Eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorders.
- Female to male ratio of 10:1
- Occurs in 3% of females with bimodal peak ages of 14.5 years and 18 years. There has been an increase in the incidence in young children and adults greater than 40.
- The highest incidence is in industrialized countries and the higher socio-economic groups.
- 50% will fully recover and 20% never improve
- The mortality rate in patients with eating disorders is 12x that in the general population.
- The mean lifetime duration of disease is 5.9 years for anorexia, 5.8 years for bulimia, and 14.4 years for binge-eating
- Combination of genetics, sociocultural, and neurochemical factors.
- Preexisting psychiatric traits include dependency, isolation, and developmental immaturity.
- Childhood preoccupation with thin body image
- History of dieting
- Activities that emphasize lean body types (ballet, running, wrestiling, skating, and gymnastics
- Female Athlete Triad: eating disordeer, amenorrhea, osteoporosis
- Significant family distres
- History of Sexual abuse
- Exposure to Pro-Ana Websites
Common Clinical Manifestations
- Cardiac arrythmias, CHF, hypotension, and bradycardia
- Sleep disturbances
- Irregular menses, amenorrhea, infertility, oligomenorrhea
- Constipation and rectal prolapse
- Bone marrow suppression with pancytopenia.
- Poor growth
- Electrolyte disturbances secondary to vomiting, use of laxatives, and diuretics, and excessive water intake.
- Hair loss, lanugo hair development, dry skin, abrasions on the hands secondary to inducing vomiting.
- Decrease bone density with resultant increase number of fractures.
- Decrease eating in public
- Reluctant to be weighed
- Acts withdrawn
- Missing school and work
- Increased exercise
- Substance abuse
Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders Definition of
- Anorexia nervosa
- < 85% ideal body weight or BMI of < 17.5
- Intense fear of weight gain
- Perception of body unrealistic. "Feels fat"
- Denial of hunger
- High academic success and over-achievers.
- Intense amount of exercise
- 2 subtypes:restricting and binge eating/purge
- 2x/week for 3 months
- Eat very rapidly and unable to control eating and stop
- Purging (vomiting, use of ipecac, diuretics, laxatives, enemas, caffeine, and other uppers)
- Increase exercise to counteract binges
- Binge Eating (proposed by DSM-V)
- Recurrent episodes of binge eating episodes characterized by an unusually large amount of food and sense of loss of control
- Binge-eating episodes are associaed with 3 or more of the following
- Eating more rapidly than normal
- Eating until feeling uncomfortably full
- Eating when not physically hungry
- Eating alone because of embarrassment over amount eating
- Feelings of disgust, depression, or guilt after overeating
- Presence of marked distress ove binge eating'
- Occurrence of binge eating, on average, > 1x/wk for 3 months
- Not associated with inappropriate compensatory behavior (purging)
- Monitor growth and weight changes. May have frequent fluctuation of weight. Has there been an arrest of pubertal development.
- Menstrual history, exercise history
- Are there an increase number of fractures?
- Electrolyte levels and CBC
- Complete physical examination.
- Signs unique in bulemia: paroatid gland hypertrophy, teeth enamel erosion, skin lesion on fingers( Russell's sign)
- Psychiatric assessment for suicide, depression, and obsessive compulsive traits
- Chronic disease- diabetes mellitus and inflammatory bowel disease
- Discuss problem with the patient and their family
- Encourage improving nutritional status but may need to use enteral or parenteral means
- Should refer to medical and psychiatric specialist in eating disorders
- Pharmocotherapy often used but should obtain an ECG prior to instituting therapy because of the risk of arrythmias with some drugs.
- Often require inpatient management.
- Monitor for refeeding syndrome, especially if severely underweight (<75% ideal body weight)
- Malnourishment depletes intracellular phosphate stores. Glycolysis which occurs with refeeding can further deplet stores leading to severe hypophosphatemia
- Manifestations include heart failure, rhabdomyolysis, seizures, delirium
- Hypokalemia and hypomagnesemia can also occur
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