Diagnostic criteria for anorexia nervosa. (4) And what are the types of anorexia nervosa?
- refusal to maintain body weight at or above a minimally normal weight for age & height (BMI < 17.5)
- intense fear of gaining weight or becoming fat
- disturbance in the way in which 1’s body shape or weight is experienced
- in postmenarcheal female: amenorrhoea (at least 3 cycles)
types:
- restricting
- binge-eating/purging
Diagnostic criteria for bulimia nervosa. (4) And what are the types of bulimia nervosa?
- recurrent episodes of binge eating
- recurrent purging/ excessive exercise
- at least once a week for 3 months
- self-evaluation is influenced by body shape & weight
types:
- purging
- non-purging
What is comorbidity?
refers to the occurrence of more than one disorder at the same time
List co-morbid psychiatric illnesses
- depression
- OCD
- anxiety disorder
- personality disorder (OCPD, borderline PD)
General factors of eating disorders
- Genetic
- Socio-cultural (dieting, criticism, teasing)
- Psychological (lack of control)
- Physical (obesity)
- Personality (perfectionism)
Individual factors (At least 5)
- perfectionism, high-self expectations
- poor body image
- low self-esteem
- extreme need for approval
- tendency to think in black and white
- feelings of anxiety and sadness
Family factors (4)
- avoidance of conflict
- unrealistically high expectations
- overly dependant
- overvalue physical appearance
Life events/trigger factors
- build of life events
- major life transitions
- problems in communication in the family
- traumatic / stressful life events
- problems in social or romantic r/s
Complications of eating disorders (At least 5)
- fluid & electrolyte abnormalities
- GI complications
- cardiovascular (hypotension, bradycardia, arrhythmia, ECG changes)
- metabolism
- musculoskeletal (muscle-wasting, osteoporosis, suboptimal weight)
- CNS (secondary depression, cognitive impairment, cerebral atrophy)
- reproductive (reproductive immaturity, hypoestrogenic state)
Weight restoration:
Restore to: (3)
- min. healthy weight (BMI 18.5 or pre-morbid weight)
- resumption of reproductive function (return of menses / arrival of menarche)
- resumption of growth & development
Restore to what weight per week?
~1kg/week
Medications to treat:
1) SSRIs
2) 2nd gen antipsychotics eg. OLZP, RISP, QTP (may be useful in weight resistance)
3) Anti anxiety agents (may be useful before eating)
Are eating disorders hereditary?
Yes.
Meal supervision (nutritional rehab)
- ensure completion of adequate meals
- correct abnormal eating habits
- defuse anxiety & tension
- model normal eating
- intro of social element of eating
