Feeding and eating disoders Notes

NOTES NOTES FEEDING & EATNG DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Psychological disorders causing unhealthy relationship with food, body image ▪ Often begin in teens/early adulthood CAUSES ▪ Genetic, environmental ▪ High comorbidity with obsessivecompulsive disorder, depression, anxiety COMPLICATIONS ▪ Refeeding syndrome (refeeding → secretion of insulin → cells take in electrolytes from already low serum levels → even lower serum electrolyte levels → cardiac arrhythmia/death) SIGNS & SYMPTOMS ▪ Unhealthy relationship with food (physically, mentally) ▪ Distorted view of body, belief that body weight/appearance crucial for self-worth ▪ Restrictive food intake/compensatory behaviors (purging/excessive exercise) DIAGNOSIS ▪ See individual disorders TREATMENT PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy OTHER INTERVENTIONS ▪ Careful weight gain 708 OSMOSIS.ORG

Chapter 95 Feeding & Eating Disorders ANOREXIA NERVOSA osms.it/anorexia-nervosa PATHOLOGY & CAUSES ▪ Eating disorder characterized by restrictive food intake (leading to significantly low body weight), fear of weight gain, distorted view of body ▪ Often begins in teens/early adulthood TYPES Atypical anorexia nervosa ▪ Label for individuals with anorexia symptoms without significantly low body weight Restricting anorexia nervosa ▪ Individual loses weight only by via highly restricted food intake/excessive exercise Binge-eating/purging anorexia nervosa ▪ Individual loses weight by purging (e.g. vomiting, use of laxatives/diuretics/enemas) CAUSES ▪ Genetic (e.g. abnormalities in hunger signals), environmental (e.g. peer pressure/ forces of popular culture) ▪ High comorbidity with obsessivecompulsive disorder, depression, anxiety COMPLICATIONS ▪ Refeeding syndrome, difficulty breathing, heart failure, brain damage, suicidal ideation, death SIGNS & SYMPTOMS ▪ Fear of weight gain → restrictive food behaviors, purging, excessive exercise, weight checks, food rituals ▪ Restrictive food intake → electrolyte abnormalities, vitamin deficiencies, muscle loss, low creatinine levels, fatigue → brain damage, weakened bones, dry/scaly skin, hair falls out, menstruation stops, difficulty breathing, slow heartbeat, hypotension, congestive heart failure, edema (especially in feet), bone marrow shuts down (→ dampened immune response, low energy levels, easier bleeding/bruising) ▪ If purging by vomiting: enamel erosion, parotid gland swelling, bad breath, bruised/ calloused knuckles (Russell’s sign), stomach tearing, fast heartbeat, depletion of electrolytes DIAGNOSIS ▪ Restrictive food intake (leading to significantly low body weight) ▫ If body weight cannot be described as significantly low, diagnosis = atypical anorexia nervosa ▪ Fear of weight gain ▪ Distorted view of body ▪ Restricting type: individual has not repeatedly binge-eaten or purged over ≤ three months (instead, attempts to lose weight by restricting food intake/exercising excessively) ▪ Binge-eating/purging anorexia nervosa: repeated binge-eating/purging over ≤ three months Specify severity ▪ Mild: BMI > 17 ▪ Moderate: BMI 16–17 ▪ Severe: BMI 15–16 ▪ Extreme: BMI < 15 TREATMENT PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy OTHER INTERVENTIONS ▪ Careful weight gain OSMOSIS.ORG 709

BULIMIA NERVOSA osms.it/bulimia-nervosa PATHOLOGY & CAUSES ▪ Eating disorder characterized by repeated binge-eating, compensatory behaviors to prevent weight gain, belief that body weight/appearance crucial for self-worth ▪ Compensatory behaviors/”purges”: vomiting, use of laxatives/diuretics/enemas ▪ Attempts to conceal behaviors ▪ Often begins in teens/early adulthood CAUSES ▪ Genetic (e.g. abnormalities in hunger signals), environmental (e.g. peer pressure/ forces of popular culture) ▪ High comorbidity with obsessivecompulsive disorder, depression, anxiety COMPLICATIONS ▪ Refeeding syndrome, diabetes mellitus, fast heartbeat, suicidal ideation, death SIGNS & SYMPTOMS ▪ Binge-eating, compensatory behaviors (usually purposeful vomiting) ▪ Endocrine changes → menstruation stops/ never starts, increased risk of diabetes mellitus ▪ If purging by vomiting: enamel erosion, parotid gland swelling, bad breath, bruised/ calloused knuckles (Russell’s sign), stomach tearing, fast heartbeat, depletion of electrolytes ▪ Compensatory behaviors to prevent weight gain, concurrent with binge-eating ▪ Distorted view of body, belief that body weight/appearance crucial for self-worth Specify severity ▪ Mild: 1–3 compensatory behaviors/week ▪ Moderate: 4–7 compensatory behaviors/ week ▪ Severe: 8–13 compensatory behaviors/ week ▪ Extreme: > 14 compensatory behaviors/ week TREATMENT MEDICATIONS ▪ Antidepressants (e.g. selective serotonin reuptake inhibitors) PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy OTHER INTERVENTIONS ▪ Careful weight gain DIAGNOSIS ▪ Must occur exclusive of anorexia nervosa ▪ Repeated binge-eating over ≤ three months ▪ Binge-eating classification requires sense of loss of control 710 OSMOSIS.ORG Figure 95.1 Erosion of the enamel of the mandibular teeth of an individual with bulimia nervosa.