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35 Cards in this Set

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4 criteria of Anorexia Nervosa
Refusal to maintain body weight at normal level (85%)
Intense fear of gaining weight or becoming fat
Disturbance in way one's body weight or shape is experienced
Amenorrhea (absence of at least 3 consecutive cycles)
Two subtypes of Anorexia Nervosa
Restricting - NO binge eating or purging

Binging/Purging - binge eating or purging during current episode
3 criteria for Bulimia Nervosa
Recurrent episodes of binge eating (sense of lack of control)
Recurrent inappropriate compensatory behavior
Self evaluation is unduly influenced by body shape and weight
Two subtypes of Bulimia Nervosa
Purging - vomiting, misuse of laxatives, etc.

Non-purging - other, inappropriate compensatory methods
Time period for inappropiate behaviors in Bulimia
BOTH eating and compensatory behavior on average:

At least twice a week for three months
Positive reinforcement
When behavior is rewarded by something positive
Negative reinforcement
When behavior results in a release from something negative
95% eating disorders begin as what?
Normal dieting
How do men respond to hunger?
More acute hunger

Eat earlier in the day
Eat more rapidly
What does dieting alter in women that it does not affect in men?
Serotonin and prolactin
When men feel overweight, what are they more likely to do?
Exercise, as opposed to dieting
What finding is peculiar in ultramarathoners?
1/3 to 1/2 of them stop menstruating BEFORE dieting/training
Why is anorexia a misnomer?
Because "anorexics" DO experience hunger

They just fight their urge to eat
Pure restricting anorexia develops in people w/ what type of personality?
Perfectionistic, rigid, socially insecure people

~OCPD
Binge/purge anorexia develops in people w/ what type of personality?
Extroverted, impulsive, sensitive to rejection

Often meet criteria for Borderline
How do binge/purgers usually interact with their parents?
More alienated from (rather than enmeshed with) their parents
How do binge/purgers tend to see the world?
As a stressful, uncaring place

They turn to dieting for gratification
How are mothers of restrictive anorexics most often described?
Intrusive, dominating, and critical

Often also introverted and phobic
How are fathers of restrictive anorexics most often described?
Passive, submissive

Often belittled by their wives
This family feature is shown by families of both anorexics and bulimics
High expectations of the children
Starvation associated with what brain finding in 82% of pts.
Cerebral atrophy
Starvation leads to what metabolic change in the brain?
Increased caudate metabolism

Remember, also a sign of OCD
What is missing in bulimics, preventing them from feeling sated?
An appropriate CCK resposne

Injected exogenous CCK makes bulimics feel sated
Peptide YY
The most potent feeding stimulator known

Stimulates carb craving
Feeding decreases levels and leads to satiety
This occurs ~2 hours after a purge and can be associated with increased hunger
Rebound hypoglycemia
Use of Olanzapine in Anorexia
Modestly useful in decreasing anxiety, depression, and obsessions

INCREASES likelihood of weight gain
What type of pts. are SSRIs effective in?
WEIGHT RESTORED
Use of Amitriptyline in Anorexia
Small reduction in number of days to target weight

NOTE: side effects limit use
Use of Fluoxetine in Anorexia
Useful in preventing relapse in WEIGHT RESTORED pts.

NOT useful in emaciated state
NOTE: tryptophan is required for serotonin synthesis
Use of SSRIs in Bulimia
Decrease urge to binge and purge

NOTE: risk of hyponatremia in pts. who are Na depleted
Use of MAO-Is in Bulimia
Very effective

BUT, risk of hypertensive crisis if dietary restrictions not obeyed
Use of Buproprion in Bulimia
Effective

BUT, contraindicated due to high risk of seizures
Which drugs do you NOT want to prescibe to anorexics/bulimics?
BDZs

High risk of addiction
High seizure potential
Treatment steps for eating disorders (5)
STOP THE BEHAVIOR
Treat medical complications
Treat comorbid psych conditions
Address reinforcers
Treat in an ambulatory setting
What are the primary obstacles to treating eating disorders (2)?
Pts. lack of insight
Difficulty chaging established patterns of behavior