Psychiatric disorder with highest rate of mortality
Anorexia nervosa (slow death from starvation, cardiac or suicide) has a 20% mortality rate.
Eating disorder most likely to cause sudden death?
Bulimia (gag reflex stops working and you choke)
What is an eating disorder
Persistent disturbance of eating behavior that impairs both physical and mental health.
Groups at risk for development of an eating disorder
Frequent dieters, athletes and military (stress, weigh-ins, achievement)
Anorexia nervosa definition
Denial of impact of low weight, use of weight to determine happiness and disturbed perception of physique.
How common is anorexia and bulimia nervosa?
1-4% lifetime prevalence. 1:10 male:female
Distinctive features of anorexia
Sense of specialness, effort and competitiveness.
Co-morbid conditions with anorexia and bulimia nervosa
Depression, anxiety, PTSD, OCD and substance abuse
Physiological consequences of anorexia nervosa.
Good prognosis for anorexia
Early age of onset and early intervention by family and social network.
When do you admit someone with anorexia?
What is commonly used to prevent relapse of anorexia after recovery?
Role of provider in managing anorexia and bulimia
Recognize signs, refer to mental health and treat health complications
Definition of bulimia nervosa
Binge eating w/inappropriate compensatory behavior (vomiting, laxatives, diuretics, enemas, fasting, exercise) 1x a week for 3 months. Self-evaluation is influenced by physique. **Anorexia trumps bulimia**
Eating an amount of food larger than the average person would eat and a lack of control over eating during that episode.
How does bulimia affect the body?
Chipmunk cheeks, esophageal erosions, perimylolysis (erosion of tooth enamel).
Good treatments for bulimia
Psychotherapy, CBT and SSRIs
Most prevalent eating disorder. What defines it?
Binge eating disorder, highly associated with obesity. Note that there are no compensatory behaviors. Marked distress from binge eating. Binges 1x a week for 3 months.
Psychotherapy for binge eating disorders
Help them see that food is okay to eat, but try to prevent obesity
Comorbid in people with binge eating disorders
75% have another psychiatric disorder (obesity, anxiety)
What should you always assess for in people who present that are overweight or obese?
Binge eating disorder
Treating binge eating disorders
Psychotherapy, appetite suppressants, antidepressants
Definition of eating disorders not otherwise specified.
Anorexia w/normal weight range. bulimia less than 1x a week, compensatory behavior after eating small amounts of food, chewing and spitting out large amounts of food.
Most prevalent eating disorders in military women?
Bulimia and not otherwise specified. Deployed women at higher risk
How do weigh ins affect men in military
15% perform eating disorder habits around weigh ins
Physican’s role in preventing/treating eating disorders
Moderation in eating/exercise, collaborate with mental health provider, don’t refer solely for nutritional counseling, monitor physical comorbidities and be supportive.