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(C) BD > Lecture 17: Eating Disorders > Flashcards

Lecture 17: Eating Disorders Flashcards

1
Q

What are the 4 ways we can interpret Body Image?

A
  • Perceptual: How we see ourselves
  • Affective: How we feel about how we look
  • Cognitive: Our thoughts and beliefs about our body
  • Behavioral: What we do in relation to how we look
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2
Q

What is body dissatisfication?

A
  • Chronic negative perception of one’s body.
  • Developed countries: Heavy emphasis on thin for females, lean/muscular body for men.
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3
Q

What differentiates body dissatisfaction vs eating disorder?

A
  • Morbid fear of weight gain
  • Idea that one cannot be too thin overrides ALL other interests and affairs.
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4
Q

What historical risk factors might suggest body dissatisfaction?

A
  • Low self esteem
  • Type A perfectionists
  • Activities with emphasis on being thin (ballet, modeling, athletics)
  • Larger body size
  • Homosexuality in males
  • Acculturation into Western society
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5
Q

What are some biological risk factors that might suggest body dissatisfaction?

A
  • Mothers/sisters of anorexic are 8x likely.
  • Identical twins highly likely. (esp anorexia)
  • Anorexia: disturbance in serotonin, dopamine or NE.
  • Bulimia: disturbance in serotonin
  • Possible difficulty with recognizing hunger and satiety states.
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6
Q

What medication is commonly given for psychiatric mood disorders that CANNOT be given in someone with an eating disorder?

A

Wellbutrin/bupropion.

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7
Q

What kind of family is more likely to induce anorexia?

A
  • Rigid
  • Controlling
  • Organized
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8
Q

What kind of family is more likely to induce bulimia/binge eating disorder (BED)?

A
  • Chaotic
  • Critical
  • Conflicted
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9
Q

What is meant by inaffective parents in regards to eating disorders?

A
  • Feeding at times of anxiety rather than hunger.
  • Comforting at times of hunger rather than anxiety.
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10
Q

What is alexithymia?

A

Inability to describe or identify their own emotions.

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11
Q

What are some cognitive risk factors of eating disorders/body dissatisfaction?

A
  • Body size is the only important part of their self-image.
  • Mistrust of companions for appearance.
  • Ignore/difficulty accepting objective evidence of their body’s state.
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12
Q

What must we first do when screening for an eating disorder?

A

80% of population is dieting, so we need to differentiate between normative vs abnormal.

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13
Q

Why can eating disorders cause amenorrhea?

A

Lack of nutrients to make estrogen.

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14
Q

What are the screening forms we use for eating disorders?

A
  • SCOFF Questionaire (2+ positive = likely)
  • ESP Questionnaire (Eating disorder screen for primary care)
  • EAT form
  • PHQ form
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15
Q

What are the 5 questions/topics of the SCOFF form?

A
  • Do you make yourself SICK bc you feel full?
  • Have you lost CONTROL over how much you eat?
  • Have you lost more than ONE stone (14lbs) in a month?
  • Do you think you’re FAT when others say you’re thin?
  • Does FOOD dominate your life?
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16
Q

What is the classic presentation of avoidant/restrictive food intake disorder?

A

Underweight child with an average BMI of 16.
* Decreased bone mineral density
* Comorbid anxiety
* Comorbid general medical disorder

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17
Q

What is the DSM-V-TR Diagnostic criteria for avoidant/restrictive food intake disorder?

A
  1. Avoiding or restricting food intake (lack of interest/aversive experience)
  2. Nutritional needs not met manifested by at least 1 of the following:
    * Clinically significant weight loss/poor growth/failure to achieve weight goal.
    * Nutritional deficiency
    * Oral supplements needed to achieve adequate nutrition
    * Impaired psychosocial functioning

Must have both of the conditions present.

Cannot be due to a LACK of food availability.

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18
Q

Who is the classic demographic of anorexia nervosa?

A

Adolescent white female.
* Most common: 12-15
* Most common: 17-21
* Average age: 18 yrs

Puberty and college

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19
Q

What characterizes AN?

A
  • Restricted energy intake
  • Intense fear of weight gain
  • Distorted perception of weight
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20
Q

How is AN severity classified? What counts as mild vs extreme?

A

BMI.
* Mild: BMI >= 17
* Moderate: BMI 16-16.99
* Severe: BMI 15-15.99
* Extreme: BMI < 15

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21
Q

What are the two subtypes of AN?

A
  • Binge-eating: Engaging in purging behaviors.
  • Restrictive: NO purging behaviors, they just restrict their calorie intake.
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22
Q

What are some examples of food-related obsessions?

A
  • Collect recipes, prepare food for family.
  • Food-related occupation
  • Fears of eating in public
23
Q

What signs are typically seen in patients with AN?

A
  • Depression
  • Bone pain
  • Amenorrhea
  • GI constipation/abd pain
  • Hair loss
  • Brittle nail
  • Russell’s sign (callousing on knuckles due to purging behaviors)
  • Lanugo (tiny hair growing everywhere to retain heat)
  • Sallow complexion (slightly yellowish/pale)
24
Q

What complications are most concerning in AN patients?

