weight (DSM-IV)
2. Restriction of energy intake requirements = LBW
3. Fear of gaining (won't eat a cheerio)
4. Body image disturbance (dysmorphism)
5. Missed menstrual cycles at least 3 times (DSM-IV)

Types:
1. restricting (won't eat, won't purge)
2. Binge/purge type (does binge or purge)
3. Severity based upon BMI!!!!

4

Some facts about AN:

1. Female > male (increasing in males thanks to things like Adonis complex)
2. Individual socioeconomics unrelated!!!
3. Industrialization related, perhaps job related (model or gymnast), media related
4. Patients work around food or have expertise
5. think TYPE A personality with being rigid, controlling, high-acheving
6. Not as high ADDICTION rates, but depression and suicide can occur!!!

5

Etiology of AN:

1. There is a genetic component (family mood/drug disorders)
2. ?Neurepinephrine imbalance-low
3. Endogenous opiate imbalance-high
4. Media/industry
5. Family sacrifice (works three jobs for you to go to Harvard)
6. Fears independence and maturation (don't want to grow up so you look small/thin)
7. Lack sense of autonomy/self
8. Feel need to take control in life or are being rigidly controlled!!

6

What tends to run with AN (comorbidity)?

1. Depression 50%
2. Suicide increase
3. OCD and anxiety disorders
4. Think rigid and PERFECTIONISTIC TRAITS
5. Denial, minimization, delusion (comes later in unit)

7

List of med issues for AN?

1. Weight loss and now more sens to 2. hypothermia!!
3. Edema (less protein so water leaks out)
4. Bradycardia, hypotention, SYNCOPE!!
5. Amenorrhea
6. Electrolyte imbalance, HYPOKALEMIA!!
7. ST, T, QT cardiac changes!!
8. Lanugo hair
9. Osteoporosis
10. Delayed gastric emptying
11. Metabolic acidosis
12. Organ failure

8

Course of AN:

1. from spontaneous recovery to gradual starvation and death
2. Recovery is partial: food preoccupation, but then poor social relations and depression continue (harm reduction method)
3. Have to admit hunger, loss of denial, mature and increase esteem to favor prognosis
4. Bulimia aspects COULD contiue

9

Treat AN:

HOSPITALIZATION!!
1. restore nutritional state if 20% typical weight lost; 2-6 months if 30% lost
2. FORCED TUBE FEEDINGS if severe, you see end organ damage, or have electrolyte (hypokalemic) or cardiac findings; maybe patient unwilling to comply!!
3. Need FIRM consistency (you need to stay at a certain weight for me or you will be HOSPITALIZED!!)
4. Behavioral plan

10

Programming:

1. AM weights
2. I/Os
3. Labs
4. Inaccessible bathrooms
5. Progressive diets yield rewards (token economy if they put weight back on)
Keep treatment going during day, THEN as outpatient if you feel good enough about them

11

Psychotherapy for AN?

1. Psychodynamic
2. CBT (token economy)
3. Family (parents might be part of the problem)

12

Bulimia nervosa criteria

1. recurrent binge eating: eating atypically large amount in discrete period of time disproportionate to typical eating
2. Purging vs. non-purging types
3. NO ANOREXIA present
4. Loss of control (feel compelled)
5. Compensatory behaviors!!!: vomiting, laxative use, enemas, diuretics, exercise
6. BINGES 1x/week for 3 months
7. NEED COMPENSATORY BEHAVIORS to make diagnosis

13

BN facts/etio/comorbid:

1. Prev: bulimia > anorexia
2. Female > male
3. Later onset
4. Normal to obese premorbidly (NOT SKINNY)
5. Think personality disorder and substance abuse (NOT TYPE A personality)
6. Maybe serotonin loss (use SSRI's)
7. Increased ENDORPHINS
8. Perfectionism (as a society)
9. Again dysfunctional family, but less rigid, more conflicted
10: outgoing, angry, impulsive traits, BORDERLINE personality
11. More addiction and anxiety

14

Medical issues with BN:

1. poor dentition: ENAMEL LOSS!!
2. Abraided knuckles (RUSSELL'S SIGN)
3. Normal/overweight
4. SEXUALLY ACTIVE (AN not as much)
5. Labs: LOW PO4, LOW Mg
6. Salivary enlargement (throw up a lot = larger glands)
7. Esophagitis/tears in esophagus

15

Course of BN; treat:

1. better than anorexia
2. wax/wane course
3. 3 yr follow up: 30% do well

1. Individual therapy (CBT, group, family therapy)
2. Meds (SSRI's)
3. Thorough med evaluation and follow-up
4. Thorough psychiatric evaluation
5. hospitalization RARELY needed

16

Meds for BN:

1. antidepressants (SSRI's APPROVED!!)
2. If not 1, use imipramine, desipramine (both TCA), maybe trazodone or MAOi

17

Other diagnoses:

1. Avoidant/restrictive food intake disorder: know that it DOESN'T MEET FULL ANOREXIA CRITERIA
2. Binge eating disorder (NO PURGES OR COMPENSATIONS)