Eating Disorders

Summary

This comprehensive overview covers eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. It outlines diagnostic criteria, medical complications, and the epidemiology of these disorders. Anorexia and bulimia nervosa have distinct symptoms and types, with associated medical risks like cardiac arrhythmias, electrolyte imbalances, and gastrointestinal issues. The prevalence of eating disorders varies, with anorexia and bulimia being more common in women. Treatment focuses on both pharmacological options like SSRIs and psychological therapies such as CBT. Early diagnosis and a multidisciplinary approach are essential for effective management and improving long-term outcomes.

Takeaways

• 😀 Anorexia nervosa (AN) is characterized by refusal to maintain a minimum normal body weight, intense fear of gaining weight, body image disturbance, and amenorrhea.
• 😀 There are two types of anorexia nervosa: restricting type and binge eating or purging type.
• 😀 Bulimia nervosa (BN) involves recurrent binge eating episodes followed by inappropriate compensatory behaviors, such as purging, occurring at least twice a week for three months.
• 😀 BN has two types: purging type and non-purging type.
• 😀 Eating disorders often have significant medical complications such as cachexia, reduced thyroid metabolism, bradycardia, delayed gastric emptying, and cognitive impairment.
• 😀 Recurrent purging in BN can lead to serious medical complications like electrolyte imbalances, salivary gland inflammation, esophageal erosions, and dental enamel decay.
• 😀 Binge Eating Disorder (BED) is characterized by episodes of binge eating without compensatory behaviors, and episodes are not linked to hunger or satiety cues.
• 😀 The lifetime prevalence of anorexia nervosa is 0.9% in women and 0.3% in men, with a peak onset at 16-18 years in females and 12 years in males.
• 😀 The lifetime prevalence of bulimia nervosa is 1-1.5% in women, with the onset typically occurring in adolescence or early adulthood.
• 😀 Psychological treatments, especially Cognitive Behavioral Therapy (CBT), and medications like SSRIs (e.g., fluoxetine) are key components of managing eating disorders.
• 😀 Early intervention, both inpatient and outpatient care, combined with pharmacological and psychological treatments, is essential to reduce the high morbidity and mortality rates associated with eating disorders.

Q & A

What are the four key features of Anorexia Nervosa (AN) according to the DSM-4 criteria?

The four key features of Anorexia Nervosa are: a refusal to maintain a minimum normal body weight, an intense fear of gaining weight, body image disturbance, and amenorrhea (absence of menstrual periods).

What are the two types of Anorexia Nervosa?

The two types of Anorexia Nervosa are: the restricting type and the binge eating or purging type.

What are the five key features of Bulimia Nervosa (BN) according to the DSM-4 criteria?

The five key features of Bulimia Nervosa are: recurrent binge eating episodes followed by inappropriate compensatory behaviors at least twice a week for three months, undue self-evaluation influenced by body shape and weight, and the disturbance does not occur exclusively during episodes of Anorexia Nervosa.

What are some medical complications associated with eating disorders?

Medical complications include cachexia, reduced thyroid metabolism, cardiac muscle loss leading to bradycardia and arrhythmias, gastrointestinal issues such as delayed gastric emptying and constipation, reproductive problems like amenorrhea and infertility, edema, lanugo (fine body hair), leukopenia, osteoporosis, and neuropsychiatric issues like depression and cognitive disorders.

What are the medical complications related to purging in eating disorders?

Medical complications related to purging include electrolyte abnormalities (e.g., low potassium and chloride), gastrointestinal issues such as salivary gland enlargement, pancreatic inflammation, esophageal and gastric erosions, and dental enamel erosion. Seizures, fatigue, and weakness due to metabolic abnormalities are also common.

What is the lifetime prevalence of Anorexia Nervosa in women and men?

The lifetime prevalence of Anorexia Nervosa is 0.9% in women and 0.3% in men.

What is the peak age of onset for Anorexia Nervosa in females and males?

The peak age of onset for Anorexia Nervosa is 16 to 18 years in females and 12 years in males.

What are common comorbid conditions with Anorexia Nervosa?

Common comorbid conditions with Anorexia Nervosa include depression (65% of cases), social phobia (34%), and obsessive-compulsive disorder (26%).

What is the lifetime prevalence of Bulimia Nervosa and when does it typically begin?

The lifetime prevalence of Bulimia Nervosa is 1 to 1.5% in women, and the onset usually occurs in adolescence or early adulthood.

What are the management guidelines for Anorexia Nervosa and Bulimia Nervosa?

Management for Anorexia Nervosa typically involves outpatient care, with hospital admission only for life-threatening medical issues. Fluoxetine (SSRIs) is often used, especially for obsessive thoughts. Psychological therapy, including family therapy, is beneficial. Bulimia Nervosa is generally managed outpatient, with SSRIs like fluoxetine for treatment. Cognitive Behavioral Therapy (CBT) is effective for addressing negative cognitions, and group support may also be helpful.