eating disorders (329 E2)

Question 1

amenorrhea

Answer 1

the loss of menstrual periods in girls & women post puberty

Question 2

anorexia nervosa (AN)

Answer 2

a life threatening eating disorder characterized by:

• intense fear of weight gain
• severely distorted body image
• restriction of calories relative to requirements w/ significantly low BMI

Question 3

binge eating disorder

Answer 3

an eating disorder characterized by recurrent episodes of binge eating, w/ accompanying marked distressed and impaired control over such behavior

Question 4

bulimia nervosa (BN)

Answer 4

an eating disorder in which the individual engages in recurrent episodes of uncontrollable binge eating and compensatory behavior to avoid wt gain through purging methods such as self induced vomiting, use of laxatives, diuretics or excessive exercise
needs to occur 1x/wk for 3 months for dx

Question 5

eating disorders

Answer 5

• consistently below or above a person’s caloric needs to maintain a healthy weight
• can be accompanied by anxiety and guilt
• occurs w/o hunger or fails to produce satiety
• results in physiologic imbalances or medical complications

Question 6

lanugo

Answer 6

downy growth of body hair on the face and back

Question 7

pica

Answer 7

ingestion of substances that have no nutritional value, such as dirt or paint

• usually early childhood
• males & female affected equally
• monitoring eating behavior is essential
• rewarding appropriate eating can be helping

Question 8

refeeding syndrome

Answer 8

a sudden shift in the electrolytes that help your body metabolize food

Question 9

rumination disorder

Answer 9

characterized by undigested food being returned to the mouth. it is then rechewed, reswallowed or spit out

• dx after 1m of sx, at any age
• occurs more frequently among people w/ ID
• childhood neglect is predisposing factor to the development of this disorder

Question 10

Russell’s sign

Answer 10

calluses and/or scars on back of hands and knuckles from self induced vomiting

Question 11

satiety

Answer 11

comfortable fullness

Question 12

eating disorder progression

Answer 12

normal eating -> development of risk factors (low self esteem, dieting, body dissat) -> partial syndrome eating disorder (binge eating & serious dieting) -> full syndrome eating disorder -> treatment

Question 13

etiology of EDs: psychological factors

Answer 13

• low self esteem
• feelings of inadequacy
• lack of control in life
• depression, anxiety, stress, loneliness, trauma

Question 14

etiology of EDs: interpersonal factors

Answer 14

• troubled relationships
• difficulty expressing emotions
• hx of being teased based on size/wt
• hx of physical or sexual abuse

Question 15

etiology of EDs: social factors

Answer 15

• cultural pressures that glorify “thinness” or muscularity & place value on obtaining the “perfect body”
• narrow definitions of beauty
• cultural norms that values people on the basis of physical appearance and not inner qualities and strengths

Question 16

etiology of EDs: biological factors

Answer 16

• irregular hormones functions
• genetics

Question 17

etiology of EDs: neurobiological

Answer 17

demonstrates that altered brain serotonin function contribute to the dysregulation of appetite, mood and impulse control

Question 18

etiology of EDs: environmental

Answer 18

• childhood trauma and sexual abuse
• hx of abuse have a poorer prognosis
• culture influences the development of self concept & satisfaction w/ body size

Question 19

co morbidities / dual dx & eating disorders

Answer 19

• pts w/ anorexia, have hx of anxiety 25-50% of the time
• up to 33% of pt w/ binge purge behavior have co morbid alcohol or substance abuse problem
• bulimia frequently coexists w/ major depressions, substance abuse and personality disorders

Question 20

anorexia nervosa: restricting type

Answer 20

describes individuals that do not regularly engage in binge eating or purging behavior -> wt loss is accomplished through dieting, fasting and/or excessive exercise

during last 3 months

Question 21

anorexia nervosa: binge eating & purging type

Answer 21

refers to those who regularly engage in binge eating or purging behavior

during last 3 months

Question 22

S/s of anorexia nervosa (AN)

