Eating Disorders

Anorexia nervosa:

Is a life-threatening eating disorder characterized by the client’s restriction of nutritional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even its very existence. 

Subgroups of anorexia nervosa:

Restricting, binge eating and purging 

Restricting subtype:

Patient loses weight primarily through dieting, fasting, or excessive exercising. 

Binge eating subtype:

Means consuming a large amount of food (far greater than most people eat at one time) in a discrete period of usually 2 hours or less. 

Purging subtype:

Involves compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics.  

Physical problems caused by anorexia nervosa:

Amenorrhea, constipation, loverly sensitive to cold, lanugo hair, loss of body fat, muscle atrophy, hair loss, dry skin, dental caries, pedal edema, bradycardia, arrythmias, orthostatis, enlarged parotid glands and hypothermia, and electrolyte imbalances.  

Bulimia nervosa:

Is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. 

Binge eating disorder:

Is characterized by recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress. 

Night eating syndrome:

Is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss. Most pt’s are obese.  

Pica:

Persistent ingestion of nonfood substances such as hair. 

Rumination:

Repeated regurgitation of food that is then rechewed, reswallowed, or spat out. 

Pica and rumination is most common in _.

Infants, very young children, and persons with intellectual developmental disability.  

Orthorexia nervosa:

Is an obsession with proper or healthful eating. Behaviors include compulsive checking of ingredients; cutting out increasing number of food groups; inability to eat only “healthy” or “pure” foods; unusual interest in what others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs.  

Behaviors associated with anorexia nervosa and bulimia nervosa:

Mood disorders, anxiety disorders, substance abuse, depression and obsessive–compulsive disorder (most common), perfectionism, obsessive–compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, traits associated with avoidant personality disorder, high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder. 

Risk factors for anorexia nervosa:

Obesity, dieting at an early age, issues of developing autonomy and identity, family history of mood or anxiety disorders, dissatisfaction w/ body image, family lacks emotional support, parental maltreatment, cultural ideal of thinness. 

Risk factors for bulimia nervosa:

Obesity, early dieting, possible serotonin and norepinephrine disturbances, family history of mood or anxiety disorders, self-perception of being overweight, chaotic family w/ loose boundaries, parental maltreatment including sexual abuse, weight-related teasing, and cultural ideal of thinness.  

Anorexia nervosa medical treatment:

Management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances, CBT therapy, family therapy, psychopharmacology therapy, supervised bathroom visits, TPN and tube feeds may be required. 

Onset and course of anorexia nervosa:

Typically begins 14-18 yo, early phase the pt is pleased with weight control, this leads to depression and lability in mood (compulsive behaviors increase), which causes social isolation and paranoia that others want to make them fat.  

What prompts hospitalization for an anorexia nervosa pt? 

Severe fluid, electrolyte, and metabolic imbalances; cardiovascular complications; severe weight loss and its consequences; and risk for suicide. 

Psychopharmacology drugs for anorexia nervosa:

Amitriptyline, antihistamine cyproheptadine (weight gain), olanzapine (body image distortion), SSRI antidepressants. 

Onset and course of bulimia:

Begins around 18-19 yo, frequently begins during or after dieting, between episodes, may eat restrictively to set them up for the next binge and purge. These patients will go to great lengths to hide the problem. 

Manifestations of bulimia:

Sore throat, irregular menstruation, constipation, abdominal pain, bloating, headache, fatigue, lethargy, hypotension, dry skin, hair loss, dental erosion, parotid gland swelling, calluses on the dorsal aspect of the hand “Russel’s sign”. 

Medical management for bulimia:

CBT (most effective) and psychopharmacology (antidepressants for short-term, desipramine, imipramine, amitriptyline, nortriptyline, phenelzine, and fluoxetine).