Eating Disorders Flashcards

1
Q

What screening tool is used for eating disorders?

A

SCOFF questionnaire

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2
Q

SCOFF questionnaire features

A

If score 2 or more positive answers, then an eating disorder is more likely

  • do you make yourself SICK because you feel uncomfortably full?
  • Do you worry you have lost CONTROL over how much you eat?
  • have you recently lost more than ONE STONE in a three month period?
  • do you believe yourself to be FAT when others say you are too thin?
  • would you say that FOOD dominates your life?
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3
Q

Key features of obsessive weight losing disorders

A

Obsessive fear of fatness with avoidance of food and other sources of calories

A range of compulsive compensatory behaviours when food cannot be avoided

In time these behaviours are the only way to avoid the experience of anxiety AND there are secondary physical and psychological consequences of starvation

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4
Q

ICD-10 classification for anorexia nervosa

A

Body weight < 15% of expected
Body image distortion
Self induced
(amenorrhoea)

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5
Q

Who gets anorexia nervosa?

A

75% occur before age 22

90% in females

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6
Q

Presentation of anorexia nervosa

A
Restriction of intake to reduce weight 
Relies on compulsive compensatory behaviours when food cannot be avoided 
fear of weight gain 
cold intolerance 
blue hands and feet
constipation 
bloating
delayed puberty
primary / secondary amenorrhoea
dry skin
fainting 
hypotension 
lanugo hair 
scalp hair loss
early satiety 
weakness, fatigue 
short stature 
osteopenia and osteoporosis   
loss of muscle (including cardiac muscle)
Infertility
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7
Q

Examples of compensatory behaviours

A
Self induced vomiting/purging
excessive exercise 
abuse of appetite suppressants / diuretics / laxatives 
strict diet
fasting
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8
Q

How can constipation of anorexia nervosa relate to the psychological aspect of it?

A

Gut slows down - reduced peristalsis and so this can lead to e.g. a tight tummy which can contribute to the psychological aspect

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9
Q

What is bulimia nervosa?

A

Binges and the resulting compensatory behaviour - which must occur a minimum or two times per week for 3 months

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10
Q

Presentation of bulimia nervosa

A

Episodes of binge eating with a sense of loss of control
Binge eating with a sense of loss of control
Binge eating is followed by a compensatory behaviour of the purging type or non purging type
Dissatisfaction with body shape and weight
mouth sores
Hoarse voice
pharyngeal trauma
dental caries / damaged teeth
heartburn
chest pain
oesophageal rupture
impulsivity (stealing, alcohol abuse, drugs/tobacco)
muscle cramps
weakness
bloody diarrhoea
irregular periods
fainting
swollen parotid glands (Parotid enlargement)
hypotension
Electrolyte abnormalities
Dehydration

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11
Q

Why do upper GI problems occur in bulimia nervosa?

A

Due to vomiting and gastric acid in the upper GI

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12
Q

What is a particular worry in bulimia nervosa?

A

Electrolytes - especially potassium as this can cause cardiac arrhythmias

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13
Q

What is binge eating disorder?

A

Similar to bulimia nervosa but in the absence of purging behaviours

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14
Q

Presentation of binge eating disorder

A

ongoing and/or repetitive cycles often including

  • unusually fast eating, usually alone
  • unusually large amounts consumed
  • uncomfortably full; often buzzed after eating
  • embarrassment, shame, guilt
  • depression
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15
Q

Methods of avoiding calorie intake

A

Diets - veggie / vegan
Not touching food or grease
Developing dislikes, pickiness or even ‘allergies’
Interpreting all the symptoms as allergy or ingestion
Eating very slowly
only eating at certain times
avoiding parties and social occasions
Spoiling or messing of food, bizarre combinations
refusing to eat more than the person who eats the least
rules about finishing last etc
medication abuse
- appetite suppressants (gum, cigarettes)
- alternative, OTC and www medications

