Psychiatry [EATING DISORDERS]

Methods used in eating disorders Restriction ↓ Caloric intake (fasting, dieting)

Restriction is the act where weight loss is achieved through ↑ Caloric expenditure (exercise)
dieting, fasting, and extreme exercise. No calories ever go in; it’s
predominant in anorexia nervosa. Binge Purge Eating / Binging then induced emesis
Emesis Dorsal hand scars (from emesis)
Binge-purge is the act where there’s copious eating (the binge) Dental erosion (from emesis)
and then some form of elimination (the purge). If emesis is the Metabolic Alkalosis, K, Mg disorders
Binge Purge Eating / Binging then induced diarrhea
method of evacuation, there will be a metabolic alkalosis and E-
Laxative Metabolic Acidosis
lyte abnormalities. Signs of emesis include parotid swelling,
Diarrhea
dental erosion and dorsal hand scars. If laxative use is the method,
look for metabolic acidosis and (not surprisingly) diarrhea. The appearance of the patient is often dependent on the
disorder, not the method she uses.
Anorexia Nervosa
Anorexia Nervosa is a severe body dysmorphic disorder. The Anorexia Nervosa
patient (10:1 F:M) fears getting fat or believes she is fat despite Anxiety Is thin, fears getting fat, thinks she’s fat
being underweight, AND there’s a lack of recognition of how Method Restriction (can purge)
seriously underweight she is. The classic patient is a woman who Weight Underweight
is underweight and malnourished: amenorrhea, emaciation, Tx: CBT + Antipsychotics
lanugo, cold intolerance. Severe signs include bradycardia, SSRI/SnRI if OCD or MDD
leukopenia, and hypotension. F/u: Hospitalize if ↓BMI or E-lytes
Relapse common in 5 years
If a girl is <85% ideal body weight or extreme anorexia (BMI Death from medical or suicide
< 15), she should be hospitalized. This requires force feeds,
intravenous nutrition, and often electrolyte replacement. WHO Severity by BMI
Severity BMI
Cognitive behavioral therapy is critical to control the Mild > 17
Moderate 16-16.9
dysmorphic aspect. Medications are usually directed at comorbid
Severe 15-15.9
conditions – SSRI/SRNI for Major depression or OCD
Extreme < 15
(fluoxetine), and anti-psychotics can be used as primary
treatment.
Anorexia nervosa is categorized by the WEIGHT
Most will relapse in 5 years. Deaths result from suicide and
medical complications.

Bulimia Nervosa Bulimia Nervosa

Bulimia Nervosa patients also fear getting fat and have an Anxiety Binge, feeling ashamed
unrealistic self-body image. However, the anxiety is more a Method Purge (can restrict)
product of the action (Binge) than the weight body image. Weight Normal weight (or overweight)
Bulimics often have a normal or overweight BMI. The behavior Tx: SSRI (Fluoxetine), CBT
associated with Bulimia is binge: eating abnormally large F/u: Bupropion causes seizures
amounts of food / a lack of control during eating. But after, the
patient may have inappropriate compensatory behaviors: purge, Bulimia Severity
fasting, or excessive exercise. These compensatory behaviors Severity Compensatory behavior /
happen at least once a week for 3 months. Treatment centers week
around fluoxetine and CBT. Mild 1-3
Moderate 4-7
Never give bupropion in Bulimia as there’s an increased risk of Severe 8-13
Extreme > 14
seizures. Weight loss medications are also contraindicated in
Bulimia.
Bulimia nervosa is categorized by the PURGE
Binge-Eating Disorder
It’s Bulimia, except there’s no purge and the patients are
overweight.

© OnlineMedEd. http://www.onlinemeded.org
 Psychiatry [EATING DISORDERS]

Other Eating Disorders

Here are some other quick hitters if you’re going for the 270.

PICA is the eating of non-food substances for over a month.

These non-food substances must not be expected given
developmental age. Look for soap, paint, paper, air, or chalk. This
will most likely present as a toxicity from the ingested substance.

Rumination Disorder involves regurgitation of food for a least a

month. It’s mostly in infants, or those with developmental
problems. It’s related to overfeeding and the inability to cope with
the sensation of fullness.

Avoidant / Restrictive Food Intake Disorder is characterized

by a lack of interest in eating food; it’s accompanied by weight
loss, nutritional deficiency, or the need for supplementation. It
also happens in infancy and early childhood.

© OnlineMedEd. http://www.onlinemeded.org