Eating Disorders
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Introduction
Anorexia nervosa (AN) affects 1% of adolescent and young adult females, with an onset of 13-20 years old.
Bulemia nervosa (BN) has a incidence of 2-4% in adolescent and young adult females, with an onset of 16-18.
Females are more affected than males (10:1).
Anorexia Nervosa
- Weight under the 85% of expected, or failure to meet growth expectation
- intense fear of gaining weight
- distorted perception of body image
- amennorhea (over 3 consecutive months)
Bulemia Nervosa
Recurrent episodes of binge eating:
- eating an amount of food definitely larger than most people would eat in a similar amount of time and in similar circumstances
- a sense of lack of control over eating during the episode
Recurrent, inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, laxatives, diuretics, enemas, or other mediciations, fasting, or excessive exercise.
Binge eating and compensation both occur, on average, at least twice a week for 3 months
self-evaluation is unduly influenced by body shape and weight
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Eating disorders are multifactorial, with psychological, sociological, and biological underpinnings.
Individual: perfectionism, lack of control in some life areas, history of sexual abuse
personality: obsessive-compulsive, histrionic, borderline
familial: maitenance of equilibrium in a dysfunctional family
cultural: prevalent in industrialized societies, where thinness is idolized in the media
genetic
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Inquire into
- onset of behaviours
- childhood weight and height
- weight loss history
- exercise frequency, intensity, and type
- dietary history
- restricting behaviours
- binging, purging
- medication misuse
- menstrual history
- previous treatments
Associated symptoms can include:
- hypothermia
- constipation
- hair loss
- lanugo hair growth
- early satiety
- nausea
- fatigue
Past medical history
- anxiety
- depression
- OCD
Social history
- supports
Physical Exam
Assess current height and weight, and compare to previous.
Knuckles can be raw from kneeling over the toilet during vomiting.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Consequences and Course
Mortality is 5-10%!!!
Severe eating disorders can lead to:
- hypothyroidism
- delayed puberty
- hypotension
- cardiac abnormalities: prolonged QT interval, bradycardia, arrhythmias, valvular disease
- electrolyte abnormalities
- tooth decay
- esophagitis
- constipation
Resources and References
Topic Development
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