Feeding and Eating Disorders

Restriction

Limiting intake of food

Purging

Eliminating food through vomiting or misuse of laxatives/diuretics

Bingeing

Eating an excessive quantity of food in a discrete period

General presenting Complaints

Rapid or extreme weight changes. Distorted body image. Avoidance of meals or eating rituals. Amenorrhea or other hormonal disturbances. Gastrointestinal complaints without medical cause

neurotransmitter

The neuroscience of eating disorders shows Altered ______ activity: especially serotonin, dopamine, and norepinephrine pathways. Neuroimaging studies show altered brain activation in areas related to reward, impulse control, and body perception

Hyperthyroidism

Medical cause that mimics an eating disorder marked by increased metabolism and weight loss

Diabetes Type 1

Medical cause that mimics an eating disorder marked by weight loss, polyphagia, and ketosis

GI Disorder (e.g., Crohn’s)

Medical cause that mimics an eating disorder marked by malabsorption and pain with eating

Brain tumor (hypothalamic)

Medical cause that mimics an eating disorder marked by appetite and behavioral changes

Assessment tools

SCOFF questionnaire, eating attitudes test (EAT-26), body mass index (BMI) and nutritional labs (albumin, electrolytes)

SCOFF questionnaire

Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than one stone (14 pounds) in a 3-month period? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life?

A score of ≥2 is suggestive of an eating disorder.

Hospitalization indications

BMI <15 kg/m2, Bradycardia (HR < 40 bpm), hypotension (SBP <90 mmHg), electrolyte imbalance (severe hypokalemia (<2.5 mmol/L)), syncope or seizures present, active suicidal ideation

medical aspects

Dehydration, cardiac arrhythmias, GI complications, menstrual irregularities, osteoporosis

Psychosocial aspects

Isolation, anxiety, depression, perfectionism, impaired academic/social functioning

SSRIs

Psychopharmocological treatment for Bulimia Nervosa and Binge-Eating Disorder. Caution: SSRIs ineffective for Anorexia Nervosa until weight is restored

Cognitive Behavioral Therapy (CBT)

Evidence-based psychotherapy, especially for Bulimia and Binge-Eating Disorder

Family-Based Treatment (FBT/Maudsley Method)

Psychotherapy treatment of an ED, especially for adolescents with Anorexia Nervosa

Dialectical Behavior Therapy (DBT)

Psychotherapy treatment for ED. Useful for comorbid borderline personality traits

CBT Triad in Eating Disorders

Thoughts: “I’m fat”, Feelings: Anxiety, shame, Behaviors: Restriction, binging, purging

Eating disorder

Abnormal eating patterns that disrupt health or psychosocial functioning

Anorexia nervosa

Diet and exercise that leads to low body weight. Intense fear of gaining weight. Distorted perception of body weight. Increased mortality. Low GnRH secretion, low LH and FSH, amenorrhea, inability to concentrate urine, hyponatremia, creatinine low, hypokalemia (due to purging), decreased bone density, high cortisol, osteopenia, osteoporosis, anemia, leukopenia, thrombocytopenia. Bradycardia, hypotension, decreased bowel sounds, dry/scaly skin (xerosis), hair loss, lanugo hair growth. Treatment: nutritional rehabilitation, psychotherapy, SSRIs

Bulimia nervosa

Binge eat and inappropriate compensation to avoid weight gain. Occurs at least once a week for three months. Usually have a normal body weight. Purging complications: contraction alkalosis, hypokalemia, low urinary chloride, parotid swelling, erosion of dental enamel, Russel’s sign (scars on knuckle from induced-vomiting)

Binge eating disorder

Binge eating = compulsive overeating. Often eaten quickly. Patient feels the lack control and is ashamed/embarrassed. No inappropriate compensation. Weight gain seen. Occurs at least once a week for three months. Treatment: psychotherapy, SSRIs (used but less effective), lisdexamfetamine, topiramate

Refeeding syndrome

Following anorexia nervosa, hypophosphatemia that leads to cardiac and respiratory failure