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Flashcards in Eating Disorders Deck (23)
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1

describe diagnostic criteria for anorexia nervosa

  1. restriction of food that leads to being significantly underweight
    • 18.5 BMI is the lower limit of normal
    • Adults:
      • BMI < 17 (clearly below normal)
        BMI ≥ 17 but around 18.5 (grey zone)
    • children (2-18 yrs):
      • BMI < 5th percentile 
  2. intense fear of weight gain
    • evidenced by extreme preoccupation and frequent assessment behaviors that interefere with weight gain)
  3. body image disturbance
    • ​​belief of being overweight or denies the seriousness of low weight, etc.

2

describe anorexia subtypes

  • binge-eating/purging type: the person recurrently binges AND/OR purges*
  • restricting type: the person does not recurrently binge of purge* (weight loss is primarily through dieting, fasting, and/or exercise)
  • purge = use of vomiting, laxatives, diuretics, or enemas to eliminate calories

3

Clicker #1

  • does she meet criteria? YES
    • BMI for child is below 5th percentile 
    • has fear of gaining weight
    • has disturbance of body image
  • does she binge/purge?
    • yes, she purges, so she is the binge eating/purging type

4

what are indicators of excessive thinness?

  • low BMI
  • amenorrhea & loss of sex drive
  • constipation
  • hypothermia 
  • bradycardia & hypotension
  • hypercholesterolemia
  • anemia
  • leukopenia
  • low bone mineral desnity

5

describe indicators of excessive vomiting

  • calloused knuckles (Russell's sign)
  • dental enamel erosion
  • salivary gland inflammation 
    • "chipmunk cheeks"
  • subconjunctival hemorrhage
  • hypokalemia (loss of electrolytes) 

6

describe the psychological and social factors of anorexia

  • excessive weight loss may result from:
    • dieting due to cultural pressures to be thin
    • using dieting as a means to "control" one's life (especially when establishing autonomy from parents in adolescence)
    • a perfectionist personality trait leading to obsessive dieting
  • weight loss is reinforced (internally and externally)

7

describe biological factors explaining anorexia

  • there is a genetic susceptibility to anorexia
  • a person may inherit biochemical alterations leading to obesessiveness
  • cultural pressures may direct the obsessiveness to body image

8

describe the treatment of anorexia

  • a patient is typically not self-referred, since anorexia tends not to be distressful
  • in-patient hospitalization:
    • behavioral technique (reinforcement/punishment) are utilized to achieve the immediate goal of weight gain
    • an attendant often supervises the patient to thwart attempts to lose weight 

9

describe psychotherapy/pharmacological treatments of anorexia

  • psychotherapy 
    • CBT: the goal is to change patient's attitude about food/weight and stop their destructive eating habits
  • pharmacological
    • no drug is consistently effective for anorexia
    • ADs and appetite stimulants are tried but often lack effectiveness 

10

explain the outcome of anorexia treatment

  • short-term: good repsonse to treatment (weight-gain) in a controlled, in-patient setting
  • long-term: prognosis tends to be poor
    • patients tend to relapse once released into their home environment

11

describe the diagnostic criteria for bulimia nervosa

  1. recurrent binge eating
    • eating a large amount in a discrete period
    • eating is out of control during the episode
  2. recurrent inappropriate compensatory behavior for binge
    • purging (vomiting, laxative, diuretics, enemas)
    • non-purging (fasting and/or excessive exercise)
  3. the binge/inappropriate compensatory behaviors must occur ≥ 1  time/week for 3 months
  4. self-evaluation is unduly influenced by body shape and weight

12

  • BMI is < 17 (14) so that makes it anorexia nervosa, binge eating/purging type

13

name features of bulimia

  • bulimics typically have normal body weight or slightly overweight

14

describe the course of bulimia

  • symptoms tend to being in adolescence and be chronic
  • binging & purging (BMI = < 17): anorexia
  • binging and purging (BMI = 25): bulimia

15

describe biological factors of bulimia

  • a person may be inheriting biochemical changes that leads to impulse dyscontrol
  • low (unstable) serotonin is associated with this disorder
    • SSRIs can help 

16

describe the treatment of bulimia

  • a patient typically initiates treatment, since the disorder distresses the patient
    • treatment is usually out-patient based
    • CBT is essential
    • AD medications may be a useful adjunct to help with impulse dyscontrol
  • with greater motivation to change, the prognosis is better for bulimia than anorexia

17

describe diagnostic criteria for binge-eating disorder (BED)

  1. binge eating at least 1 time/week for 3 months
  2. binging is associated with behaviors such as:
    • rapid eating
    • eating until uncomofortably full
    • eating when not physically hungry
    • eating alone due to shame about quantitiy
    • feeling disgusted/guilt/depressed after binge
  3. NO inappropriate compensatory behavior

18

describe the features of BED

  • BED is usually associated (not necessarily) with obesity (BMI > 30) but considered a distinct problem:
    • there is greater distress and functional impairment in BED than in obesity
  • health consequences of BED are similar to those of obesity

19

describe the course, etiology and treatment for BED

  • course:
    • adolescence with chronic course
  • etiology:
    • unknown but different from bulimia (in BED, dysfunctional dieting doesn't precede binging)
  • treatment: CBT and ADs

20

clicker #3

  • BMI is not <17, so not anorexia
  • she binges regulary AND inappropriately compensates (purges), so therefore bulimia

21

  • BMI is < 17, so anorexia possible
  • phobia of gaining weight
  • distorted judgement
  • therefore anorexia
  • does she regularly binge or purge? YES, so anorexia, binge-eating/purging type

22

  • BMI not low, so not anorexia
  • does she inappropriately compensate? no, so not bulimia
  • therefore, binge-eating disorder

23

describe screening for eating disorders (SCOFF questions)

  • S: Sick (induce vomiting?)
  • C: Control (lose control?)
  • O: One (1 "stone" weight loss in 3 months?)
    • 1 stone = 14 pounds/6.5 kgs
  • F: Fat (believe fat?)
  • F: Food (food dominates)

yes to ≥ 2 suggests an eating problem