Week 1: eating disorder psychology

Question 1

What are the key eating disorder recongised on the ICD11?

Answer 1

Anorexia Nervosa
Bulimia NErvosa
Binge eating disorder
Pica
ARFID
OSFED

Question 2

How might OSFED by further subdivided?

Answer 2

Atypical anorexia nervosa - BMI >18.5
Bulima/Binge Eating disorder of low frequency/duration

Question 3

Whata re the ICD diagnositic criteria for anorexia nervosa?

Answer 3

BMI 18.5 or less
Persistent patterns of behaviour to prevent normal resotarion of weight
Body image distortion
Low body weight/shape is important to persons self evaluation
Intense fear of gaining weight

Question 4

What are the ICD-11 subtypes of anorexia nervosa?

Answer 4

Significantly low body weight - BMI 14-18.5
Dangerously low body weight - BMI below 14
Restricting pattern - exercise or restricted diet
Binge-purge pattern - binge and/or purging alongside restriction
Anorexia Nervosa - in recovery with normal body weight n normally given when behaviours have stopped for >1yr

Question 5

What are the ICD diagnostic criteria for Bulima Nervosa?

Answer 5

Not significantly underweight
Preoccupation with weight/shape influences self evaluation
Episodes of binge eating with recurrent compensatory behaviour

Question 6

What are the diagnositic criteria for a binge episode?

Answer 6

Discrete period of time
Subjective loss of control
More than usual - typically over 1000s calories

Question 7

What are the ICD diagnositic criteria for Binge Eating Disorder?

Answer 7

Frequenct bindges
Feel distressed and other negative emotions (guilt/disgust)
Not associated with compensatory behaviour

Question 8

What are the ICD diagnostic criteria for ARFID?

Answer 8

Abnormal eating/feeding resulting in insufficent variety of quantity of food
May have significant weight loss or failure to grow
Impaired health and functioning as a result
Not due to concerns around body shape or weight
Isnt caused by underlying health condition, effects of meds or lack of food availability.

Question 9

What are the ICD-10 main subtypes of ARFID?

Answer 9

Specific phobia - e.g choking, allergy
‘Picky eating’ - taste, texture, colour, brand
Lack of appetite/interest or somatic anxiety symptoms.

Question 10

What are the key features of anorexia nervosa specif in children?

Answer 10

Do not use BMI rather is BMI for age is under the fifth percentile
Prepubertal onset can lead to delayed pubertal events or arrested puberty

Question 11

What are the key characertistics of anorexia nervosa in men specifically?

Answer 11

Loss of sexual interest or potency
Differences in idealised body shape - muscular or lean desire, starvation changes focus to law weight.

Question 12

What is bigorexia?

Answer 12

Believes they are small and skinny
Whilst in reality they are normally or greater than normal muscular

Question 13

What is drunkorexia?

Answer 13

When a person restricits intake in order to save calories for alcohol

Question 14

What is orthorexia?

Answer 14

Obsessed with a healthy or clean diet

Question 15

What is Type 1 diabetes eating disorder?

Answer 15

Omitting insulin - aka diabulimia - in order to loose weight

Question 16

How common are eating disorders in HIC?

Answer 16

15% of young women
5.5% of young men
Will suffer from an eating disorder

Question 17

What are some figures around the prevalence and life span of anorexia nervosa?

Answer 17

One of the most common chronic illnesses in adolscence - at least as high as T1DM
Peak diagnosis is between 15-25
Average illness duration is around 6 years

Question 18

What physical illnesses are often considered as differential diagnosis alongside eating disorders?

Answer 18

Gastrointestinal condition
Endocrine conditions

Question 19

What mental disorders are often considered as differential diagnosis for eating disorders?

Answer 19

Depressive disorder
Anxiety disorder
Driven by personaltity disorder - use changing/controlling food behaviour to diminish symptoms

Question 20

What co-morbid mental health conditions are people with anorexia nervosa also often diagnosed with?

Answer 20

Depression
Anxiety
OCD
Personality disorders - avoidant or anankastic

Question 21

What co-morbid mental health conditions are commin in Bulimia?

Answer 21

Depression
Substance missuse
Self harm/suicide attempts
Emotionally unstable personality disorder

Question 22

What was the Minnesota Starvation study?

Answer 22

In 1944 to 1945 - 36 men monitored on their normal diet then slowly starved - monitored physical and psychological changes - restored the weight monitored how easy that was and any remaining physical or psychological changes remained.

