Eating Disorders - Titus-Lay

Question 1

DSM 5 Diagnostic Criteria for Anorexia

Answer 1

Restriction of energy intake leading to a significantly low body weight

Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight

Disturbance in the way in which one’s body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 2

Body weights lowest to highest based on eating disorders (anorexia, binge and purge, binge, bulemia)

Answer 2

Anorexia < Bulemia/binge and purge < healthy eating < binge eating < obesity

Question 3

Anorexia is more prevalent in males or females?

Answer 3

Females

0.9% lifetime prevalence in females

Question 4

Female to male ratio of anorexia prevalence?

Answer 4

3:1

Question 5

Other conditions common in people with anorexia?

Answer 5

Depression
OCD
Suicidal ideation

Question 6

2 types of anorexia

Answer 6

Restricting type

Binge-eating/purging type

Question 7

Restricting type of AN

In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior

Answer 7

Has NOT

Weight loss is accomplished through dieting, fasting, and/or excessive exercise

Question 8

Binge-eating/purging type

In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior

Answer 8

Has

Question 9

What is the main difference between the binge-eating/purging type of AN and bulimia nervosa disorder?

Answer 9

binge-eating/purging type of AN typically have a lower body weight

Question 10

BMI of mild AN

Answer 10

> 17

Question 11

BMI of moderate AN

Answer 11

16-16.9

Question 12

BMI of severe AN

Answer 12

15-15.9

Question 13

BMI of extreme AN

Answer 13

<15

Question 14

What is the lowest normal BMI according to the CDC and WHO?

Answer 14

18.5

Question 15

Health consequences of AN

Answer 15

Slow HR and low BP - risk for HF and fatal arrhythmia
Reduced bone density
Muscle loss/weakness
Severe dehydration
Fainting, fatigue, overall weakness
Dry skin, hair loss
Growth of a downy layer of hair all over the body (including the face)

Question 16

How does the body cope with not having enough energy to perform daily function?

Answer 16

It slows down to preserve energy

Question 17

What results in re-feeding syndrome?

Answer 17

A shift from fat metabolism to glucose metabolism

Question 18

Consequences and main concern of re-feeding syndrome?

Answer 18

Electrolyte imbalances (K, Mg, and Phos)
Water retention
Severe edema
Multiple organ failure (main concern!)

Question 19

Inpatient treatment of AN

Answer 19

Electrolyte and fluid correction
Increase calories by 500 kcal/d every 4 days to 3500 kcal/d
Cognitive behavioral therapy
Pharmacotherapy

Question 20

Outpatient treatment of AN

Answer 20

1200-1500 kcal/d
Increase weekly by 500 kcal
Cognitive behavioral therapy
Pharmacotherapy

Question 21

Pharmacotherapy for AN

Answer 21

No drug therapy is FDA approved yet

Fluoxetine and TCAs may be helpful

Question 22

What drug is contraindicated in AN?

Answer 22

Bupropion

Question 23

DSM 5 Diagnostic Criteria for Binge eating disorder

Answer 23

Marked distress regarding binge eating

Occurs, on average, at least once a week for 3 months

NOT associated with recurrent use of inappropriate compensatory behavior

Recurrent episodes of binge eating characterized by BOTH of the following:

• Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time
• A sense of lack of control over eating during the episode

Question 24

Binge-eating episodes are associated with 3 or more of what 5 criteria?

Answer 24

Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed or very guilty afterward

Question 25

Female to male ratio of prevalence of binge eating disorder

Answer 25

1:0.7

Question 26

What other conditions are common in people with binge eating disorder?

Answer 26

Depression Anxiety Borderline personality disorder Substance use disorders

Question 27

How many calories count as a binge?

Answer 27

~3500 kcal | Some people can eat upwards of 6,000-10,000 kcal in one episode

Question 28

How many episodes in mild binge eating disorder?

Answer 28

1-3 per week

Question 29

How many episodes in moderate binge eating disorder?

Answer 29

4-7 per week

Question 30

How many episodes in severe binge eating disorder?

Answer 30

8-13 per week

Question 31

How many episodes in extreme binge eating disorder?

Answer 31

14 or more per week

Question 32

Health consequences of binge eating disorder?

