Eating Disorders

Question 1

What is criteria for Anorexia Nervosa?

Answer 1

• Intense weight loss – self induced starvation
• intense dieting / exercising
• disrupted body image
• signs of starvation

Question 2

What are the subtypes of Anorexia?

Answer 2

• • Binge/Purge – large amount of food in a short amount of time, then compensatory behavior to rid the food/weight
• • Restricting Type – severely limiting caloric intake

Question 3

What might be some key signs of starvation symptoms?

Answer 3

• hypothermia, cold intolerance
• amenorrhea
• bradycardia/hypotension
• alopecia/dry skin
• Pancytopenia
• Fatigue
• *Every Organ System Affected**

Question 4

Who most likely develop Anorexia?

Answer 4

• Females, mid-teens
• Dieting for one reason or another can lead to it
• FamHx of mood disorders
• Usually onset at beginning of puberty

Question 5

What are the social influences that can contribute?

Answer 5

• Performance pressures in sports (Gymnastics, Wrestling)
• Teasing about weight
• Media Influences

Question 6

What is the biggest red flag in Anorexia?

Answer 6

Weight Loss in Teenagers!

Question 7

What is the best treatment option of Anorexia?

Answer 7

Typically they are resistant to treatment and there is no sure-fire test to confirm it other than symptoms and excessive weight loss.

• • Food
• • May requrie inpatient hospitalization to correct metabolic abnormalities
• • Team approach to therapy working in all aspects of their life eating, medical, psych, behavior

Question 8

How is bulimia nervosa different from Anorexia?

Answer 8

• Episodes of Over-eating, then compensatory behavior to prevent weight gain occuring at least 1x per week for 3 months. Depending on number of episodes a week correlates to severity.

Question 9

What are common methods of purging besides vomiting?

Answer 9

• Misuse of Laxatives, diuretics, enemas

- Excessive Exercise, restrictive dieting, skipping meals

Question 10

What might be physical signs that can make you suspicious a patient is bulimic?

Answer 10

• Parotid Hypertrophy
• Russel’s Sign – abrasions on knuckles from inducing vomiting
• Dental erosions and caries (Freq dental visits)

Question 11

You are seeing a patient who you are suspicious of being bulimic and do electrolyte testing, what might be the finding if they are abusing laxatives?

Answer 11

• Low Potassium, High Chloride, Low Bicarb

Question 12

You are seeing a patient who you are suspicious of being bulimic and do electrolyte testing, what might be the finding if they are abusing diuretics?

Answer 12

• Low Potassium, Low Sodium, High Bicarb

Question 13

If you are suspicious of a patient to have an eating disorder and or electrolyte testing. The results indicate she has hypokalemia, hyponatremia, elevated bicarb, hypomagnesium, elevated serum amylase. What should you suspect?

Answer 13

The patient is purging by vomiting or abusing diuretics

Question 14

What is a possible symptoms of the hypokalemia experienced from vomiting in bulimia?

Answer 14

Cardiac Arrhythmias

Question 15

If a patient is found to be purging more than 3 times per week with their binge eating, what should be the recommended treatment?

Answer 15

Inpatient Evaluation and treatment.

Question 16

What are social conditions associated with bulimia?

Answer 16

• Depression
• Temperament –overachiever, secretive, self-critical, outgoing, impulsive
• Other substance use and abuse

Question 17

What are the most common treatments that can help bulmia nervosa successfully?

Answer 17

Most are outpatients unless 3x+ per week

• Cognitive-Behavioral Therapy
• Family Therapy (to be more supportive)
• SSRI – Fluoxetine

Question 18

What is it considered if a person multiple times per month has a single sitting in which they binge eat countless calories, even though they had been speaking of how they are on a diet and worried about what they eat. After this binge episode there is no compensatory behavior to counter-act the food.

Answer 18

Binge-Eating Disorder

• • Binge Eating with marked distress minimum once per week in a 3 month period
• • However, NO Compensatory Behavior

Question 19

How are Anorexia Nervosa and Avoidant/Restrictive Food Intake disorder different from one another?

Answer 19

• Both involve persistent failure to meet appropriate guidelines of nutrition/energy needs
• However – These patients do not experience a distorted self-image on how their body is viewed

Question 20

How is purging disorder different from bulimia disorder?

Answer 20

Purging Disorder – the patients frequently purge, but do not necessarily have a distorted body image or restricted diet/obsessing over food.

Question 21

What is considered reasonable weight loss in an adult?

Answer 21

• 5-10% Body Weight Loss over 6 months or 1-2 lbs lost per week
  Children/Teens – should lose weight slower than adults or have a goal to just maintain weight

Question 22

What are reasonable dietary changes to help weight loss goals?

Answer 22

• Limit Portion Sizes

- Behavioral Modifications – BEST, food diary, change patterns of eating and how you eat.