Eating Disorders - Exam 3

Question 1

What is body image? What is it influenced by?

Answer 1

The perception that a person has of their physical self
The thoughts and feelings they have as a result of that perception

individual and environmental factors

Question 2

Body dissatisfaction is strongly tied to chronic _____ of one’s body

Answer 2

negative perception

Question 3

What makes body dissatisfaction different from an eating disorder?

Answer 3

“Morbid fear of weight gain”
The idea that “one cannot be too thin” overrides all other interests and affairs

Question 4

What are risk factors for body dissatsifaction?

Answer 4

late childhood/adolescence
female
low self esteem
perfectionism, high achievers, anxiety, “black and white” world views
with emphasis on “thinness” - ballet, modeling, athletics
frequent dieting for weight loss or high body image concerns expressed around patient
larger body size
homosexuality in males

Question 5

Does body dissatisfaction have a genetic component?

Answer 5

Yes! Mothers/sisters of anorexic pts - 8x as likely to also have

More common in identical (monozygotic) twins

Question 6

**What is anorexia thought to be an imbalance between? Bulimia?

Answer 6

disturbances in serotonin, dopamine, norepinephrine

deficient in serotonin

possible that is it difficult to recognize hunger and satiety states

Question 7

What are the family risk factors for eating disorder?

Answer 7

Enmeshed parenting
Conflict-avoidant families
Inflexibility
Push for very high levels of success
Family members with body dissatisfaction or poor eating habits/eating disorders

Anorexic families - rigid, controlling, organized
Bulimic/BED families - chaotic, critical, conflicted

Question 8

Eating disorders are often related to _____ or ______ of parents

Answer 8

effectiveness and ineffectiveness

Question 9

Interferes with self-ability to accurately identify
____ versus ____ and feeling helpless as a result. What 2 traits do pts display?

Answer 9

hunger versus and emotions

alexithymia and dependency

Question 10

Define alexithymia.

Answer 10

unable to feel their emotions

Question 11

Pts with eating disorders often feel that their ____ is the only important part of their self-image. If they are not thin, what does it make them feel?

Answer 11

body size

If they are not exceedingly thin, they feel it “proves” they are weak, lazy, inferior, unlovable, incompetent

Question 12

What are four screening tools for eating disorders? Which 2 are self administered?

Answer 12

SCOFF Questionnaire
ESP Questionnaire
EAT Form- Self
PHQ Form- Self

Question 13

Avoidant / Restrictive Food Intake Disorder when do they commonly present? What is the classic presentation? What is the average BMI?

Answer 13

Typically begins in infancy or early childhood

underweight child (average BMI - 16)

Question 14

_______ may be due to lack of interest in food, sensory characteristics of food, or conditioned negative response following an aversive experience. What is the tx? What can it NOT be due to?

Answer 14

Avoidant / Restrictive Food Intake Disorder

nutritional counseling
CBT: Family based therapy
Consider referral to speech and language pathologist

NOT due to lack of food availability, culturally/religious practice or other medical condition

Question 15

What is the age of onset for anorexia? What gender?

Answer 15

Early adolescence - 12-15 yrs

Late adolescence/early adulthood - 17-21 years

Average age at onset - 18 years

women, white

Question 16

What is anorexia defined by? What must their BMI be under?

Answer 16

restricted energy intake characterized by low body weight
intense fear of gaining weight
distorted perception of weight

**BMI must be less than 17.5

Question 17

How do you classify anorexia?

Answer 17

Question 18

What are the 2 subtypes of anorexia?

Answer 18

Question 19

What are some abnormal food behaviors commonly seen in anorexic pts?

Answer 19

Reduction in total food intake
Exclusion of highly caloric foods
May claim distaste for food or epigastric pain
May have food-related obsessions

Question 20

Depression, irritability
Fatigue and weakness
bone pain
Constipation
Abdominal pain
Hair loss, brittle nails
Russell’s sign
Dental enamel erosion
Osteoporosis
Bradycardia
Dry and flaky skin
Lanugo
Petechiae on extremities
Sallow complexion

What am I?
What is the Russell’s sign?

Answer 20

anorexia
callouses on the knuckles from making themselves vomit

Question 21

What is lanugo?

Answer 21

peach fuzz that grows all over the body due to trying to keep the body war,

Question 22

What is superior mesenteric artery syndrome?