Answer 22

• low body wt (15% or more below what is expected for age, ht & activity level)
• amenorrhea
• lanugo
• mottled, cool skin
• peripheral edema
• lack of energy & muscle weakness
• constipation
• low BP, pulse & vitals
• abnormal labs
• impaired renal funciton
• decreased bone density
• anemic pancytopenia

Question 23

w/ eating disorders, when do electrolytes become abnormal

Answer 23

usually only w/ purging

Question 24

anorexia nervosa
epidemiology

Answer 24

• uncommon before puberty or after 40 years old
• regardless of gender, more common in athletes
• higher in the LGTBQ community
• less common than bulimia
• co morbid w/ bipolar, anxiety, OCD, depression, PTSD, trauma related disorders & alcohol/substance use

Question 25

anorexia nervosa etiology: biological

Answer 25

- genetic & familial - comorbids - glucose & lipid metabolism? - neurobio: tryptophan & impact on serotonin synthesis

Question 26

anorexia nervosa etiology: psychological & cognitive

Answer 26

- egosyntonic disorders (knows the action is harmful but believes benefit outweighs the harm) - struggle significantly w/ emotional ID, regulation & processing - exhibit low distress tolerance & deficits in behavioral control in response to distress

Question 27

anorexia nervosa etiology: environmental

Answer 27

- internalization of a thin body ideal - associated w/ cultures that values thinness

Question 28

anorexia nervosa risk factors

Answer 28

female, fam hx, hx of obesity, dieting, over exercising, low self esteem, body dissat, lack of assertiveness, other EDs, hx of abuse, comorbid conditions, distorted body image, media, fashion industry, being an athlete

Question 29

warning signs of anorexia nervosa

Answer 29

- dramatic wt loss - preoccupation w/ weight, food, calories, fat grams & dieting - refusal to eat certain foods, progressing to restrictions against whole categories of food - frequent comments about feeling "fat" or overweight despite wt loss - anxiety about gaining wt or being "fat" - denial of hunger - development of food rituals - consistent excuses to avoid mealtimes or situations involving food - excessive, rigid exercise regimen - w/draw from usual friends & activites - behaviors and attitudes indicating that wt loss, dieting & control of food are becoming primary concerns

Question 30

clinical course of anorexia nervosa

Answer 30

- chronic condition w/ relapses characterized by significant wt loss & 50% relapse wt - often continue to be preoccupied w/ food - 10 to 25% develop bulimia - 1 in 5 AN death is by suicide - poor outcomes r/t initial lower min wt, presence of purging & earlier age of onset **difficult to treat but recovery is possible**

Question 31

goals for anorexia nervosa

Answer 31

- initial goals: start nutritional rehab, health teaching & promotion - later goals: resolving conflicts around body image, inc effective coping, address underlying conflicts & assisting family w/ health functioning & comm

Question 32

treatment modalities for anorexia nervosa

Answer 32

- hospitalization - intensive therapies - outpatient partial hospitalization

Question 33

criteria for hospitalization for anorexia nervosa

Answer 33

- extreme lyte imbalance or wt below 75% IBW - less than 10% body fat - daytime heart rate <50 bpm - a systolic bp <90 - temp <96 - arrhythmias

Question 34

treatment for anorexia nervosa once medically stable

Answer 34

- wt restoration program begins - goal is set at 90% IBW - precise mealtimes, adherence to selected menu, observation during meals & weigh ins - constant monitoring during bathroom trips - monitor for refeeding syndrome - milieu therapy focusing on eating behavior & anxiety, dysphoria, low self esteem & lack of control

Question 35

other treatments for anorexia nervosa

Answer 35

- fluoxetine for has been proven helpful for obsessive compulsive behavior - CBT

Question 36

bulimia nervosa overview

Answer 36

- more prevalent then AN - mean onset 18 - typically, normal wt - generally not life threatening - outpatient treatment - better outcomes & lower mortality rates - medications are effectives

