Eating+Disorders

=**Eating Disorders**=


 * 1. List the DSM-IV diagnostic criteria for anorexia nervosa and bulimia nervosa.**

__Anorexia:__
 * Refusal to maintain body weight (below 85% expected body weight)
 * Intense fear of gaining weight
 * disturbed perceptions of body weight / shape
 * Amenorrhea for 3+ consecutive months

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)

Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

__Bulimia Nervosa__
 * a. Recurrent episodes of binge eating (eating very large amount of food within 2 hours, a sense of lack of control over eating)
 * b. Recurrent behavior to prevent weight gain: vomiting, laxatives, diuretics, enemas, fasting, or excessive exercise
 * Both a. and b. occur 2+ times a week for 3+ months
 * Self- evaluation is unduly influenced by body shape and weight
 * The disturbance does not occur exclusively during AN

Purging type: vomiting, laxatives, diuretics, enemas

Nonpurging type: fasting or excessive exercise only


 * 2. Discuss how the following factors pertain to eating disorders: genetic factors, dynamics, predisposition to depression, and personality pathology.**

Genetic factors for anorexia are indicated by a higher prevalence in MZ twins than dizygotic twins (50% vs. 14%). The family dynamic may also play a role with anorexia seen as being related to a family that is enmeshed, overprotective, and avoidant of conflict. Depression is often comorbid, with low self esteem often seen. All or none thinking and dissatisfaction with one’s body can contribute to eating disorders.

__AN:__
 * 3. Know the epidemiology of eating disorders.**
 * 1% adolescent females
 * 95% are female, increasing males in younger groups
 * peak onsets: 12-13 and 17-18 yrs old
 * Developed countries
 * Higher in professions that require thinness – gymnasts, models, ballerinas, figure skaters, runners, swimmers

__BN:__
 * 3% of young women
 * occasional symptoms- up to 40% college females
 * 90-95% are females
 * onset is later than AN. 50% of anorexics end up with bulimia.


 * 4. Expound theories that explain why eating disorders are found predominately among females.**

Body image problems related to societal pressure, the average woman’s healthy weight is above what society dictates it should be. Women tend to have higher instance of depression and lower self esteem. Sucks being a teenage girl.


 * 5. Discuss the effects of starvation in anorexia nervosa on the following systems: cardiovascular, hemoatologic, gastrointestinal, metabolic, dermatologic, reproductive, and skeletal.**


 * cardiovascular: hypokalemia can lead to irrythmia
 * hemoatologic: anemia can result from malnutrition
 * gastrointestinal: damage to mucosa from vomiting and overuse of laxitives
 * metabolic: lower metabolism due to malnutriton
 * dermatologic: dry skin, brittle nails
 * reproductive: amenorrhea due to lower bodyfat
 * skeletal: osteoporosis due to malnutrition

Brain shrinks


 * 6. Present the role of medications in the treatment of anorexia nervosa and bulimia nervosa.**

Pharmacologic treatment of AN has a limited role due to the low weight increasing sensitivity to side effects and the patient may be unwilling to take medication. It is indicated for severe neurovegetative symptoms, rituals, or anxiety. The first line treatment is antidepressants.


 * 7. Outline the key elements of cognitive behavioral therapy for bulimia nervosa.**

__AN:__
 * Average 20 sessions
 * Semi structured and problem oriented
 * Commit to eating 3 meals plus snacks each day
 * Plan meals
 * Educate patient about disease
 * Record eating behavior and feelings
 * ID cognitive distortions
 * Relapse prevention


 * 8. Understand the psychiatric and physical morbidity of eating disorders.**

__AN:__ 30-50% of patients with AN have a full recovery within a few years. There is a better prognosis for patients with younger onset, or restricter subtype. Death results from starvation, cardiac arrhythmias, suicide. 5-10% patients after 10 yrs of illness, 20% of patients after 20 years of illness.

__BN:__


 * 9. Discuss the etiology and treatment of rumination disorder in infant and adult populations.**

DSM:
 * Repeated regurgitation and rechewing of food for 1+ months after normal functioning
 * Not due to medical condition
 * Not exclusive to An or BN (see in 10% of bulimics)

Most common among infants 3months- 1 year old and mentally retarded children and adults. It can be used as a pleasurable self-stimulation, tension relieving mechanism, learned attention-getting behavior. It is treated with a “time out,” electric shock, pepper sauce or lemon juice squirt on the tongue during act, overcorrection- wash lips, use soap, use lotion, or satiation bring in food often.


 * 10. Explain the differential diagnosis and etiology theories of pica.**

Differential diagnosis:
 * Iron and Zinc deficiencies
 * Schizophrenia
 * Autistic disorder
 * Psychosocial dwarfism- severely neglected kids, they resort to odd behavior
 * Kleine-Levin syndrome- very rare. Occurs in young boys.  Fall asleep and sleep for weeks wake up and are ravenously hungry.

It is believed to occur for several reaseons: nutritional deficiencies – craving dirt and ice for Iron / Zn deficiencies, parental neglect / deprivation – compensatory mechanism to satisfy oral needs. It is treated with psychosocial, environmental and behavioral therapy.