eating disorders

Question 1

obesity definition

Answer 1

excessive amt body fat vs lean body mass, BMI >30

Question 2

tx of obesity

Answer 2

most interventions show little to no difference
behavioral weight loss treatment has strong research support in short term, maintenance problematic
morbidly obese pts w bariatric surgery = most effective long term intervention

Question 3

bariatric surgeries

Answer 3

roux-en-y gastric bypass
vertical sleeve gastrectomy
less than 0.5% mortality
*reduces cardiac risk and mortality rates, type 2 DM, psych symptoms

Question 4

anorexia nervosa criteria

Answer 4

1- body weight below 85% expected
2- intense fear of gaining wt or becoming fat although underweight
3- disturbance in body wt/shape experiences, undue influence on self-evaluation, or denial of seriousness of low body wt

Question 5

subtypes of anorexia nervosa

Answer 5

restricting type

binge/purge type

Question 6

severity levels of anorexia nervosa

Answer 6

mild: BMI >17
moderate: 16-16.99
severe: 15-15.99
extreme: less than 15

Question 7

epidemiology of AN

Answer 7

.4% females, 10x more in F vs M
peak onset a/w stressor b/t 14-18 yo
risk factors: middle-upper class, female, involved in activities valuing thinness (ballet, swimming, gymnastics)

Question 8

prognosis for AN

Answer 8

variable course and outcome
most in remission w/i 5 years, lower if hospitalization required
mortality 5%
improved prognosis w early dx and tx

Question 9

tx for AN

Answer 9

m/c: outpatient

family therapy, CBT

Question 10

complications of AN

Answer 10

dehydration, electrolyte imbalances, arrhythmia (low K), dilated intestines -> constipation, dental problems, altered brain composition, low platelets and RBC/WBCs d/t hypoglycemia, amenorrhea, osteoporosis, infertility, low T (males), edema, dry skin (xerosis), lanugo, acrocyanosis (blue hands and feet), renal failure, hyperthyroid and bradycardia, dizziness, mitral valve prolapse

Question 11

bulimia nervosa criteria

Answer 11

1- recurrent episodes of binge eating, including feeling of lack of control during eating
2- recurrent inappropriate compensation to prevent wt gain (vomiting, laxatives, diuretics, enemas, fasting, excessive exercise)
3- binge eating and compensation at least 1/w for 3 months
4- self-eval influenced too much by body wt/shape
5- disturbance not exclusively during AN episodes

Question 12

severity level for BN

Answer 12

mild: 1-3 compensatory episodes per week
moderate: 4-7 episodes
severe: 8-13 episodes
extreme: 14+ episodes

Question 13

epidemiology of BN

Answer 13

1-1.5% young F, possibly ~20% college F
m/c: young F, F»M
2% mortality per decade
RF: childhood obesity, early puberty, hx abuse, anxiety, low self image, depression, wt concerns

Question 14

prognosis for BN

Answer 14

best for young pts with early intervention and supportive friends

Question 15

tx for BN

Answer 15

therapy (most effective): CBT*, IPT, family therapy
antidepressants (SSRIs)
healthy weight program (?)

Question 16

complications of BN

Answer 16

purging can lead to: abdominal pain, bloating, sore throat, esophageal complications, constipation, dehydration, enlarged parotids, finger calluses, dental problms, hematemesis, gastric rupture, aspiration pneumonia
lower BMR -> weight gain
laxatives/diuretics: low fluids, water retention, low K (arrhythmia), poor bowel motility, cramps
menstrual irregularities, infertility, osteoporosis

Question 17

personality d/o in restricting AN

Answer 17

23% have OCPD

19% have avoidant personality d/o

Question 18

personality d/o with binge-purge disorders (AN subtype, BN)

Answer 18

borderline personality disorder in 26% binge-purge AN and 28% BN

Question 19

criteria for binge eating d/o

Answer 19

1- recurrent binge eating episodes
2- binges a/w 3+ of: eating more rapidly than usual, eating until uncomfortably full, eating when not hungry, eating alone d/t embarrassment, feeling disgusted or guilty after overeating
3- marked distress
4- occurs avg 2/week for 6 mos
5- no regular use of compensatory behavior, not exclusively during AN or BN

Question 20

epidemiology of binge eating disorder

Answer 20

m/c eating disorder
40% are male
average onset: teens, avg tx: 30 yo
risk factors: family hx, biological factors, long-term dieting, psychological issues

Question 21

tx for BED

Answer 21

psychotherapy: CBT, interpersonal psychotherapy
meds: antidepressants, anticonvulsants (topamax)
behavioral weight loss programs after stabilized

Question 22

other specified feeding or eating disorders

Answer 22

• atypical AN (normal weight, all other sx same)
• BN behaviors at lower frequency than required
• BED behaviors but lower frequency
• purging disorder
• night eating syndrome

Question 23

factors determining level of care needed for eating disorders

Answer 23

weight, cardiac, metabolic status*
potential for suicidal behaviors
requirement of hospitalization (poorer prognosis, tx less effective, gray matter deficits persist)
effectiveness of other tx, co-morbid psych conditions

Question 24

issues addressed in therapy for eating disorders

Answer 24

maladaptive patterns of eating-related behaviors (restricting, binge-purge, excessive exercise), disturbed attitude about body weight, powerlessness, need for control or perfection
mistrust, relationship problems, lack of assertiveness, difficulty expressing negative emotions, mood disturbances, body shame, self-esteem, body/wt checking behavior, etc.