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16
Q

Methods of getting rid of calories

A
Self induced vomiting
Chewing or spitting it out
Over exercise - often secret
Overactivity
- obsessive housework 
- fidgeting / twitching
- never sitting down 
- fetching one item at a time
- carrying heavy loads 
Cooling making the body shiver 
- inadequate dress
- open windows 
Blood letting
- cutting themselves and letting blood out 
Medication abuse
- alternative, OTC and www medications
- excessive caffeine and stimulant consumption 
- laxatives, ipecac 
- pain killers to allow exercise despite damage
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17
Q

Presentation of body checking

A
Repeated weighting
mirror gazing
self measurement
self photographing 
trying on particularly tight clothes
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18
Q

Other eating disorder behaviours

A

Body checking
displaying emaciation to elicit reassuringly shocked attention
cruising pro ana websites/facebook/emailing fellow disorders
competing with self and others to attain lower and lower targets
compulsive browsing of gossip magazines and websites
deliberate self harm if ‘rules’ are broken

19
Q

Psychological consequences of eating disorder

A

Obsessive weight losing feels like a solution not a problem
Extreme overvaluation of low weight and thin shape resembles religious belief - with the patient willing to sacrifice even other highly valued things to the cause
reduced coherence and narrowed focus of interest (a difficulty in seeing the bigger picture)
starved person is unable to interpret emotion
Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food
Depression at low weight rarely responds to medication
Anxiety eating in company, followed by guilt after eating
People who rely on eating disordered behaviour to ‘solve’ their problems fail to develop other ways to cope in life, tolerate distress or feel rewarded and fulfilled

20
Q

What is binge eating disorder?

A

Similar to bulimia nervosa but in the absence of purging behaviours

21
Q

Presentation of binge eating disorder

A

ongoing and/or repetitive cycles often including

  • unusually fast eating, usually alone
  • unusually large amounts consumed
  • uncomfortably full; often buzzed after eating
  • embarrassment, shame, guilt
  • depression
22
Q

Methods of avoiding calorie intake

A

Diets - veggie / vegan
Not touching food or grease
Developing dislikes, pickiness or even ‘allergies’
Interpreting all the symptoms as allergy or ingestion
Eating very slowly
only eating at certain times
avoiding parties and social occasions
Spoiling or messing of food, bizarre combinations
refusing to eat more than the person who eats the least
rules about finishing last etc
medication abuse
- appetite suppressants (gum, cigarettes)
- alternative, OTC and www medications

23
Q

Methods of getting rid of calories

A
Self induced vomiting
Chewing or spitting it out
Over exercise - often secret
Overactivity
- obsessive housework 
- fidgeting / twitching
- never sitting down 
- fetching one item at a time
- carrying heavy loads 
Cooling making the body shiver 
- inadequate dress
- open windows 
Blood letting
- cutting themselves and letting blood out 
Medication abuse
- alternative, OTC and www medications
- excessive caffeine and stimulant consumption 
- laxatives, ipecac 
- pain killers to allow exercise despite damage
24
Q

Presentation of body checking

A
Repeated weighting
mirror gazing
self measurement
self photographing 
trying on particularly tight clothes
25
Q

Other eating disorder behaviours

A

Body checking
displaying emaciation to elicit reassuringly shocked attention
cruising pro ana websites/facebook/emailing fellow disorders
competing with self and others to attain lower and lower targets
compulsive browsing of gossip magazines and websites
deliberate self harm if ‘rules’ are broken

26
Q

Psychological consequences of eating disorder

A

Obsessive weight losing feels like a solution not a problem
Extreme overvaluation of low weight and thin shape resembles religious belief - with the patient willing to sacrifice even other highly valued things to the cause
reduced coherence and narrowed focus of interest (a difficulty in seeing the bigger picture)
starved person is unable to interpret emotion
Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food
Depression at low weight rarely responds to medication
Anxiety eating in company, followed by guilt after eating
People who rely on eating disordered behaviour to ‘solve’ their problems fail to develop other ways to cope in life, tolerate distress or feel rewarded and fulfilled

