Eating Disorders

Question 0

What criteria for AN is going away in DSM V? Why?

Answer 0

Amenorrhea criterion is going away.
Reasons: Men can have AN, pre-menarche girls can have AN, lots of women have amenorrhea for other reasons.
(but if you see amenorrhea / irregular periods, you should still be suspicious)

Question 1

4 criteria for anorexia nervosa (AN)?

Answer 1

A. Not eating enough -> weight loss to <85% of expected.
B. Fear of weight gain.
C. Disturbed body image.
D. Amenorrhea x3 due to weight loss.

Question 2

What causes death in AN? (2 major causes)

Answer 2

Electrolytes messed up -> arrhythmias / death.

Suicide.

Question 3

What’s are typical situations for the onset of AN?

Answer 3

Crises in life transitions in school, family, sexuality.

dieting and weight loss is often initially positively reinforced by peers

Question 4

Approximate prevalence of AN in American and British women?

Answer 4

0.5 - 2%

Question 5

Candidate genes that may play small role in risk for AN? (name 2)

Answer 5

5-HT 1D receptor

Delta opioid receptor

Question 6

Does AN respond to SSRIs? Why was this unexpected?

Answer 6

Nope. This was unexpected because decreased serotonin metabolites (5-HIAA) are found in AN but they increase in recovery.
(but Bulimia nervosa does respond well to SSRIs)

Question 7

3 things that mandate inpatient treatment for AN?

Answer 7

“Marked weight loss.”
Significant complications (e.g. alkalosis, arrhythmia).
Extreme psychological distress (e.g. suicidal ideation).

Question 8

One pharmacotherapy that might help AN? Why would AN patients often not be keen on this?

Answer 8

Atypical antipsychotics - show some efficacy in open-label trials.
They cause weight gain / metabolic syndrome… which is kind of the sum of all fears for someone with AN.

Question 9

What are 3 aspects of inpatient AN treatment?

Answer 9

Refeeding to 85-90% of ideal weight.
Intensive psychotherapy.
Maintenance of weight and psych improvements.

Question 10

What proportion of treated AN patients have good outcomes? What is the mortality rate among those with bad outcomes?

Answer 10

2/3 have good outcomes.

Of those with bad outcomes, mortality rate is 8-10%.

Question 11

3 phases of family therapy for adolescents?

Answer 11

Phase 1: Put parents in charge of re-feeding (under advisement of therapist).
Phase 2: Return independence to the patient.
Phase 3: Focus more more general issues of adolescence.

Question 12

Are parents considered to be part of the etiology of AN in adolescents / children?

Answer 12

No, not anymore. It’s not useful to blame parents, it’s best to work with them.
(anecdotally, though, I’ve heard of parents whose influence was terrible for their daughters’ body image…)

Question 13

For adults with AN, what’s the way to go?

Answer 13

CBT.

Question 14

5 DSM-IV-TR categories of criteria for Bulimia Nervosa (BN)?

Answer 14

A. Binge eating.
B. Compensatory behaviors (purging, exercise)
C. Duration and frequency: At least 1x/wk for at least 3mo.
D. Body image issues.
E. Is not AN (i.e. patient is not underweight).

Question 15

What if it looks like BN, but the patient is underweight?

Answer 15

It’s classified as AN with purging.

Question 16

How does body image compare between patients with BN vs. patients with AN?

Answer 16

BN patients’ views of their bodies are not as grossly distorted as in patients with AN, probably because cognition is distorted by starvation in AN. But patients with BN are still dissatisfied with their bodies.

Question 17

Approximate lifetime prevalence of BN among men and women?

Answer 17

0. 5% in men.

1. 5% in women.

Question 18

Several risk factors for BN?

Answer 18

Kind of obvious stuff: Sensitivity to cultural expectations of thinness, low self-esteem, chronic dieters, depression, anxiety, genetics…

Question 19

What was the conclusion from computer attentional task and fMRI studies on patients with BN?

Answer 19

More impulsive, less self-regulation in BN vs. controls.

Question 20

When do first binges in BN usually occur?

Answer 20

After severe calorie deprivation in dieting. Then compensatory behavior follows.

Question 21

What percentage of patients with BN have a good outcome? Risk factors for not having a good outcome? (name 3)

Answer 21

75%

Risk factors for bad outcome: Substance abuse, self-destructive behavior, “personality disturbances.”

Question 22

3-4 complications of BN?

Answer 22

Hypokalemia & dental erosion <- vomiting.
Electrolyte imbalance (can cause arrhythmia, but rarely fatal)
Parotid gland enlargement w. increased salivary amylase.

Question 23

How is anxiety related to bingeing and purging?

Answer 23

Bingeing increases anxiety, purging (temporarily) decreases anxiety. -> negative reinforcement.
Highly analogous to OCD, in which purging could be considered a compulsion.

Question 24

4 treatment modalities for BN?

Answer 24

Behavioral therapy (BT) -logging binges, purges, etc.. Anti-depressants. CBT. Interpersonal therapy (IPT)

Question 25

What was the description of IPT?

Answer 25

Addressing low self-esteem, negative thinking, relationship problems, etc.

Question 26

How do the efficacy of IPT, CBT, and BT compare?

Answer 26

BT is least effective. | CBT marginally better than IPT, but IPT can work in cases where CBT doesn't. (and they're not mutually exclusive)

Question 27

3 reasons to use anti-depressants in BN?

Answer 27

It's often co-morbid with depression. 5-HT is involved in satiety. There's evidence that their use helps BN. (the most important reason...)

Question 28

What's the duration / frequency criterion for Binge-eating Disorder (BED)?

Answer 28

At least 1x/wk, for at least 3mo. (same as in BN)

Question 29

Key difference between BED and BN?

Answer 29

There's no compensatory behavior in BED. (affected people are more likely to be overweight / obese, but that's not a criterion)

Question 30

Approximate lifetime prevalence of BED in the US?

Answer 30

3.5% for women, 2% in men.

Question 31

How heritable is BED?

Answer 31

Quite. 74% according to the Swedish Twin Register...

Question 32

One piece of evidence that people with BED are "addicted" to food?

Answer 32

PET scans show cocaine-like increased in dopamine in the striatum in response to food in people with obesity and BED.

Question 33

How do the outcomes of CBT vs. behavioral weight control (BWC) for BED compare?

Answer 33

Both work pretty well at decreasing binging behavior, but only BWC results in substantial weight loss.

Question 34

What pharmacotherapy can be used for BED?

Answer 34

SRIs

Question 35

4 forms of FED-NEC? (feeding or eating disorders not elsewhere classified)

Answer 35

Purging Disorder Night Eating Syndrome Atypical AN Sub-threshold BN

Question 36

What's purging disorder (PD)?

Answer 36

Purging behaviors after eating normal amounts of food (i.e. no bingeing), usu. normal body weight, at least 1x/wk for at least 3mo.

Question 37

What are the 2 main criteria for night-eating syndrome?

Answer 37

Either one of... Eating more than 25% of calories after the evening meal. Waking up at least 2x/wk to eat. (there's other stuff about depressed mood in evening, desire to eat in evening, etc. but...)

Question 38

What's atypical AN?

Answer 38

Meet all criteria for AN except for the weight threshold (but they may well be on their way there).

Question 39

What's sub-threshold BN?

Answer 39

BN, but the frequency is less than 1x/wk or the duration is < 3mo.