Psych - Eating Disorders

Front 1

DMS IV criteria for anorexia

Back 1

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of the body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

D. In postmenarchal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea, if her periods occur only following hormone, e.g., estrogen administration).

Front 2

DSM IV criteria for bulimia

Back 2

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. eating, in a discrete period of time (e.g., within any two hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances;
2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating);

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise;

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months;

D. Self evaluation unduly influenced by body shape and weight;

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Front 3

Continuum of eating disorders

Back 3

Mild
Normative discontent - dieting and weight consciousness
Eating disorder symptomatology
Diagnosable disorder
Severe

Front 4

Only country with higher rate of eating disorders than USA

Back 4

Japan

Front 5

Anorexia Nervosa (AN) genetic risk

Back 5

Family hx of eating disorder, affective disorder

Front 6

Bulimia Nervosa (BN) genetic risk

Back 6

Family hx of eating disorder, affective disorder, OR SUBSTANCE ABUSE

Front 7

Comorbidities with anorexia

Back 7

Depression, OCD, substance abuse, personality disorder, PTSD

Front 8

Comorbidities with bulimia

Back 8

Depression, substance abuse, PTSD.

Front 9

Childhood experience common in people with anorexia or bulimia

Back 9

sexual or physical abuse.

Front 10

Precipitating factors to cause an eating disorder

Back 10

Separational loss
Disruption in family homeostasis
New environmental demands (such as due to maturation)
Personal illness
Dieting

Front 11

Anorexia subtypes

Back 11

Restricting - No binging or purging

Binge eating/purging type - Has binged or purged during the episode of anorexia.

Front 12

Purging

Back 12

self-induced vomiting, misuse of laxatives, diuretics, enemas.

Front 13

AN - early signs/sx

Back 13

Psych - Distorted body image, dieting, preoccupation with food

Physical changes - hair loss, feeling cold, bloated, nauseous after small amt of food, amenorrhea

GI issues, depression, weakness, decreased concentration.

Front 14

AN - physical exam

Back 14

Thin, pale, DEPENDENT EDEMA, muscle wasting

CV - bradycardia, hypotension, arrythmias, orthostatic HTN, chest pain, palpitations

GI - discomfort.

Front 15

Lab studies for AN

Back 15

Neutropenia, anemia.
Hypokalemia, metab acid/alk (dependent on whether laxatives or vomiting is occurring)
hypocalcemia, increased serum amylase, hypomagnesemia.
Euthyroid sick syndrome - decreased T3, low normal to normal T4, normal TSH
EKG - bradycardia and prolonged QT

Front 16

How to differentiate btwn laxative of vomiting

Back 16

Laxatives - Metabolic acidosis

Vomiting - Metabolic alkalosis

Front 17

Euthyroid sick syndrome

Back 17

Low T3, decreased to normal T4, normal TSH

Front 18

DDx for AN (medical)

Back 18

Malabsorption, endocrine issues (e.g. hyperthyroidism), malignancy (causing cachexia, n/v, loss of appetite).

Front 19

DDx for AN (psychological)

Back 19

Psychotic illness (somatic delusions), depression, anxiety, body dysmorphic disorder, OCD (food-related consumptive behaviors)

Front 20

Tx of AN

Back 20

Nutritional rehab - get pt back to normal menstruation and ovulation (90% of normal body weight)

Psychosocial rehab

Front 21

Modalities of tx for AN

Back 21

Inpt and partial hospitalization programs for medical stabilization
Indiv psychtherapy
family therapy
group therapy
12-step programs (overeaters anon, food addicts anon)
medication - usually not used acutely. especially in severely underweight pts. but SSRIs may help prevent relapse after weight recovery.

Front 22

Eating disorder not otherwise specified (NOS)

Back 22

Over 50% of eating disorder pts.
Many meet most, but not all, DSM IV criteria.

Front 23

Almost anorexic (Eating disorder not otherwise specified (NOS))

Back 23

Weight greater than 85% expected.
Not amenorrheic for three months.

But then meets the rest of the anorexia criteria

Front 24

Almost bulimic (Eating disorder not otherwise specified (NOS))

Back 24

Binge and purge less than twice per week

But then meets the rest of the bulimia criteria.

Front 25

Binge eating disorder

Back 25

Binge eating in absence of compensatory behaviors.
Overweight of obesity is common but not required.
Psychosocial features include body dissatisfaction, low self-esteem, depression.

Front 26

Bulimia rarely seen under age...

Back 26

12

(anorexia can start earlier)

Front 27

Body dysmorphic disorder - who has it more? Men or women?

Back 27

=

Front 28

Cluster of personality disorders linking with anorexia

Back 28

Cluster C

Front 29

Cluster of personality disorders linking with bulimia

Back 29

Cluster B and C

Front 30

Female athlete triad

Back 30

Disordered eating, amenorrhea, osteoporosis.

Front 31

Two types of bulimia nervosa

Back 31

Purging - regularly purges.

Non-purging - Has used other inappropriate episodes during the current episode of BN, such as fasting, excessive exercise. But HAS NOT purged.

Front 32

Early signs/sx of BN

Back 32

Psych - frequent trips to bathroom, reacts to emotional stress by overeating, guilty of eating, difficulty voluntarily stopping eating.

Physical changes - swollen salivary/parotid glands, fluctuations in weight, menstrual irreg, dental problems.

Front 33

Physical exam for BN

Back 33

Poor skin turgor, dental decay, inflamed oral mucosa, enlarged parotids

CV - arrythmias, cardiomyopathy due to electrolyte depletion

GI - discomfort.

Front 34

Mental status for BN

Back 34

Mood - irritable or depressed with mood swings.

Affect - irritable, depressed, labile

Cognition - normal usually.

Front 35

Lab studies for BN

Back 35

CBC usually normal
Electrolytes - hypokalemia and metabolic alkalosis/acid (depends on laxatives or vomiting)
Increased serum amylase due to vomiting and increased LFTs due to fatty degen of liver in late stage BN.
Urinalysis - increased spec gravity.

Pertinent normals - thyroid and EKG

Front 36

DDx of BN

Back 36

Medical - malignancy, GI disease, hyperthyroidism (causing increased appetite)

Psychiatric - Anxiety disorders, OCD

Front 37

Tx of BN

Back 37

Medical safety/stabilization - rebalance electrolytes, rehydrate, treat secondary sequelae such as cardiac arrythmias.

Reduce binge eating

Psychosocial rehab

Front 38

Modalities of tx of BN

Back 38

Inpt and partial hospitalization programs - for medical stabilization
Tx is usualyl outpt - indiv psychotherapy
Family/group therapy
12-step (overeaters anon, food addicts anon)
Medication - Fluoxetine is quite helpful!!! Sertraline may also work.

Front 39

Something to remember when treating anorexia and bulimia

Back 39

treat comorbidities!!!

Front 40

Prognosis of eating disorders in general

Back 40

10% mortality rate

Front 41

Prognosis of AN

Back 41

High rate of partial and low rate of full recovery.

Front 42

Prognosis of BN

Back 42

higher rates of both partial and full recovery compared to anorexia.