Eating Disorders Flashcards
Mortality rate of anorexia
10%
Average age of onset for anorexia
14-18
Common co-morbidities w/ anorexia
Depression (65%), social phobia (35%) and OCD (25%).
What biological factors are involved w/ anorexia?
Diminished NE and thyroid function. Increased 5HT and HPA axis activation.
DSM Criteria for anorexia
3 main things
2 subtypes
- A – Restriction of energy intake –> low body weight.
- B – Intense fear of gaining weight / becoming fat, or persistent behavior that interferes w/ weight gain, even though at a significantly low weight
- C – Disturbance in the way in which one’s body weight or shape is experienced, strong influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
- Restricting type – During last 3 months: individual has not engaged in binge eating / purging or use of laxative, diuretics, or enemas. Weight loss is achieved through dieting, fasting or excessive exercise
- Binge eating / purging type – During last 3 months: recurrent episodes of binge eating or purging. Main diff b/w this and bulemia: Bulemia pxs don’t restrict calories and aren’t nearly as underweight as anorexia pxs. No fear of gaining weight as seen in anorexia.
Consequences of anorexia
Dehydration, hypothermia, bradycardia, hypotension, electrolyte disturbances, amenorrhea
Predictors of poor outcome for anorexia
longer duraction of illness, OLDER AGE AT ONSET, prior psychiatric hospitalization, poor pre-morbid adjustment, co-morbid personality disorder.
Medical complications of purging
Hypocalcemia, hypokalemia, metabolic alkalosis, ECG changes, fatty degneration of liver, malnutrion, parotid gland enlargement
DSM Criteria for Bulemia (5 things)
- A – Recurrent episodes of binge eating and sensing a lack of control over eating
- B – Compensatory behaviors to prevent weight gain including vomiting, laxatives, diuretics, fasting, or excessive exercise
- C – Binging / purging occurs at least twice a week for 3 months
- D – Self-evaluation is strongly influenced by body shape / weight
- E – Disturbance does not occur only during episodes of anorexia
Treating eating disorders
- Hospitalization for severe starvation, hypotension, hypothermia, electrolyte imbalance, depression, or suicidal ideation.
- CBT – emphasizes monitoring food intake, binging / purging, identification of emotions, challenging distorted beliefs about self-image.
- Interpersonal psychotherapy – effective for bulimia and binge eating disorder due to common interpersonal stressors triggering binging.
- Maudsley Method – Tx anorexia in girls greater than 18 y/o living at home. Gives parents permission to set reasonable, healthy expectations at each meal
- Fluoxetine (SSRI) is helpful for anorexia and bulimia
- TCA’s are contraindicated in pxs w/ anorexia due to risk of cardiac rhythm disturbance
- Bupropion is contraindicated in pxs w/ anorexia and bulimia due to risk of seizures
- Atypical antispychotics may tx distorted beliefs about weight
- Naltrexone (opioid antagonist) and ondansetron (5HT3 receptor antagonist; anti-emetic) are useful for bulimia
- Both refeeding and return to healthy weight may have antidepressant effects
What is re-feeding syndrome?
Sudden shift from fat to carb metabolism and sudden increase in insulin may lead to increased cellular uptake of phosphate as well as a fall in serum phosphate, K, Mg, glucose, and thiamine. May cause respiratory failure, cardiac failure, hypotension, irregular heartbeats, seizures, coma, or sudden death. Avoid by using progressive calorie / electrolyte / vitamin intake.
Diff dx for eating disorders
Seizures, tumors, TB, type 1 DM.
All may cause weight loss.
What is a common delusion in eating disorders/
That someone is poisoning their food
How is body dysmorphic disorder diff than eating disorders?
Body dysmorphic disorder is usually regarding 1 specific part of body, not weight.