Question 23

What were the key findings of the Minnesota Starvation Study?

Answer 23

Large changes in personality and behaviour changes
Adapted unusual eating habits (over use of condiments), obsession over food
Low mood - isolated themselves
Episodes of psychosis - self harmed.
In recovery - reported struggling to understand hunger signals, take up to 2 years to return to normality.
Physical - decreased energy, heart rate, temperature and strength

Question 24

What are some of the biological risks of eating disorders?

Answer 24

AN: large gentic link 11.3x more likley if close relative has
BN: 5x more likely if a close relative
Gender 10:1 in F:M
Early puberty - early body changes in comparison to friends can increase dysmorphia
Type 1 diabetes - food focused treatment

Question 25

What are some of the suspected genes involved in Anorexia Nervosa?

Answer 25

Mutations in metabolism particulary regulating blood sugar levels and body fat May allow patients to starve their body for longer. May also be gentic effects on brain structure -personality etc. Includes ESRRA, gherline, leptin and other appetite regulating genes

Question 26

What are some social risks for eating disorders?

Answer 26

Dieting industry Profession - model, dance, competitive sport Upbringing Acculturation - change of body standards between different cultures Social media - particularly instagram

Question 27

What are the risks of eating disorders for the patient and surrounding society?

Answer 27

AN highest mortality rate of any major psychiatric disorder Burden of care on families is equal to that of depression or schrizopenia Economic/social estimates suggest comparable burden as for anxiety or depression

Question 28

What are some of the risks of starvation?

Answer 28

Cardiac arrythmias Postural hypotension Hypothermia Bone marrow suppression Electrolyte imbalance osteoporosis Muscle wasting Impaired fertility Imparied cognitive function Liver pathology Kidney failure

Question 29

What are some of the negative effects of vomiting?

Answer 29

Enamel erosion Swollen parotid gland -increased amylase/bicarbonate productino gastric and Oesophageal trauma - Mallory Weiss tear Electrolye imbalance - low K+ Na+ Cl-

Question 30

What are some of the complications of using laxatives as a compensatory behaviour in an eating disorder?

Answer 30

Loss of water and electrolytes Rectal bleedings Abdominal Cramps rebound constipation (when stop taking laxatives - hence suggest gradual reduction rather than stopping)

Question 31

What are some of the complications of using exercise as a compensatory behaviour in an eating disorder?

Answer 31

Physical exhaustion Muscle damage Elevated creatine kinase Cardiac/ECG abnormalities - bradycardia, heart block. Rhabdomyolysis - release of protein from damaged muscle causes kidney damage

Question 32

What is falsifying weight and how might eating disorder patients do this?

Answer 32

Trying to weigh more on the scales that they actually are Drinking lots of water before weighing Hiding weights in hair/shoes

Question 33

What is the basic theory of refeeding syndrome?

Answer 33

Starved individual - low glucose, low insulin levels, low mineral and electrolytes Refeed - spike in glucose levels, high insulin spike, glucose absorbed into cells - also absorb vitamins and minerals as part of the process Particularly phosphate, magnesium, potassium, sodium and thimaine Leads to dangerously and rapidly low plasma levels of these.

Question 34

What are some of the potential complications of re-feeding syndrome?

Answer 34

Wernicks/ korsakoff - brain and memory disorders Odema and cardiac failure from Na+

Question 35

What in particular is at risk of re-feeding syndrome?

Answer 35

Very low BMI Very little or no nutrition for the last 5 days Co-morbid alcohol dependence Co-morbid physical health condition such as cancer Parental feeding > NG feeding > Oral feeding

Question 36

What risks (potentially dangerous situations) need to be considered/ screened for in eating disorder patients?

Answer 36

Risk to self - self harm or suicide Safe to drive - typically no if BMI is under 16 - affect concentration Able to work - no if BMI <16 Child care - concentration and judgement Activities - horse riding Universities guidance of if sit to attend (often no as concentration impaired and difficult to monitor exercise and intake)

Question 37

What assessments are always carried out to identify risk of complications in an eating disorder patient?

Answer 37

Weight, height - BMI and rate of weight loss BP (postural), Pulse and temp ECG Sit up/sqaut test FBC, U&E, Glucose, Bone marrow function and Mg levels

Question 38

What is the sit up squat test?

Answer 38

1. sit up - patient lies down flat on the floor and sits up if possible without using their hands 2. Squat-stand - rise without using hands Scored sepeartly. 0 - unable 1 - able using hands 2- able with difficulty 3- able with no difficulty

Question 39

What are some red flags for a high risk to life in ED patients?