A

Cardiac complications: decreased heart mass/volume, dysrhytmias, CHF, mitral valve prolapse, orthostatic hypotension.

25
Q

What are the MCC of death from AN?

A

Consequences of starvation, suicide, or electrolyte imbalance.

26
Q

What is the workup for all suspected anorexic patients?

A
  • EKG
  • UA (sp. gravity)
  • Serum labs of CMP, phosporus, magnesium, INR, CBC with diff.
27
Q

What would prompt us to admit someone for AN?

A
  • Unstable vitals OR hypothermia (< 35C/95F)
  • End-organ complications
  • Cardiac complications (HR < 30 or 40 w/ hypotension)
  • Psych complications (SI, acute food refusal)
  • Nutrition complications (Weight < 70% goal, marked dehydration, refeeding syndrome)
28
Q

What is refeeding syndrome?

A

Massive shifts in electrolyte levels as the body is NOT used to this much food. Causes the patient to become very sick, such as fatigue, weakness, etc.

29
Q

What are the main goals of treating AN?

A
  • Medical stability/managing complications
  • Healthy weight
  • Healthy nutrition
  • Address underlying psychopathology.
30
Q

When are psych meds used for AN? Which ones?

A

Not first line, but you can use olanzapine or lorazepam or prozac ideally.
AVOID ESCITALOPRAM (QT) or VENLAFAXINE (CARDIAC)

Prozac causes weight gain, which we want in this situation.

31
Q

How is prognosis for AN?

A
  • 50% good
  • 25% medium
  • 25% poor
32
Q

What are factors that indicate poor prognosis for AN?

A
  • Later onset
  • Longer duration
  • Lower minimal weight
  • Lower body fat after weight goal met.
  • Psych comorbidities
33
Q

What is the all-cause mortality of AN?

A

6x more likely :(
Usually due to the medical complications or suicide.

34
Q

What is the classic patient of bulimia nervosa?

A

Adolescent white female

35
Q

What characterizes BN?

A
  • Recurrent binge eating and inappropriate compensatory behaviors at least ONCE A WEEK FOR 3 MONTHS (usually vomiting).
  • Self-evaluation unduly influenced by body weight.
36
Q

What are some examples of compensatory behaviors in BN?

A
  • Vomiting: 80-90%
  • Laxative use
  • Enema, diuretics, fasting
37
Q

What are the subtypes of BN?

A
  • Purging: self-induced vomiting or use of laxatives.
  • Nonpurging: Fasting or excessive exercise.
38
Q

What is the typical behavioral pattern for BN?

A
  • Caloric restriction
  • Binge eating secretly
  • Compensatory mechanism (with guilt and depressing)
  • Slightly more control over their other behaviors than AN.
39
Q

What are the clinical findings for BN?

A

Same as AN, but their body weight is usually normal or above normal.

40
Q

What are the GI complications of BN?

A
  • Salivary gland hypertrophy
  • Loss of gag reflex
  • GI tract dysmotility
  • GERD
  • Esophageal tears or rupture
  • Malabsorption
  • Diarrhea
  • Constipation
  • Pancreatitis
41
Q

How does salivary gland hypertrophy typically present?

A

image

42
Q

What is the workup for all suspected BN patients?

A
  • UA
  • Serum labs
  • LFTs
  • CBC w/ diff
  • EKG
  • Ca
  • Mg
  • P
43
Q

When would we admit a BN patient?

A
  • Unstable medical condition
  • SI/severe psychiatric disorder
  • Refusal of treatment with potential to get worse.
44
Q

How do we manage BN?

A
  • CBT (good efficacy in BN specifically)
  • Antidepressants (Fluoxetine 1st line)
  • TCA if no improvement on antidepressants
  • AVOID BUPROPION
45
Q

What is the all-cause mortality in BN?

A

2x (AN is 6x)

46
Q

What are the most dangerous comorbidities with BN?

A

Psychiatric disorders.

47
Q

What demographic is most common to see binge eating disorder? (BED)

A

30% prevalence in weight-control programs
Median age of onset is 23 yrs.

Hgher prevalence than AN and BN.

48
Q

What characterizes BED?

A

Recurrent binge eating WITHOUT compensatory behaviors.

49
Q

How do we calculate BED severity?

A

Frequency of binge eating episodes per week.
* Mild: 1-3
* Moderate 4-7
* Severe: 8-13
* Extreme: 14+

50
Q

What are some commonly reported symptoms for BED?

A
  • Coping/comfort mechanism is eating food.
  • Continue eating even if full.
  • Eat very quickly
  • Feelings of shame, guilt, or hopelessness after episode.
  • Hiding their habits.
51
Q

What comorbidities tend to be common in BED?

A
  • Obesity, leading to HTN, DM, CAD, HLD
  • Impaired functioning
  • Comorbid psych disorders
52
Q

Why do BED patients tend to have a higher risk of cancer?

A

Consuming much more potentially unhealthy calories.

53
Q

How do we manage BED?

A
  • Psychotherapy first (CBT)
  • Behavioral weight loss therapy
  • Pharmacotherapy (SSRIs, Anticonvulsants, vyvanse)
  • DO NOT USE ANTIOBESITY DRUGS (too many SE)

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