EATING DISORDERS

Anorexia Nervosa Bulimia Nervosa Binge-eating disorder

 Refusal to maintain normal weight for Required:  Recurrent binge eating
age and height (<85% expected)  Binging (excessive food intake w/in 2 hr  Severe distress over binging
 Intense fear of gaining weight period)  Binging 2 days/week for 6
 Distorted body image  Sense of lack of control during episode months w/ no
 Amenorrhea ≥3 months (Not using  Recurrent inappropriate compensatory compensatory behaviors
OCP) behavior to prevent weight gain (self-induced  3:
vomiting, laxatives, diuretics, enemas, other 1. Eating rapidly
Specific subtype: meds, fasting, excessive exercise) 2. Eating until
 Restricting: during anorexic episode, pt  Behaviors occur at least 2x/week for 3 uncomfortably full
severely limits calorie intake w/out months 3. Eating large amounts
bingeing or purging  Perception of self-worth excessively influenced when not hungry
 Binge eating/purging: during anorexic by body weight and shape 4. Eating alone due to
episode, pt engaged in bingeing +  Disturbance does not occur exclusively during embarrassment over
purging behaviors (laxatives, diuretics, episodes of anorexia nervosa eating habits
or enemas) 5. Feeling disgusted,
Types: depressed, or guilty
 Purging: involves vomiting, laxatives, or after overeating
diuretics
 Nonpurging: excessive exercise or fasting
Most pts. are obese (20% over
Usually maintain normal weight and symptoms ideal body weight)
are ego-dystonic (distressing)
Risks Female sex Female Gender (90%)
Adolescence and puberty Perfectionism
Obsessive and perfectionist traits Borderline personality d/o and OCO predict
Western media poorer course/outcome
Upper socioeconomic class Body image dissatisfaction
Also common in pts mother
Hx of sexual abuse
Impulsivity (Self-injurious behavior)
FHx of alcoholism, depression, eating disorder
Childhood overweight or obesity
Exposure to media pressure
Diagnosis PE PE
 Initial weight (if <85% BMI, schedule  Parotid hypertrophy
weekly appts to record sx and weights)  Dental erosion
 Clothing style? Baggy  Russell sign – scarring on dorsum of hands
 Lanugo hair due to vomiting
 Oral exam: erosion of tooth enamel or  Self-harm
swollen salivary glands (signs of
repetitive vomiting) Labs:
 CBC
Labs:  CMP: Sodium,  Potassium, Chloride,  Bicarb
 CBC (Anemia, leucopenia, (alkalosis d/t vomiting)
thrombocytopenia)  LFTs (drug OD, alcohol ingestion, excess
 Electrolytes (hypokalemia, exercise)
hypochloremia,  bicarb)  Mg, Phos
 TFTs  U/A
 LFTs  Pregnancy test
 Urine pregnancy test if amenorrheic  B12, Folate, ferritin
 If amenorrheric for >6 months: Bone  ECG
densitometry and hormone levels  DEXA bone density
(prolactin, FSH, LH)
Treatment If >20% below IBW  Hospitalize Cognitive Behavioral therapy (CBT) Individual psychotherapy and
Nutritional and meal support behavioral therapy w/ Strict diet
Outpatient: Pharmacotherapy and exercise program
Behavioral therapy  1st line = SSRIs (Fluoxetine) Pharmactherapy as adjuncts:
Supervised weight-programs  Then TCAs  Stimulants (phentermine,
Antidepressants to promote weight gain: amphetamine) – suppress
 Paroxetine appetite
 Mirtazapine  Orlistat (Xenical) – inhibits
pancreatic lipase   fat
absorption from GI tract
 Sibutramine (Meridia) –
inhibits reuptake of NE,
Serotonin, and Dopamine
Complication  Slowed GI motility  Hypochloremic hypokalmic alkalosis (with
s  Primary amenorrhea or w/out arrhythmias)
 Female infertility  Esophagitis, dental erosions, calloused
 Osteopenia knuckles, salivary gland hypertropy
 Osteoporosis