Answer 22

compression due to collapse from anorexia

Question 23

What are the 3 MC causes of death from anorexia? What labs do you need to order?

Answer 23

consequences of starvation, suicide, or electrolyte imbalance

EKG for cardiac dysrhythmias
UA for specific gravity

Question 24

What are some reasons to admit a pt for anorexia? Need to admit a pt if their ideal body weight is below _____

Answer 24

Unstable vitals or Hypothermia (<35 C or 95 F)
End-organ complications
Cardiac complications
Psych complications
nutrition complications

weight is below 70% ideal body weight

Question 25

What is refeeding syndrome?

Answer 25

Potentially fatal shifting of fluids and electrolytes that can occur as a result of refeeding feeding them too quickly, dying of organ failure

Question 26

What is the tx for anorexia?

Answer 26

medical stability healthy weight healthy nutrition treat underlying psychopathology **Psych meds are not first line treatment

Question 27

Psych meds are not first line for _____ but ____, _____ and _____ have some evidence that they are helpful. NOT FIRST LINE!!!

Answer 27

antipsychotic (olanzapine) anxiolytic (lorazepam) fluoxetine (Prozac)

Question 28

**Some evidence suggests that using ______ at higher doses can prevent relapse once weight is restored.

Answer 28

fluoxetine (Prozac)

Question 29

What are some indicators of poor outcomes for anorexia pts?

Answer 29

Later age at onset longer duration lower minimal weight lower body fat after weight restoration psych comorbidities

Question 30

____ of anorexia pts eventually relapse

Answer 30

35-55%

Question 31

What are the pt factors for bulimia?

Answer 31

women average age is 18-20 white adolescent female

Question 32

What is the DSM criteria for bulimia? What are some common compensatory behaviors?

Answer 32

Recurrent binge eating and inappropriate compensatory behaviors at least once a week for three months vomiting, laxative, enemas, diuretics, fasting

Question 33

What are some examples of non-purging behaviors?

Answer 33

fasting or excessive exercise

Question 34

Do bulimic pts feel bad about binge eating? Do they have control?

Answer 34

YES! often with guilt and depression Slightly more control over timing of behaviors - arrange around work, school, etc.

Question 35

If vomiting - eroded dental enamel and “puffy cheeks” due to _____ may be seen. What is the body weight in bulimia?

Answer 35

parotid hypertrophy **Body weight typically within or above the normal range

Question 36

In bulimia ____ complaints are the MC? What is xerosis?

Answer 36

GI complications salivary gland hypertrophy, loss of gag reflex, GI tract dysmotility, GERD, esophageal tears or rupture, malabsorption, diarrhea, constipation, pancreatitis extreme cracked skin

Question 37

What is the tx for bulimia? Can use ____ if no improvement with SSRI. What is CI?

Answer 37

CBT!!! antidepressants are often helpful!! (fluoxetine- first line) TCA if no improvement with SSRIs **Bupropion is contraindicated in bulimia and anorexia - can cause seizures

Question 38

____ of bulimic patients have a positive lifetime history of suicide attempt. High comorbidity with ????. ____ recover in longer follow-up

Answer 38

25-40% anxiety, depressive disorders, personality disorders, PTSD, and substance use 60%

Question 39

What is the median age of onset for binge eating disorder?

Answer 39

23 years, higher prevalence but not as well researched

Question 40

What is binge eating disorder defined as? How is the severity ranked?

Answer 40

Recurrent binge eating without compensatory behaviors severity is ranked by frequency of episodes per week: Mild: 1-3 Moderate: 4-7 Severe: 8-13 Extreme: 14+

Question 41

Do binge eating patients feel bad about their behavior?

Answer 41

Feelings of shame, guilt, and hopelessness frequently occur during or immediately following a binge-eating episode will try and hide eating habits

Question 42

What BMI category does binge eating disorder pts fall into? Have a high risk of _____

Answer 42

About 50% of patients are overweight or obese More likely to be overweight or obese prior to BED onset higher risk of cancer

Question 43

What is tx for binge eating disorder? Would you use antiobesity drugs?

Answer 43

First line: CBT!! behavioral weight loss therapy may try meds: SSRIs- try first alt: topiramate, zonisamide) Lisdexamfetamine (Vyvanse) **Antiobesity drugs not recommended due to SE, limited efficacy in BED patients