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Flashcards in Eating Disorders Deck (38)
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What is DSM-5 CRITERIA-Anorexia Nervosa?

Restriction of energy intake relative to requirements, leading to:
-a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.


DSM-5 CRITERIA-Anorexia Nervosa
1. Fear of what?
2. Severe body image disturbance in which body image affected how?

1. Fear of weight gain
2. predominant measure of self-worth with denial of the seriousness of the illness


Subtypes of Anorexia Nervosa

1. Restricting
2. Binge eating/purging


Describe the following subtypes of Anorexia Nervosa:
1. Restricting?
2. Binge eating/purging?
-When is it considered anorexic?

1. Restricting
-Restriction of intake to reduce weight

2. Binge eating/purging
-May binge and/or purge to control weight
-Considered anorexic if she is 15% below ideal body weight


Signs and Symptoms

1. Dry skin
2. Cold intolerance
3. Blue hands and feet
4. Constipation
5. Bloating
6. Delayed puberty
7. Primary or secondary amenorrhea
8. Fainting
9. Orthostatic hypotension
10. Lanugo hair
11. Scalp hair loss
12. Early satiety
13. Weakness, fatigue
14. Short stature
15. Osteopenia
16. Breast atrophy
17. Atrophic vaginitis
18. Pitting edema
19. Cardiac murmurs
20. Sinus brady
21. hypothermia



1. Recurrent of binge eating.

2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting: misuse of laxatives, diuretics, or other meds; fasting; or excessive exercise.

3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

4. Self-evaluation is unduly influenced by body shape and weight.

5. The disturbance does not occur exclusively during periods of anorexia nervosa.


An episode of binge eating is characterized by what?

1. Eating in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

2. A sense of lack of control over eating during the episode.


Bulimia-signs and symptoms

1. Mouth sores
2. Pharyngeal trauma
3. Dental caries
4. Heartburn, chest pain
5. Esophageal rupture
6. Impulsivity
7. Muscle cramps
8. Weakness
9. Bloody diarrhea
10. Bleeding or easy bruising
11. Irregular periods
12. Fainting
13. Swollen parotid glands
14. Hypotension
15. Russell’s Sign (calluses on the back of the hands from self induced vomiting)


Impulsivity symptoms of Bulmia?

1. Stealing
2. Alcohol abuse
3. Drugs/tobacco


Binge Eating Disorder…

1. Eating, in a discrete period of time, an amount of food that is larger than most people would eat in a similar period

2. Occurs 2 days per week for a six month duration

3. Associated with a lack of control and with distress over the binge eating


Binge eating disorder: Must have at least 3 of the 5 criteria?

1. Eating much more rapidly than normal

2. Eating until uncomfortably full

3. Eating large amounts of food when not feeling physically hungry

4. Eating alone because of embarrassment

5. Feeling disgusted, depressed or very guilty over overeating


Eating Disorder,NOS…. DSM-5 Criteria

1. All criteria for anorexia nervosa except has regular menses

2. All criteria for anorexia nervosa except weight still in normal range

3. All criteria for bulimia nervosa except binges less than twice a week or for less than 3 months

4. Patients with normal body weight who regularly engage in inappropriate compensatory behavior after eating small amounts of food (ie, self-induced vomiting after eating two cookies)

5. A patient who repeatedly chews and spits out large amounts of food without swallowing


Associated Psychiatric Conditions
with eating disorders? 4

1. anxiety disorders

2. obsessive-compulsive disorder

3. personality disorders

4. substance abuse.


Screening Tools:
SCOFF Questionnaire
Which questions are involved in this?

1. Do you make yourself Sick because you feel uncomfortably full?

2. Do you worry you have lost
Control over how much you eat?

3. Have you recently lost more than 14 pounds or 6.35 kg (One stone) in a three month period?

4. Do you believe yourself to be Fat when others say you are too thin?

5. Would you say that Food dominates your life?


Screening Tool: Eating Disorder Screen for Primary Care (ESP)
5 questions

1. Are you satisfied with your eating patterns? (No is abnormal)

2. Do you ever eat in secret? (Yes is abnormal)

3. Does your weight affect the way you feel about yourself? (Yes is abnormal)

4. Have any members of your family suffered with an eating disorder? (Yes is abnormal)

5. Do you currently suffer with or have you ever suffered in the past with an eating disorder? (Yes is abnormal)


What do we want to ask on the history?

1. Maximum height and weight
2. Exercise habits: intensity, hours per week
3. Stress levels
4. Habits and behaviors: smoking, alcohol, drugs, sexual activity
5. Eating attitudes and behaviors
6. Review of systems


PE for anorexia?

1. Vital signs to include orthostatics

2. Skin and extremity evaluation

3. Cardiac exam

4. Abdominal exam

5. Neuro exam
--Evaluate for other causes of weight loss or vomiting (brain tumor)


Anorexia PE:
1. Skin findings? 3

2. Cardiac Exam? 3


-MVP (heart muscle shrinks but the valves do not)


Additional PE findings for bulimia?

1. Parotid gland hypertrophy
2. Erosion of the teeth enamel


Laboratory Assessement

1. CBC: anemia
2. Electrolytes,
3. BUN/Cr
4. Mg, K+, Calcium
5. Albumin, serum protein
6. B-HCG
7. UA: specific gravity
8. Thyroid function tests
9. Serum prolactin
10. FSH
11. Bone density


Differential Diagnosis

1. New onset diabetes
2. Adrenal insufficiency
3. Primary depression with anorexia
4. Inflammatory bowel disease
5. Abdominal masses
6. Central nervous system lesions


Complication: Fluid and electrolyte imbalances

1. Hypokalemia
2. Hyponatremia
3. Hypochloremic alkalosis
4. Elevated BUN
5. Inability to concentrate urine
6. Decreased GFR
7. Ketonuria


One of the most severe complications
-Difficult to reverse

Treatment? 4

1. Weight gain
2. 1200-1500 mg/day of elemental calcium
3. Multivitamin with 400 IU vitamin D
4. Consider estrogen/progesterone replacement


Secondary 1.________ affects more than 90% of patients with anorexia
2. Caused by low levels of what? 2

1. amenorrhea

2. FSH and LH


Menses resumes within how long of achieving 90% IBW?

6 months


Cardiac Changes

1. MVP
2. Long QT


1. Risk of heart failure is greatest when?

1. the first 2 weeks of refeeding


Risk of heart failure is greatest in the first 2 weeks of refeeding
1. What causes this? 2
2. How should we proceed then? 3

1. Reduced cardiac contractility and refeeding edema

-Slow refeeding,
-repletion of K+,
-avoidance of sodium intake


Anorexia treatment?

1. Cognitive behavioral therapy
2. Interdisciplinary care team
-Medical provider
-Dietician with experience in Eating Disorders
-Mental health professional


Overall, disappointing results
Effective only for treating co-morbid conditions of depression and OCD

But two medications that may be helpful? 2

1. Anxiolytics may be helpful before meals to suppress the anxiety associated with eating

2. Case reports in the literature supporting the use of olanzapine (Zyprexa)… atypical antipsychotic