EATING DISORDERS

BY GROUP 5
CONTENTS
• Introduction
• Types
• Anorexia Nervosa
• Bulimia Nervosa
• Binge-eating disorder
INTRODUCTION

• Eating disorders are mental illnesses which are characterize by a

persistent disturbances of eating or eating related behavior which
results in the altered consumption or absorption of food and
significantly impairs physical health or psychosocial functioning.
TYPES
• Eating disorders include
1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge-eating disorder
ANOREXIA NERVOSA
• This is a type of eating disorder where patients are preoccupied with their
weight, body image and being thin. It is often associated with obsessive-
compulsive personality traits.
• It involves low body weight and restriction of calorie intake.
• It is chronic and relapsing illness.
• It is divided into 2 main subtypes:
1. Restricting type: has not regularly engaged in binge-eating or purging
behavior, weight loss is achieved through diet, fasting and/or excessive
exercise
2. Binge-eating/purging type: Eating binges followed by self-induced vomiting
and/or using laxatives, enemas or diuretics.
DSM-5 Criteria;
• Restriction of energy intake relative to requirements, leading to
significant low body weight (defined as > minimally
NORMAL/EXPECTED)
• Intense fear of gaining weight or becoming fat or persistent behaviors
that prevent weight gain.
• Disturbed body image, undue influence of weight or shape on self
evaluation or denial of the seriousness of the current low body
weight.
COMPLICATIONS & physical manifestation

• Amenorrhea
• Cold intolerance/hypothermia
• Hypotension /bradycardia /Arrhythmias
• Acute coronary syndrome
• Cardiomyopathy
• Mitral valve prolapse, constipation
• Edema
• Lanugo hair
• Alopecia
• Dehydration
• Peripheral neuropathy/ seizures / hypothyroidism
• Osteopenia/ osteoporosis
INVESTIGATIONS and findings

1. Serum electrolytes : hyponatremia, hypocholeremic hypokalemic

alkalosis( if vomiting)
2. ECG – Arrhythmias (QT prolongation)
3. Lipid profile – hypercholesterolemia
4. FBC –leukopenia, anemia
5. BUN – elevated
6. GH/ Cortisol increased, Reduced Gonadotropins, reduced sex steroid
hormones
7. TFH- hypothyroidism
8. Blood glucose -hypoglycemic
9. osteopenia
Epidemiology
• F : M is 10: 1
• 1 year prevalence is about 0.4% in young females
• Bimodal age of onset (13-14 ;Hormonal influences age 17-18
environmental)
• More common in industrialized countries where food is abundant and
a thin body ideal is held.
• Common in sports that involve thinness, revealing attire, subjective
judging and weight classes. E.g. running, ballet, diving, cheerleading
and figure skating.
Etiology
• Multifactorial
• Genetics
• Psychodynamics
• Social theories.
Differential diagnosis
• Medical conditions -
Endocrine disorders
Gastrointestinal illness
Genetic disorders
Cancers
AIDS
• Psychiatric conditions
MDD
Bulimia
Others like somatic symptom disorder in schizophrenia
TREATMENT

• Food is the best medicine

• Treated as outpatients except if patients are dangerously below ideal
body weight (<20- 25%) or if they are serious medical or psychiatric
complications, in which case they should be hospitalized for
supervised refeeding.
• Treatment involves CBT, Family therapy and supervised weight gain
programs
• SSRI’s have not been effective in the treatment of AN but may be used
for comorbid anxiety or depression.
Prognosis
• Mortality rate is cumulative and approximately 5% per decade due to
starvation, suicide or cardiac failure.
• Rates are approximately 12 per 100,000 per year
case :
• classic example of anorexia nervosa: An extremely thin
amenorrheic teenage girl whose mother says she eats very
little, does aerobics for 2 hours a day, and ritualistically
performs 400 sit-ups every day (500 if she has “overeaten”)
BULIMIA NERVOSA