Answer 39

These risks indicate hospitalisation is needed - lost more than 1kg per week for more than 2 weeks - BMI below 13 - HR below 40 - standing BP below 90mmHg with postural drop - abnormal biochemistry and bloods Others include: severe dehydration, significant ECG abnormalities, reduced strength, postural drop above 20mmhg, exercising for more than 2 hours a day, moderate to high suidicde risk

Question 40

What are some amber flags for risk to life in an ED patient?

Answer 40

Loosing over 0.5kg per week for 2 weeks + BMI between 13-14.9 HR between 40-50 Standing BP below 90mmHg with occasional postural drop Moderate dehydration

Question 41

What signs should be looked for during a physical examination for an ED?

Answer 41

General appearance Body temperature/ paleness parotid glad swelling Russel sign Lanugo Erythma ab igne Sub-conjuctival haemorrohage

Question 42

Why is it important to intervene early in an eating disorder?

Answer 42

Brain changes are more malleable in the early stage - after recovery Greater percentage of patient recover is recognised and treated within the first 2-3yrs In later stages habits are more compulsive and entrenched

Question 43

What is the main goal of nutritional management of eating disorders?

Answer 43

Ran by dietitians and occupational therapists regular eating and snacks aiming for 0.5-1kg restoration per week May take food shopping, or cooking food Encourage eating in different social situations Psychoeducation

Question 44

How can beig vegan/vegetarian complicate eating disorde recovery?

Answer 44

Difficult to distinguish is decision is part of eating disorder in order to decrease calorific intake Can make it harder to gain weight as limited Vegan nutritional substitutes May need to feed substances against their beliefs.

Question 45

What is the set point concept in Eating disorder treatment?

Answer 45

Everyone has an indivdual set point - range of weight that out body will try to maintain in order to have optimal biological functioning. Body metabolism and function can adapt to variations in intake in order to maintain a body weight Explains why different people have a different healthy weight

Question 46

What is part of the medical management of eating disorders?

Answer 46

Monitor physical parameters - BMI, bloods, vital signs Monitor for signs of refeeding syndrome - important to start gradual but should not underfeed No medication for anorexia itself but patient may be given Olanzapine (anti-psychotic to reduce emotional turmoil) in low dose as an off-licenes

Question 47

How can bone density be managed in an eating disorder recovery?

Answer 47

DEXA scan - identify bone density May have oteopenia or osteoporosis May be given a calcium supplement or alendronic acid The only way to restore bone density is to restore weight

Question 48

WHat are the different possible treatment setting for eating disorders?

Answer 48

GP monitoring/community centre/ day service Medical ward (if high risk of physical abnormalities or refeeding syndrome) Specialist Eating Disorder Unit

Question 49

What medical treatments might a person with an eating disorder be given?

Answer 49

Nasogastric feeding Bed rest v chair rest Frequency of monitoring bloods/investigation/obs

Question 50

What psychological treatment may be offered to those with anorexia nervosa?

Answer 50

CBT MANTRA Specialist Supportive Clinical Management Eating disorder focused FPT

Question 51

How does risk and readiness to change alter the treatment plan in eating disorder patients?

Answer 51

Low risk wanting change - standard treatment Low risk not ready to change - motivation work and discharge High risk and wanting change - intensive treatment High risk and not wanting change - consider the use of the mental health act.

Question 52

How does the mental health act apply to eating disorders?

Answer 52

Disorder thought to impair judgement and capcity therefore can be put under the mental health act Main reason: risk of self neglect Medical treatment given without consent if it treats a symptoms or manifestation this includes NG tubes and Blood tests Patient may be out on a medical ward or a psychiatric ward.

Question 53

What makes treating a patient with an eating disorder difficult?

Answer 53

Behaviour can appear as aggressive or naughty - remember this is a manifestation of the disease and may not appear in other aspects of personality Patients are often coherent and articulate Patients know a lot about the disease - method to score higher on tests - eating well before a meal or falsifying weight or trying to appear as wanting to make change to avoid sanction Confusion of capacity - severely ill often lack capacity, can fluctuate and can be hard to assess as appear high capacity in areas unrelated to food.

Question 54

What is the progression from abnormal to normal in an ED patient ECG?

Answer 54

Normal Hypokalaemia onset Low T wave Low T wave with a high U wave Low T wave, high U wave and low S_T segment