Answer 32

``` High blood pressure High cholesterol Heart disease T2DM Gallbladder disease ```

Question 33

Binge eating disorder treatment

Answer 33

Cognitive behavioral therapy Pharmacotherpy CBT + medication provides best outcomes

Question 34

Pharmacotherapy for binge eating disorder

Answer 34

Lisdexamfetamine (FDA approved for moderate-severe) | SSRIs, TCAs, armodafinil, topiramate (not FDA approved)

Question 35

DSM 5 Criteria for Bulimia Nervosa diagnosis

Answer 35

Recurrent inappropriate compensatory behaviors in order to prevent weight gain (vomiting, laxatives, diuretics, excessive exercise) Occur on average at least once weekly for 3 months Self-evaluation is excessively influenced by body shape and weight Disturbance does not occur exclusively during episodes of anorexia nervosa Recurrent episodes of binge eating characterized by both of the following: - Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time - A sense of lack of control over eating during the episode

Question 36

Female to male ratio of prevalence of bulmia nervosa

Answer 36

3:1

Question 37

What puts individuals at an increased risk of developing bulimia nervosa

Answer 37

Individuals with anxiety as a child History of sexual or physical abuse Childhood obesity Early pubertal maturation

Question 38

What disorders are common in people with bulimia nervosa?

Answer 38

Atypical depression Seasonal affective disorder Impulsive disorders (borderline personality disorder, substance use disorders, bipolar disorder)

Question 39

How many episodes in mild bulimia?

Answer 39

1-3 per week

Question 40

How many episodes in moderate bulimia?

Answer 40

4-7 per week

Question 41

How many episodes in severe bulimia?

Answer 41

8-13 per week

Question 42

How many episodes in severe bulimia?

Answer 42

14 or more per week

Question 43

Methods of purging for bulimia nervosa?

Answer 43

``` Vomiting Laxatives Diuretics Excessive exercise "diabulimia" ```

Question 44

What is diabulimia?

Answer 44

When type 1 diabetics do not give themselves insulin to make themselves lose weight

Question 45

Health consequences of bulimia?

Answer 45

Electrolyte imbalances Inflammation, gastric rupture, esophageal rupture from frequent vomiting Tooth decay and staining from stomach acid released during frequent vomiting Chronic irregular bowel movements and constipation as a result of laxative abuse Physical sores from exercising too much Diabetic ketoacidois from withholding insulin in type 1 DM

Question 46

Treatment of bulimia nervosa

Answer 46

CBT Pharmacotherpay CBT + medication provides best outcomes

Question 47

Pharmacotherapy for bulimia

Answer 47

Fluoxetine (FDA approved - also useful for underlying depression) TCAs, trazodone, and MAOIs (not FDA approved)

Question 48

FDA approved drug(s) for treatment of binge eating disorder

Answer 48

Lisdexamfetamine

Question 49

FDA approved drug(s) for treatment of AN

Answer 49

None!

Question 50

FDA approved drug(s) for treatment of bulimia

Answer 50

Fluoxetine

Question 51

What eating disorder meets all the criteria for AN except that despite significant weight loss, the individual's weight is within or above the normal range

Answer 51

Atypical anorexia nervosa

Question 52

What eating disorder meets all the criteria for bulimia except the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months

Answer 52

Bulimia nervosa of low frequency and/or limited duration

Question 53

What eating disorder meets all the criteria for binge-eating except that the binge eating occurs, on average, less than once a week and'or for less than 3 months

Answer 53

Binge-eating disorder of low frequency and/or limited duration

Question 54

What eating disorder is characterized by recurrent purging behavior to influence weight or shape in the absence of binge eating

Answer 54

Purging disorder

Question 55

What eating disorder is characterized by recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal?

Answer 55

Night eating syndrome

Question 56

During night eating syndrome there (is/is not) awareness and recall of the eating

Answer 56

is

Question 57

Night eating syndrome can not be better explained by what 2 things?

Answer 57

External influences such as changes in the individual's sleep-wake cycle or by local social norms Binge-eating disorder or another mental disorder, including substance use, adn is not attributable to another medical disorder or to an effect of a medication