Eating Disorders

Question 1

What is the DSM-V criteria, on which the diagnosis of anorexia nervosa is based upon?

Answer 1

1. Restriction of energy intake relative to requirements leading to significantly low body weight in context of age, sex, developmental trajectory + physical health
2. Intense fear of healthy body weight
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of current low body weight

Question 2

What are risk factors for anorexia nervosa?

Answer 2

• Female gender
• Age (adolescent + young)
• FHx → eating disorders, depression, substance abuse
• Prev criticism of eating habits / weight
• Increased pressure to be slim (ballet dancers, model, athlete)
• Hx of sexual abuse
• Low self-esteem
• Obsessive personality
• EUPD

Question 3

What are clinical features of anorexia nervosa?

Answer 3

• Reduced BMI
• Bradycardia
• Hypotension
• Enlarged salivary glands

Question 4

Which physiological abnormalities are associated w/ anorexia nervosa?

Answer 4

• Hypokalaemia
• Low FSH, LH, oestrogens + testosterone
• Raised cortisol + GH
• Impaired glucose tolerance
• Hypercholesterolaemia
• Hypercarotinaemia
• Low T3

Question 5

Management for adults with anorexia nervosa?

Answer 5

One of:

• Individual eating-disorder-focused CBT (CBT-ED)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
• Specialist supportive clinical management (SSCM)

Question 6

Management of anorexia nervosa in children and young people?

Answer 6

• First-line → anorexia focused family therapy
• Second-line → CBT

Question 7

What’s the prognosis for anorexia nervosa?

Answer 7

• Highest mortality of any mental health illness (5x higher than gen pop)
• 46% recover
• 20% develop chronic disease
• 10% die due to disorder
• Causes of death = CV complications / infections / suicide

Question 8

What is Bulimia nervosa?

Answer 8

Characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours (laxatives, diuretics, exercising)

Question 9

What is the DSM-V diagnostic criteria for bulimia nervosa?

Answer 9

• Recurrent episodes binge eating
• Sense of lack of control over eating during episode
• Recurrent inappropriate compensatory behaviour to prevent weight gain eg. vomiting, laxatives, diuretics, fasting, exercise
• Binge eating + compensatory behaviours both occur on avg at least 1/week for 3 months
• Self-evaluation unduly influenced by body shape/weight
• Disturbance does not occur exclusively during episodes

Question 10

What is the treatment for bulimia nervosa?

Answer 10

• Speicalist referral for all
• Adults:
  
  • first-line → bulimia-nervosa-focused guided self-help for adults
  • alternative → individual eating-disorder-focused CBT (CBT-ED)
• Children → bulimia-nervosa-focused family therapy (FT-BN)