27
Q

Social consequences of eating disorders

A

Other people are turned into obstacles to the eating disorder
Honest people forced to lie and cheat, even to steal about eating disorder concerns
withdrawal from friendships - ISOLATION
Loss of interest in sexual relationships

28
Q

Physical consequences of eating disorders

A
Starvation causes
- physical damage
- poor repair and resistance
- heart damage 
- reduced immunity to infections
- anaemia
- bone loss
- fertility problems 
Purging behaviours cause
- neuro chemical disruption with special damage to the brain (seizures) and to the heart (arrhythmias) 
- potassium
29
Q

Who is re-nutrition most urgent in and why?

A

Younger patients - as need good nutrition to allow growth, pubertal development and brain growth and development

30
Q

Causes of anorexia

A
Genetic predisposition 
- Eating disorders run in families
- OCD
- anxiety disorders
- perfectionism 
Perinatal factors
Life events and traumas
Perpetuating consequences of starvation and avoidance
31
Q

Precipitating factors of anorexia / eating disorders

A
puberty
- hormonal changes in brain 
- psychological response to body changes 
Dieting or non deliberate weight loss 
- possibly turn into a viscous cycle
Increased exercise
Stressful life events 
- neglect, abuse
- difficult transitions e.g. high school to uni 
- deaths and losses
- seperations and family break up 
- bullying 
- stresses esp exams
32
Q

Perpetuating factors of anorexia / eating disorders

A

Delayed gastric emptying
- sensations of fullness interpreted as fatness
Narrowing focus
- avoidance of personal interest, changes of values so that food becomes the most salient stimulus
Obsessionality
- phobia of fat increases as avoidance increases
- body checking amplifies body image concern
Families, school
High EE in family and other carers may delay recovery

33
Q

What are perpetuating factors of eating disorders a result of?

A

The ‘starvation syndrome’

34
Q

Which condition has the highest mortality of all the psychiatric disorders?

A

Anorexia nervosa

35
Q

Time for recovery in anorexia nervosa is approx..

A

6-7 years

36
Q

Death in anorexia nervosa may be from …..

A

Direct consequences of starvation

Self harm - may or may not have been truly suicidal

37
Q

Treatment of anorexia nervosa

A
RE-FEEDING
Dietary supplements 
Prokinetics 
CBT
Mantra
SSCM 
IPT or fluoxetine 60mg daily 
SSRIs (obsessional)
Olanzapine (antiphyscotic) - severe 
Specialised family work, particularly for younger patients
38
Q

What does the Scottish Mental health act allow?

A

Gives doctors responsibility to treat people even in the absence of consent to save life or prevent serious deterioration

39
Q

What to ask in a history of eating disorders

A
Diet / when started
Binges
Compensatory behaviour
Body shape
Psychiatric history 
Motivation to change
Physical assessment 
Collateral history if possible
40
Q

Under what BMI is considered to be anorexia nervosa?

A

BMI 17.5

41
Q

What is the most important electrolyte causing the problems in refeeding syndrome?

A

Phosphate

42
Q

Indicators of anorexia nervosa

A
Controlling in kitchen 
Daily exercise
Withdrawn 
Avoiding eating in public
Intolerant of disruptions to daily routine
Baggy clothes
Eating in secret
Picking at food
Low calorie food - obsessed with calorie counting (constantly reads food labels)
Strange selections of foods
43
Q

When should anorexia nervosa be referred for specialist help?

A
Rapid weight loss
BMI < 16
Marked vomiting / laxative abuse
Physical complications
Simple interventions failed 
Marked depression
44
Q

Indicators for bulimia

A
Worried about body weight
Excessive food consumption 
Trips to the bathroom after eating
Blood shot eyes
Sore throat and swollen parotid glands 
Dental problems
Exercises excessively 
Irregular menstrual periods
Depression and/or mood swings