Flashcards in Eating Disorders Deck (25)
What are the risk factors for developing an eating disorder ?
High achieving perfectionists with low self esteem
Assoc with depression and substance misuse
10% of cases are male
Is there a genetic component to eating disorders ?
Monozygotic twin concordance 65% in AN
Unlikely to be a genetic link in BN
What is the psychological theory regarding the aetiology of anorexia nervosa?
Successful weight loss gives patient sense of autonomy and achievement during times when life feels uncontrollable.
Avoiding separation from family
What is the sociocultural theory of the aetiology of anorexia nervosa?
Social pressures to be thin
Promotion of dieting
High risk groups:
Models, athletes, dancers
What elements of family life might contribute to development of anorexia nervosa?
Family enmeshment: over involved, poor boundaries
What factors may contribute to development of bulimia nervosa ?
Perfectionism and low self esteem
Promotion of dieting, pressure to be thin
History of obesity
Disturbed family dynamics
Parental weight concern
High parental expectation
Fhx: obesity, depression, substance misuse
What is the clinical presentation of anorexia nervosa?
What are physical complications of anorexia nervosa?
Lethargy and cold intolerance
Anaemia/ leukopenia/ thrombocytopenia
If severe = pancytopenia
Bradycardia, hypotension, arrhythmia
Constipation, abdo pain, ulcers, oesophageal tears, gastric rupture, delayed gastric emptying, nutritional hepatitis
Amenorrhoea, infertility, loss of libido
Osteoporosis, proximal myopathy
What might swollen submandibular a parotid glands indicate?
Anorexia or bulimia
What investigations would you undertake in suspected anorexia nervosa?
Height, weight, BMI
Bloods: ESR, TFTs to rule out organic causes
FBC, U+Es, phosphate, albumin, LFT, creative kinase, glucose to evaluate nutritional state and risk
ECG: bradycardia, Arrhythmias, long QT
What organic causes might you want to rule out in apparent anorexia nervosa?
What is EDNOS
An eating disorder not otherwise specified
What is body dysmorphic disorder?
Distorted body image
Deliberate weight loss unusual
What is Russell's sign?
Calluses or cuts on knuckles from self induced vomiting
What is melanosis coli?
Pigmentation of colonic mucosa
Seen with laxative abuse
How are patients with anorexia managed?
Engagement: with early family involvement
Psycho-education: advice on nutrition and health
Treat comorbid psychiatric illness: depression, OCD, substance misuse
Nutritional management and weight restoration: negotiate realistic weekly weight gain target 0.5-1kg target weight and eating plan
Psychotherapy: motivational interviewing, family therapy, interpersonal therapy, CBT
Medical treatment: physical complications, rapid weight loss or BMI
When might you consider inpatient treatment for anorexia nervosa?
What clinical presentation is seen in bulimia nervosa?
Binge eating: irresistible cravings, loss of control, sense of desperate urgency + compulsion, triggered by distress
Purging: shame + guilt, vomiting, laxatives, episodes of fasting, excessive exercise
Body image distortion
What complications are associated with purges in bulimia nervosa?
How are patients with bulimia nervosa managed?
Treat medical complications
SSRIS can reduce bingeing and purging by enhancing impulse control
Treat comorbid psych illness: depression, self harm, substance misuse
What are the hallmarks of nutritional decompensation?
Core body temperature
Why is establishing adequate food intake hazardous?
Refeeding syndrome: cause of mortality
Low PO4 Low K Low Mg
Due switch from fat to carbohydrate metabolism and secretion of insulin causing sudden intracellular electrolyte movement
What is the prognosis with anorexia nervosa?
After 10 years:
50% no eating disorder
40% ongoing problems
10% have died (1/3 due to suicide)
Features of poor prognosis:
V low weight, bulimic features, later onset, longer illness duration.
What is the prognosis with bulimia nervosa?
After 10 years:
70% recovered completely
29% ongoing problems
1% have dies
Poorer prognosis associated with: severe bingeing or purging, low body weight, comorbid depression