• Bulimia nervosa involves binge eating combined with behaviors

intended to counteract weight gain such as vomiting, use of laxatives,
enema or diuretics, fasting or excessive exercise.
• It is also defined by excessive food intake within 2 hour period
accompanied by a sense of lack of control.
• Here patients are embarrassed with their binge eating and are overly
concerned with body weight.
• Unlike patients with anorexia, they usually maintain normal
weight(may be over weight)
DSM-5 Criteria
• Recurrent episodes of binge eating
• Recurrent, inappropriate attempts to compensate for overeating and
prevent weight gain.
• The binge eating and compensatory behaviors occur at least once a
week for 3 months
• Perception of self-worth is excessively influenced by body weight and
shape.
• Does not occur exclusively during an episode of AN
COMPLICATIONS & physical findings
• Patients with BN and AN may have similar medical complications
related to weight loss and vomiting.
Salivary gland enlargement (sialadenosis)
Dental erosions/caries
Callouses/abrasions on dorsum of hand (Russell’s sign)
Petechiae
Peripheral edema
aspirations
EPIDEMIOLOGY

• 1-2 months prevalence in young females is 1-1.5%

• Significantly more common in F than M 10:1
• Onset is late adolescence or early adulthood
• More common in developed countries
• High incidence of comorbid mood disorders, anxiety disorders,
impulsive control disorders, substance abuse, prior physical/sexual
abuse.
ETIOLOGY

• Multifactorial
• Has similar factors as for anorexia.
• Childhood obesity and early pubertal maturation increases the risk for
bulimia nervosa
COURSE –chronic and relapsing, has better prognosis than AN
symptoms exacerbated by stressful conditions.
Prognosis – One half recover fully with treatment. One half have
chronic course with fluctuating symptoms.
• Elevated suicide risk compared to the general populations.
TREATMENT

• Antidepressants plus therapy

• SSRI’s are the 1st lines
• Fluoxetine is the only FDA-approved medication for bulimia( 60-
80mg/day)
• Nutritional counselling and education
• Therapies : CBT, interpersonal psychotherapy, group therapy and
family therapy.
Avoid bupropion due to its potential side effects to lower seizure
threshold.
case :
• classic example of bulimia nervosa: A 20-year-old college
student is referred by her dentist because of multiple dental
caries. She is normal weight for her height but feels that “she
needs to lose 15 pounds.” She reluctantly admits to eating
large quantities of food in a short period of time and then
inducing vomiting.
• Difference between AN and BN : Both anorexia and bulimia are
characterized by a desire for thinness. Both may binge and
purge. Anorexia nervosa involves low body weight and
restriction of calorie intake, and this distinguishes it from
bulimia.
BINGE-EATING DISORDER

• Patients with this condition suffer emotional distress over their binge
eating, but they do not try to control their weight by purging or
restricting calories, as do anorexics or bulimics.
• Here patients are not fixed on their body shape and weight.
DSM-5 criteria

• Recurrent episodes of binge eating( eating an excessive amount of

food in a 2 hour period associated with lack of control, with atleast 3
of the following – eating rapidly – eating until uncomfortably full,
eating large amounts of food when not hungry, eating alone due to
embarrassment and feeling disgusted/depressed/ guilty after eating)
• Severe distress over binge eating
• Binge eating occurs at least once a week for 3 months
• Binge eating is not associated with compensatory behaviors and does
not occur exclusively during the course of anorexia or bulimia.
COMPLICATIONS & physical manifestations

• Patients are typically obese

• Suffer from medical problems related to obesity like metabolic
syndrome, type 2 DM and CVS disorder.
ETIOLOGY & EPIDEMIOLOGY

• Etiology : Genetic influences; Runs in families

• Epidemiology : 1 year prevalence is 1.6% for females and 0.8% for
males. Equal prevalence in females across ethnicities and increase
prevalence among individuals seeking weight loss treatments
compared to the general populations.
COURSE &PROGNOSIS

• Typically begins in adolescence or young adulthood

• Appears to be relatively persistent though remission rates are higher
than for other forms of eating disorders
• Higher rates of psychiatric comorbidities than in obese individuals
without binge eating disorders.
TREATMENT

• Individual psychotherapy –CBT or interpersonal

• Strict diet and exercise program
• Comorbid mood disorders or anxiety disorders should be treated as
necessary.
• Pharmacotherapy – as adjuncts to promote weight loss.
Stimulants – phentamine and amphetamine- suppress appetite
Topiramate and zonisimide
Orlisat (Xenical)- inhibit pancreatic lipase, decreasing amount of fat
absorbed from GIT.
THANK YOU !!!
• Reference
First aid for the psychiatry clerkship. (4th edition)