Eating disorder

Peak onset: 16 20 years old

Epidemiology

Etiology and patho

Diagnostic criteria and

clinical presentation

Possible comorbidities

Criteria

Anorexia nervosa
- 90% female in late adolescence
- Rare > 40 y/o
- Lots of relapse <1 y/o
- Hard to pinpoint
- Abnormalities:
o Hypothalamic-pituitary-gonadal
(female athlete triad)
o Hypothalamic-pituitary-adrenal
o Hypothalampic-pituitary-thyroid
- Weight correction may not restore
some fxn (serotonin may remain
abnormal after weight restoration)
- Neurotransmitters need correction
- Impact of brain-derived
neurotrophic factor not ruled out
- Strong genetic influences:
polymorphism for serotonin-2A role
- Social/psychological/developmental
stressors, issues: (family dynamics,
vocation [athletes, models]).
Purging: voming, laxative abuse
Exercise, diuretics, enemas, saunas
Starvation

Depression
Anxiety
Borderline PD
Schizophrenia (body image distortion)
OCD
(psych symptoms resolve with refeeding)
- Refusal to maintain normal body
weight
- Distorted body image
- Psychiatric comorbidities = common
- Symptoms: very OCD
- Obsession & fear about eating &
gaining weight
- Complaints of feeling full
- Denial of symptoms
- Low self-esteem

Bulimia nervosa
- 90% female in
adolescence or early
adulthood
- Common > 40

Binge eating disorder

Do not eat regular meals

Do not feel full at the
end of meal
Laxative abuse
Feelings of guilt and
depression after
bingeing
Social isolation, troubled
relationships, and
substance abuse
Depression common
(80%)

- Concerned about body

image but not drive to
lose weight
- Binge eating followed
by self-induced
vomiting (almost
always)
- Weight fluctuation
common
- Bingeing &
compensatory purging
must occur >2/week for
3 months
-

- Recurrent episodes of
binge eating without
compensatory behaviors
- Patients usually
overweight
- Episodes >2/week for
long periods of time

Signs

Pharmacological
treatment

Notes

Red: contrast & compare

- Lethargy/weakness
- Amenorrhea
- Cachexia, vomiting, restricted food
intake
- Delayed gastric emptying and
constipation
- Bradycardia and hypotension
- Lanugo, brittle hair, dry sky
- Electrolyte imbalances
- EKG changes [heart attack as
adolescent not unusual]
- Anemia
- Elevated cholesterol
- SSRI (not for acute AN)
Initiate ONLY if depression,
anxiety, OCD persists AFTER
normal weight maintained
9 12 months
Fluoxetine 20 80 mg/day
(relapse rate high)
Caution: anticholinergic or
cardiovascular effects from drugs:
bupropion, MAOIs, TCAs
- Antipsychotics (NOT FOR BN)
Use if acute illness
Use if pt. resistant to gain weight
and severe obsessive thoughts
- Metoclopramide:
Good for GI disturbances and
satiety
Caution: anticholinergic effect
drugs
- Benzodiazepines: for anxiety and
substance abuse
- Estrogen: restore menses
- Calcium supplementation
-

Salivary gland
inflammation
Erosion of dental enamel
Callus on dorsum of
hand (inducing vomiting
using their hand and if
they do it a lot, they
develop this callus on
the back side of their
hand).

**Tolerability is primary
criterion for selection**
- SSRI:
o 9 12 months (treat
them for about a
year)
o Awesome b/c 80%
have depression
o Acute and
maintenance
o Fluoxetine: FDA
(titrated to 60
mg/day in a.m.)
o Avoid anticholinergic
effect drugs
o Takes 6 8 wks for
effects
o Mood stabilizers
(Lithium and
anticonvulsants for
bipolar)
o Benzo

- SSRI
- Anticonvulsants (for
impulse control and
promote weight
[topiramate** and
zonisamide]
- Zonisamide can cause
metabolic acidosis in
some pts so stay away
usually
- Minacipran (Sacella): NRI
o Effective in those
with purging and
younger pts.
o Approval for
fibromyalgia in US
o 100 mg/day

Dentists can tell easily

(cavities show up higher
in the tooth than
normally would)

Large sum of snack thats

like a full meal

Green: important/unique factors

Medical Complications
o
o
o
o
o
o

Metabolic and electrolyte disturbances

Dehydration (eating a lot than drinking can show sign of dehydration)
Cardiac abnormalities
Endocrine system complications
Dental problems
Brain atrophy (starvation for a long period of time. Not only the heart goes atrophy but the brain too)

Goals of therapy

Improve distorted body image

Re-establish and maintain healthy body weight
Restore normal eating patterns
Improve psychological and physical issues

Prevent relapse

Non-Pharmacological treatment

Behavioral management
Cognitive behavioral therapy
Interpersonal psychotherapy
Nutritional counseling
Family therapy