Eating Disorders Aug 3, 2011

Eating Disorders

Onyedika EgbujoPsychiatry Clinical RotationClinical No- #618Windsor University Medical School

OverviewAnorexia NervosaBulemia NervosaBinge-eating disorderPicaRuminationAvoidant/RestrictiveDiagnosisEpidemiologyMedical risksEtiologyTreatment prognosisMisconceptionsMyth: White, upper-middle class females in metropolitan areas of the western world

Eating disorders are increasing in prevalence in males, young children, older adults, and other ethnic groups.

Our field needs to do a better job screening and treatingRisk Factors for EDsPerfectionism for ANEarly PubertyFailed attempts to lose weightAntecedent illness with weight lossDiscovery that purging, fasting or exercising can compensate for binging AthleticsBeginning a dietFamily history of eating disorder, substance abuse or mood disorder

Case Vignette #1 CarlaCarla is a 13 year-old Latina female who presented to the ER with a grand-mal seizure from hyponatremia. She had been binging on water in order to fend off hunger. She was 5 ft 4 inches and 90 pounds at presentation (her previous weight had been 160 lbs). She had stopped getting her period. Carla had always been a happy child and near-straight-A student, but had recently become obsessed with her schoolwork and isolated from her friends and close-knit family. She was also angry that her mother pregnant. Anorexia Nervosa- DSM VRestriction of energy intake leading to less than minimally expected body weightIntense fear/behavior to avoid weight gain.Body image distortion; undue influence of weight on self evaluation; denial of risks of low weightAmenorrhea (in post-menarchal females)

Purging-typeRestricting-type

Anorexia: How patients may presentShe is not the same Carla Perfectionistic, obsessiveRitualistic or peculiar eating habitsMore restrictive eating patternsIm just trying to be healthyExtreme self-discipline in other areas of lifeIsolative, no interests except foodLack of identity of selfOverexercisingAnorexic voiceStubborn food as expression of autonomy

Anorexia Nervosa: EpidemiologyLifetime prevalence 0.5-1%Females:Males 10:1Usually arises during adolescence or young adulthoodIncreased risk in 1st degree biological relatives with AN 1/3 will develop bulimia nervosaLong-term mortality 10-20%Medical RisksDeath (suicide, starvation, sudden cardiac death)Hypometabolic state (bradycardia, hypotension, hypothermia)OrthostasisDehydrationArrhythmia, heart failure, liver failureMalnourishmentBone lossLanugoPeripheral edemaStunted growthDelayed sexual maturityHair loss, brittle hairCognitive impairment Water intoxicationOn recovery: Re-feeding syndromeNeurological EffectsCerebral AtrophyAssociated with weight loss but not necessarily with lowest BMIMay improve but do not necessarily return to normal

Katzman D et al, Journal of Pediatrics 1996Etiology

From Silber et.al.Medical Admission Criteria