Eating Disorders

Difference between binge eating disorder and bulimia?

a.    BED doesn’t have compensatory behaviour as criteria

Both have loss of control

Difference between anorexia and bulimia?

1. Anorexia nervosa vs bulimia nervosa

• Anorexia nervosa (AN)

  • Low body weight (BMI < 18.5 for adults)

  • Intense fear of gaining weight

  • Restrictive behaviors or binge/purge subtype

• Bulimia nervosa (BN)

  • Recurrent binge eating with compensatory behaviors

  • Normal or above-normal weight

  • Self-evaluation unduly influenced by shape/weight

2. When both anorexia-type behaviors and compensatory behaviors coexist

If the person is underweight, the DSM-5 says:

Even if there are binge/purge behaviors, the diagnosis is AN binge/purge subtype.

• If the person is normal or overweight, BN is the diagnosis.

Risk factors for refeeding syn

High risk patients: BMI < 16, unintentional weight loss > 15%, very low oral intake

Main concern with refeeding syndrome?

In refeeding syndrome, hypophosphatemia is generally the most concerning and potentially life-threatening electrolyte abnormality, even more than hypokalemia.

Metabolic disturbances in AN

low T3 - body lowers metabolism

high GH -

high total cholesterol - using fat instead of carbs - due to high IGF-1

amylase increased in setting of purging
All electrolytes decreased

T3 down

T4 low normal

TSH normal

cortisol normal

ARFID criteria

1. Fail to meet energy needs - weight loss, nutrition, or functioning

2. not due to lack of resources

3. Not BN or AN

ARFID Treatment

Psychoeducation, family therapy, if also anxiety disorder, use SSRIs, food hierarchy

Anorexia criteria

1. restriction leading to 18.5 BMI

2. fear of weight

3. distorted body image

How often must binging purging occur in bulimia

1x week for 3 months

Comorbidity of binge eating

bipolar, depression, anxiety

Treatment of binge eating disorder

CBT, vyvanse, topiramate
Prognosis better than for AN/BN

Atypical AN

all criteria for AN are met, except that despite weight loss, weight is within normal range

AN with B/P subtype patient prognosis

higher impulsivity, more likely to abuse drugs,

What % of adolscents will recover from AN in adulthood?

50-70

Good / bad prognostic factors in AN

Good prognosis	Poor prognosis
Early age of onset	Long history
Short history	Severe weight loss
Good parent-child relationship	Substance abuse
Ability to engage/motivation for change	Personality disorder

Mortality rate of AN per year

5%

Takeaways from Keys Starvation Experiment

eating in silence, withdrawn, impaired concentration, depression, anger, lability

Signs of purging

enlarged parotids, oral skin irritation, arryhtmias, hypokalemia, alkalosis, esophagitis, dental erosion

Indications for hospitalization in EDisorders

1. extremely low BMI <13

2. difficulty ambulating

3. difficulty swallowing

4. Serious medical status

5. no capacity to understand consequences

Better outcomes in treatment

early and faster weight gain

Phases of family based therapy for youth AN

Phase 1: weight restoration

• Focus on the dangers of severe malnutrition

• Help the parents in their joint attempt to restore child’s weight

• Sympathy and persistence in the expectation that starvation is not an option.

• Child is not to blame, but rather symptoms are mostly outside of their control

(externalizing the illness).

Phase 2: Returning control

• Encouraging the parents to help their child to take more control over eating once

again.

Phase 3: Establishing healthy adolescent identity

• Initiated once able to maintain weight above 95% of ideal weight on their own and

self-starvation has abated

• Review of central issues of adolescence, supporting increased personal autonomy,

development of appropriate parental boundaries

Treatment of BN

1. CBT

2. FBT for adolescents

3. can try IPT, DBT

Fluoxetine - reduces binge eating, purging, and psychological features

May require high doses. Continue for 1 year.