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Flashcards in Lecture 6: Eating Disorders Deck (25):
1

Anorexia Nervosa DSM V criteria

(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

2

AN behaviors

(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

3

AN prevalence

prevalence of 1%, more ED-NOS

4

AN gender ratio

Female: Male ratio of 1:6 – 1:20

5

AN peak onset

Peak onset between 15-19 years

6

AN risk factors

▪ 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

7

Bulimia Nervosa Criteria DSM V

(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

8

BN Behaviors

(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

9

BN prevalence

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

10

BN gender ratio

Female: Male ratio of 1:6 – 1:20

11

BN peak onset

Peak onset between 18-23 years

12

T/F. BN may arise out of AN.

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

13

BN risk factors

▪ 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

14

Binge Eating Disorder

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

15

Patients at risk for eating disorders

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

16

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

ASK!!

17

IBW

o 100lbs. + 5 lbs. per inch over 5 feet for females
o 106lbs. + 5lbs. per inch over 5 feet for males

18

criteria for AN (IBW and BMI)

BMI <85%

19

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

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

20

Physical complications of restricting/malnutrition

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

21

Physical complications of purging:

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

22

2nd Leading cause of death in AN

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

23

Clues for Anorexia Nervosa:

(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

24

Clues for Bulimia Nervosa

(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

25

Danger zone

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