Lecture 6: Eating Disorders

Question 1

Anorexia Nervosa DSM V criteria

Answer 1

(1) Restriction of energy intake relative to requirements leading to markedly
low body weight
(2) Fear of weight gain or behaviors to avoid weight gain
(3) Body image disturbance, denial of seriousness of illness, undue influence
of body weight/shape on self-evaluation
(4) No amenorrhea criterion

Question 2

AN behaviors

Answer 2

(1) Restricting eating/fasting
(2) Exercise
(3) Bingeing
(4) Vomiting
(5) Laxatives/enemas
(6) Diuretics
(7) Diet pills/stimulants
(8) Weighing, shape checking, comparison making
(9) Food rules, calorie counting

Question 3

AN prevalence

Answer 3

prevalence of 1%, more ED-NOS

Question 4

AN gender ratio

Answer 4

Female: Male ratio of 1:6 – 1:20

Question 5

AN peak onset

Answer 5

Peak onset between 15-19 years

Question 6

AN risk factors

Answer 6

▪ Biological: 33-84% heritability, increased risk w/ a family hx of eating disorders (10x), obesity, or affective disorders
▪ Psychological: comorbid psychiatric diagnoses, concerns about self control, low self esteem, low sense of efficacy, stressed by developmental tasks, early puberty, past history of abuse
▪ Social: food availability and obesity, stigmatization of obesity, media, modeling

Question 7

Bulimia Nervosa Criteria DSM V

Answer 7

(1) Recurrent binge eating
(2) Recurrent compensatory behaviors to prevent weight gain
(3) On average 1x/wk x 3months
(4) Self evaluation unduly influenced by body shape and weight
(5) Does not occur exclusively during episodes of anorexia nervosa

Question 8

BN Behaviors

Answer 8

(1) Bingeing
(2) Restricting eating/fasting
(3) Exercise
(4) Vomiting
(5) Laxatives/enemas
(6) Diuretics
(7) Diet pills/stimulants
(8) Weighing, shape checking, comparison making
(9) Food rules, calorie counting

Question 9

BN prevalence

Answer 9

prevalence of 2-4%, more ED-NOS,

Question 10

BN gender ratio

Answer 10

Female: Male ratio of 1:6 – 1:20

Question 11

BN peak onset

Answer 11

Peak onset between 18-23 years

Question 12

T/F. BN may arise out of AN.

Answer 12

(crossover from 8-62%) usu. in first 5 years

Question 13

BN risk factors

Answer 13

▪ Biological: 28-83% heritability, increased risk w/ a family hx of eating disorders (10x), obesity, or affective disorders
▪ Psychological: comorbid psychiatric diagnoses, concerns about self control, low self esteem, low sense of efficacy, stressed by developmental tasks, early puberty, past history of abuse
▪ Social: food availability and obesity, stigmatization of obesity, media, modeling

Question 14

Binge Eating Disorder

Answer 14

o Binging without compensatory behavior
o Associated with overweight/obesity
o More equal gender distribution, more adult onset

Question 15

Patients at risk for eating disorders

Answer 15

o Overweight, athletes, models, chronic illness (CF, diabetes), history of trauma (type of SIB), psychiatric comorbidity

Question 16

Look for clues and ask questions, unrecognized by PCP 50% of time!!!!!

Answer 16

ASK!!

Question 17

IBW

Answer 17

o 100lbs. + 5 lbs. per inch over 5 feet for females

o 106lbs. + 5lbs. per inch over 5 feet for males

Question 18

criteria for AN (IBW and BMI)

Answer 18

BMI <85%

Question 19

At what % IBW is mortality increased? inpatient care necessary?

Answer 19

< 65% of IBW increases mortality, <75% for inpatient care

Question 20

Physical complications of restricting/malnutrition

Answer 20

o Bones: osteopenia, osteoporosis, and fractures
o Brain: pseudo-atrophy with enlarged ventricles, low serotonin
o Cardiac: bradycardia, hypotension, orthostasis, hypothermia, arrhythmias
o Dermatology” lanugo, dry skin, edema;
o GI: constipation, motility;
o Hematology: pancytopenia;
o Endocrine: sick euthyroid syndrome, hypoglycemia, low LH, FSH, estrogen, testosterone

Question 21

Physical complications of purging:

Answer 21

Electrolyte abnormalities, elevated salivary amylase, arrhythmias, bradycardia, orthostasis, GI tears, GERD, dysmotility, dental enamel loss, parotid swelling

Question 22

2nd Leading cause of death in AN

Answer 22

Suicidality is the 2nd leading cause of death in AN (16.9% of patients attempt), 8x higher than the general population

Question 23

Clues for Anorexia Nervosa:

Answer 23

(1) Rapid/severe weight loss
(2) Dieting, calorie counting, taboo foods
(3) Excessive exercise
(4) Focus on body image/appearance
(5) Dizziness, syncope, weakness, cold intolerance, fatigue

Question 24

Clues for Bulimia Nervosa

Answer 24

(1) Weight cycles
(2) Trips to bathroom after meals
(3) Vomiting, laxatives or enemas
(4) Physical signs and symptoms: Russellʼs sign (knuckle abrasion),
parotid/salivary gland swelling, loss of dental enamel, GERD)
(5) Labs: low K, elevated HCO3

Question 25

Danger zone

Answer 25

(1) < 85/50
(3) HR ≤ low 40s
(4) Low K+, phos, or Mg
(5) Prolonged QTc
(6) Refeeding
(7) Suicidality