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Eating disorders (Types (Bulimia nervosa Recurrent episodes of binge…
Eating disorders
Types
Bulimia nervosa
Recurrent episodes of binge eating and compensatory behaviour to prevent weight gain
Binge eating disorder
Episodes of eating significantly more food in a short period of time (<2 hours) than most would
Feel lack of control, no compensatory behaviour
Anorexia nervosa
Low body weight maintained due to preoccupation with weight, either fear of fatness or a pursuit of thinness
Atypical eating disorder
Symptoms of an eating disorder but does not meet the precise diagnostic criteria
Diagnosis
Examination
Physcial
Anorexia:
cachexia, dry skin, hair loss, low muscle mass/fat, lanugo hair, Russel's sign bradycardia, hypotension, hypothermia, oedema
Bulimia:
knucke calluses, dental erosion, enlarged parotids
MSE
Check for other mental health problems
SCOFF questionnaire
Make yourself
sick
Lost
control
over eating
Lost
>1 stone
in 3m
Believe
fat
when others say thin
Food
dominates life
Investigations
Bedside
Obs - sats, HR, BP, temp
ECG - arrhythmia
Bloods
Hormones (high GH and cortisol, reduced TH)
History
Eating problem?
Worry about weight?
ICD-10 criteria
Anorexia
Deliberate weight loss by avoiding
fatty foods +/- compensation
Body image distortion
BW<15%, BMI<17.5
Abnormal HPG
Delayed puberty (if relevant)
Bulimia
Preoccupation with eating, cravings, overeating
Compensatory behaviour
Dread of fatness
Binge eating
Per bulimia, lack of compensation
Atypical
Closely resemble another disorder
but does not fulfil all criteria
Epidemiology
Young women
(adolescence/young adults)
Atypical>binge>bulimia>anorexia
Rare
Pathophysiology
Perpetuating
Unstable family environment, poorly managed mental health
Precipitating
Abuse, criticism about appearance, family dynamics, occupational/recreational pressure e.g. model, ballet,
personality type e.g. obsessive/impulsive/anxious
Predisposing factors
Female, young age, family history, Western,
other mental health problems
Complications
Physical
Pulmonary
Aspiration pneumonitis
Gastrointestinal
Reduced motility, constipation, gastric dilation,
Mallory-Weiss, swollen parotids, abnormal LFTs,
dehydration, electrolyte dist, eroded tooth enamel
Endocrine
Infertility, PCOS, amenorrhoea, hypoglycaemia,
osteopenia, thyroid problems
Neruological
Cognitive impairment, peripheral neuropathy, seizures,
weakness
Cardiovascular
Arrhythmias, mitral valve prolapse,
peripheral oedema, hypotension, sudden death,
diet pill toxicity (e.g. palpitations, hypertension)
Renal
Stones, AKI, CKD
Haematological
low WCC, anaemia, thrombocytopenia
Musculoskeletal
Reduced strength, bone density, growth (teens)
Dermatological
Russel's sign (knuckle callouses), downy hair
Social
Relationships
Occupation
Emotional
Anxiety, mood
Clinical
presentation
Bulimia
Behaviour
Compensation
Purging (vomiting/laxatives), exercise,
appetite suppressants, diuretics)
1+/wk for 3m
Binge eating
Eating more in a defined time (<2h) than normal,
1+/week for 3 months
Psychological
Loss of control over amount eaten
Fear of gaining weight
Mood disturbance (anxiety etc.)
Preoccupation and craving for food
Guilt and shame about behaviour
Self harm
Physical
Normal weight
Weight maintained BMI>17.5 adults
Others
Bloating, lethargy, GORD, abdo pain, sore throat
Anorexia
Behaviour
Avoid fattening foods
May compensate (purging, exercise,
appetite suppressants, diuretics)
Psychological
Distorted body image
Dread of fatness, persuit of thinness
Self worth in terms of shape/weight
Weight loss seen as positive
Others are mistaken
Denial of seriousness of condition
Difficulty achnowledging problem
Physical
Others
Constipation, headache, fatigue, etc.
Low weight
Maintained >15% below expected (BMI<17.5 adults)
Endocrine disorder
Amenorrhoea, loss of libido, ED
Management
Anorexia
Setting
Inpatient - low/rapid loss, physical complications,
psychiatric comorb, failed outpatient
Conservative
Weight restoration
Manage complications
Diet education
Support
Psychological
Psychotherapy (CBT, psychodynamic)
Family therapy
Bulimia/
binge eating
Setting
Usually outpatient
Psychological
CBT
Medical
SSRIs e.g. fluoxetine
Prognosis
Anorexia
10% death (complications, suicide)
Recovery less likely with duration
Bulimia
Good recovery rates
Some persist to anorexia
Death 0.5% (suicide)
Definition
Persistent disturbance of
eating behaviour resulting
in altered consumption/
absorption of food that
significantly impairs physical
health or psychosocial function