Feeding or Eating Disorders

what is anorexia nervosa?

patient who refuses to eat, due to fear of being overweight

- intense fear of becoming fat, even though underweight

- frequent weight checks

- denial of emaciated state

- weight <85% of ideal body weight

how can anorexia nervosa be distinguished from bulimia nervosa?

in anorexia, BMI is usually < 17 or body weight is <85% of IBW

which eating disorder has the highest rate of suicide?

anorexia nervosa

what are the 2 types of anorexia?

- binging/purging (laxatives/diuretics abuse &/or excessive exercise)

- restricting (eat very little &/or exercise to excess)

how is anorexia treated?

restore nutritional state

- hospitalization (if weight if <75% expected body weight)

- psychotherapy (behavioral therapy)

- pharmacotherapy (SSRIs due to added benefit of causing weight gain)

what is bulimia nervosa?

patient who has episodes of mass eating, followed by self-induced vomiting or intense exercise (compensatory behavior) at least once a week for 3 months

what are classical physical exam findings with bulimia?

- scars on knuckles

- swollen parotid glands

- dental erosions

- normal weight

- hypokalemia

how is bulimia treated?

restore nutritional state

- fluoxetine 60 mg PO once/daily

- 2nd line = TCAs or MAOIs

- behavioral/family/group therapy

a 19-year-old female who has lost 40 pounds over the last 6 months. Her body mass index is 16. When asked about her most recent meal, the patient reports that she ate an apple the previous morning.

anorexia nervosa

a 17-year-old female who is in your office for an annual sports physical. She is the star of her high school track team. She has not menstruated for 5 months. Her BMI is 15 kg/m2. On physical exam, you note calluses on the back of her hands and fine hair on her arms. She states that she only eats vegetables but has been trying to cut back as she thinks she is holding excess body fat

anorexia nervosa

a 14-year-old is female who is brought to your clinic by her mother who claims to hear the child vomiting after dinner in the evenings. The patient reportedly denies vomiting and feels fine. On physical exam, you notice petechial hemorrhages of the soft palate and conjunctiva. Further exam reveals scars on her knuckles, swollen parotid glands, dental erosions. Her weight is normal. Lab tests reveal hypochloremia and hypokalemia.

bulimia nervosa