Feeding and eating disorders 🍝

what are the eating disorders?

anorexia nervosa and bulimia nervosa

what are eating disorders?

may be classified as true psychosomatic illnesses as underlying biological vulnerability interacts with cultural stress to produce behavioral and psych sxs

what is anorexia nervosa?

technically misnomer as anorexai is a lack or loss of appetite for food

in anorexia nervos, they have full appetite, they are just actively countering these feelings

there is self-imposed starvation

what is amount of weight loss considered to be serious for dx based on?

metropolitan life insurance tables, pediatric growth charts, BMI

where is anorexia more prevalent?

in countries where thinness is the beauty standard, where there is an overemphasis on slim female figure

what are the possible etiologies of anorexia nervosa?

• Disturbances in norepi + serotonin sometimes present during acute phase of anorexia nervosa

• Few abnormalities persist into weight-restored phase of illness; if so, may be related to malnutrition

what role do genetics play in anorexia nervosa?

higher concordance rates in monozygotic vs dizygotic twins so there is a genetic factor involved

what are the s/sxs of anorexia nervosa?

• Weight loss freq. accomplished by ↓ total food intake and exclusion of ↑ kcal food → *extremely restricted

diet*

• May lose weight by purging (via self-induced vomiting or misuse of laxatives/diuretics) or by exercising excessively

• As weight declines, fear of becoming fat may increase

how is self esteem affected in anorexia nervosa?

it is overly dependent on body shape and weight

pts are obsessed with employing wide variety of techniques to estimate body size, including frequent weighting, measuring, and looking in the mirror

finish 13

what related obsessions may pts with anorexia nervosa have?

food related obsessions

frequently hoard or collect recipes

what signs of starvation may be present on PE?

emaciation, HoTN, bradycardia, dry skin, lanugo (peach fuzz), peripheral edema (ankles), petichiae on extremities, parotid hypertrophy, dental enamel erosion, OP, Russell sign

what may precede onset of diminished weight and why?

amenorrhea

we dont have enough estrogenm related to loss of body fat stores rather than decreased body mass

what are the psychiatric manifestations of anorexia nervosa?

- not sure if they are cause or consequence of malnutrition

- Studies of forced starvation* in volunteers reported sx of food preoccupations, food hoarding, binge eating, and unusual taste preferences, personality changes (e.g., depression, obsessionality,

apathy, irritability)

what will lab tests reveal in anorexia nervosa?

• Most organ systems are affected by malnutrition

• Co-existing dehydration may be indicated by ↑ BUN

what can be shown on labs of anorexia nervosa if induced vomiting is part of clinical picture?

metabolic alkalosis may

be found with ↑ bicarb, ↓ Cl, ↓ K

what will laxative abuse in anorexia nervosa reveal on lab testing?

metabolic acidosis and (+) FOB test

what does amenorrhea result from in anorexia nervosa?

↓ estrogen secretion from ↓ pituitary release of FSH and LH

what exam is recommended about every 6 months if pt has amenorrhea with anorexia nervosa?

bone density, DEXA

what general medical conditions are differentials for anorexia nervosa?

IBD, hyperthyroidism, malignancies, AIDS

which can all cause serious weight loss

how can you differentiate weight loss from general medical conditions from that of anorexia nervosa?

pts with eternal medical conditions wont have distorted body image, fear of becoming obese, or desire for further weight loss

how do anorexia nervosa patients usually get professional assistance?

they rarely seek help on their own, they ae usually brought in by family members or they'll come in for one of the sxs like fertility issues, cold intolerance, etc

how do you obtain history of pt with anorexia nervosa?

they are unreliable to obtain history from because they frequently deny the core problem

obtain history from family members

what acute intensive medical intervention may anorexia nervosa patients need?

they need to correct fluid and electrolyte imbalances, cardiac problems, and organ failure

may be beneficial to start intensive tx early because malnutrition can cause grey matter loss, OP, delayed growth, and development

in an ideal world, when should hospitalization occur?

BEFORE developments of instability

before orthostatic HoTH, arrhythmias, hypothermia

who is family therapy helpful for?

essential in children and adolescents, but adults with illness for 5 or more years rarely respond

who is group psychotherapy for?

frequently used but doesn't always achieve best results

what is the health target weight for females determined by?

by weight at which normal menstrual function returns

usually ~90% of average BMI

how is target weight determined for male pts?

by restoration of normal testicular function

which patients will hale lower rehospitalization rates?

those who achieve target weights prior to being discharges from the hospital

what can olanzapine be used for in anorexia nervosa?

aid in weight gain in adult and adolescent underweight anorexics

this is an antidepressant, a common SE of it is weight gain

what can fluoxetine be used for in anorexia nervosa?

may have utility in preventing relapse in patients whose weight has been restored

may may be used to restore bone mineral density despite lack of evidence?

hormone replacement therapy, biphosphonates, and calcium/vitamin D

what psychotherapy is useful in anorexia nervosa?

CBT and IPT may be helpful in maintaining weight and healthy eating behaviors

indicated for 1+ years following weight restoration

what are possible medical complications of anorexia nervosa?

they're common, especially if present for ≥5 years

anemia (normochomic and cytic)

impaired kidney function

arryhthmias

HoTN

OP

dental decay

what are possible psych complications of anorexia nervosa?

what does "bulimia" mean?

"ox hunger"

state in which individual repetitively consumes a large amount of food

what is needed to classify bulimia as a psychiatric illness?

emotional distress must be associated with binge eating

subjective quality of feeling loss of control over eating is integrally associated with illness

what is diagnostic criteria needed to make dx of bulimia nervosa?

- two binge eating episodes for a period of 2+ months

- previous history of concurrent dx of anorexia does not exclude diagnosis of bulimia nervosa (can have both)

- symptom of purging good has been incorporates as a required criterion

what are the s/sxs of bulimia nervosa?

- must differentiate a clinically defined binge from what would be considered a feast like during holidays

- about 3,000 kcal per binge in <40 minutes followed by a purge

- repetitive binge-purge activity

what is the most widely used compensatory behavior to control weight?

vomiting

how is vomiting induced?

fingers, hands, or instruments are inserted into oropharynx to induce vomiting by stimulating gag reflex

rarely, emetics are abused (and can cause cardiac toxicity)

how is self esteem affected in bulimia nervosa?

- dependent on body shape and weight but not to degree seen in pt with anorexia nervosa

- pts generally feel they cannot control binge-purge behavior but...

- ...are frequently able to engage in behavior and plan binges around school or work

what are the triggers in bulimia nervosa?

stimuli or triggers for binge eating may include dysphoric mood states, interpersonal stress, dietary restraint, or dissatisfaction with body shape/size

how is mood affected in bulimia nervosa?

self critical feelings and intense depression may occur following binge-purge episodes (even tho the acuity may temporarily reduce depressed feelings)

what may non-purging bulimics use to inhibit appetite or increase metabolism?

fasting, excessive exercise, overuse of thyroid hormones, prescription and OTC meds, and substances of abuse

if they have comorbid DM, they may skin doses of meds to increase inefficient metabolism of glucose

what psychological testing is done for bulimia nervosa?

the same as anorexia nervosa

what lab findings may be a result of vomiting?

loss of gastric acid → ↓ Cl → ↓ K (via renal compensatory mechanisms)