Question 37

bulimia nervosa etiology: biological

Answer 37

- neuropatho: changes in the brain may be due to eating dysregulation - genetic & familial predispositions - gene connection - biochem: lower brain serotonin

Question 38

bulimia nervosa etiology: psychological & cognitive

Answer 38

- anxiety disorders or low self esteem - impulsivity & compulsivity - chaotic, non nurturing family relationships - difficult interpersonal relationships - triggers: stress, poor body self image, food, restrictive dieting or boredom

Question 39

bulimia nervosa etiology: environmental

Answer 39

- internalization of a thin body ideal, wt based teasing or bullying - childhood sexual or physical abuse, traumatic events & environmental stress

Question 40

clinical course of bulimia nervosa

Answer 40

initially do not appear physically ill -> often at or close to normal wt -> binge & purge in secret -> treatment delayed for years -> treatment initiated when control of eating is lost -> once treatment is complete, typically there is complete recovery expect if depression &/or personality disorders are present

Question 41

risk factors of bulimia nervosa

Answer 41

- binge eating behaviors - hx fo AN - depressive signs & symptoms - problems w/ interpersonal relationships - impulsive behaviors - increased levels of anxiety and compulsivity - possible substance use disorders

Question 42

warning signs of bulimia nervosa

Answer 42

- evidence of binge eating (disappearance of large amounts of food in short time, finding wrappers & containers empty) - evidence of purging behavior (frequent bathroom trips after meals, signs of vomiting, packages of laxatives) - excessive, rigid exercise regimen - creation of lifestyle schedules or rituals to make time for binge/purge sessions - w/draw from friends and family - primary concern is wt loss & control of food - parotid swelling - Russell's sign - dental caries, tooth erosion and discoloration of teeth

Question 43

treatment of bulimia nervosa

Answer 43

(hospital is life threatening comps/SI) - outpatient for stabilization and normalizing eating - restructuring dysfunctional thoughts & attitudes about eating, wt & shape - teaching healthy boundary setting - nutrition counseling - behavior techniques like journaling to record binge/purges & precipitating emotions and environmental cues

Question 44

medications for bulimia nervosa

Answer 44

- SSRIs - fluoxetine (only FDA approved med for treatment of BN, most effective w/ CBT)

Question 45

psychological therapies for bulimia nervosa

Answer 45

- CBT (first line) - DBT - group - family therapy not usually used d/t age of pt

Question 46

epidemiology & comorbidity of BED

Answer 46

- most common eating disorder - occurs in normal wt/overwt individual - inc in women of any race - 50% of risk is d/t genetics - most prevalent w/ specific phobias, social phobia, PTSD & alcohol abuse - impulsivity and reward sensitivity, low self esteem, body dissat, difficulty coping w/ feelings - hx of trauma & adverse childhood events - hx of food insecurity

Question 47

treatment of BED

Answer 47

- hospitalization usually not required - outpatient health teaching & health promo & healthy eating & exercise - meds: SSRIs, lisdexamfetamine dimesylate - CBT & DBT - group **binge eating is not about the food but instead coping w/ emotions**

Question 48

rumination disorder interventions

Answer 48

- repositioning infants & small children during feeds - improving the interaction between caregiver & child & making mealtimes a pleasant experience often helps reduce - distracting the child when the behavior starts - family therapy may be required

Question 49

avoidant/restrictive food intake disorder

Answer 49

- can result in significant wt loss, nutritional deficiency, dependence on sups or enteral feeding, & marked interference w/ functioning - food avoidance may be related to strong dislikes r/t sensory qualities of food - males & females equally affected - seen infancy & childhood - personal anxiety and family anxiety are a risk factors

Question 50

avoidant/restrictive food intake disorder treatment

Answer 50

- primary treatment modality is some form of behavioral modification to increase regular food consumption - families caring for a child w/ a feeding disorder often need support and education in behavioral techniques but family therapy is not usually needed - tx of anxiety and depression may be helpful