Eating Disorders

Eating DisordersFazanah Khan

1Eating Disorders - OverviewAnorexia NervosaBulimia NervosaAvoidant/Restrictive Food Intake DisorderBinge Eating DisorderPicaRumination

You are conducting a periodic physical for a 15 year old male. He has no concerns and BMI is at 23. He tells you he plays competitive soccer and is part of the school swim team. He also goes to the gym 1-2 times a week. While continuing with your HEADSS assessment you would..Briefly ask about having a balanced diet and any further exercise before moving onNot bother asking about diet and exercise as hes at a healthy weightAsk specific questions using either the SCOFF or the ESPwhat was the previous option? Do I SCOFF at ESP? Sure.c it is.

The SCOFF and ESP?Ive used one or both in clinical practise beforeIve heard of them, but dont really find them necessary in the assessment of eating disordersIve never used them before, but have heard of themNever heard of themThe SCOFFDo you make yourselfSick because you feel uncomfortably full?Do you worry you have lostControl over how much you eat?Have you recently lost more thanOne stone (14 pounds or 6.35 kg) in a three month period?Do you believe yourself to beFat when others say you are too thin?Would you say thatFood dominates your life?

"yes" to two or more questions was associated with a sensitivity and specificity of 100 and 87.5 percent for the diagnosis of an eating disorder (BMJ, 1999)5 Eating Disorder Screen for Primary CareAre you satisfied with your eating patterns? (No is abnormal)Does your weight affect the way you feel about yourself? (Yes is abnormal)Have any members of your family suffered with an eating disorder? (Yes is abnormal)Do you ever eat in secret? (Yes is abnormal)Do you currently suffer with or have you ever suffered in the past with an eating disorder? (Yes is abnormal)

ESP found that two abnormal responses to the ESP had a sensitivity and specificity of 100 and 71 percent, and that the sensitivity and specificity of SCOFF was lower (78 and 88 percent, respectively). (Journal of General Internal Medicine, 2003).6What else should you ask about?

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9Risk FactorsHistory of dieting in childhoodFirst degree family member with an eating disorderChildhood preoccupation with weight and dietChildhood maltreatmentCo-morbid psychiatric illness (depression, OCD, anxiety, substance addictions)

Serotonin helps modulate feeding behaviours by producing feelings of fullness and satiety. Patients with anorexia frequently report feeling too full after eating. Serotonin also involves the regulation of mood, impulses and obsessionality. Patients with anorexia are often rigid, inhibited and perfectionistic.

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National Eating Disorder Association National Eating Disorder Information Centre Anorexia vs BulimiaAnorexia NervosaEpidemiologyPrevalence 0.6% of adults and 0.3% of adolescence bimodal age of onset: ages 13-14 due to hormonal influences and ages 17-18 due to environmental influencesmore common in athletic (ballet dancers, jockeys) and modeling occupations for both males and females

AdultsThe estimated lifetime prevalence of anorexia nervosa in the United States adult general population is 0.6%.Anorexia nervosa is more common in women than men. In one nationally representative survey, the estimated lifetime prevalence was three times greater in females than males (0.9 versus 0.3 percent) [10]. In clinical settings, the ratio of females to males with a first time diagnosis is even higher (10 to 1) [14].

A nationally representative survey of adolescents (aged 13 to 18 years) in the United States found that the lifetime prevalence of anorexia nervosa was 0.3 percent; the prevalence for females and males was identical (0.3 percent)

Deficits have been found in dopaminergic function (dopamine is thought to be involved with eating behaviour, motivation, and reward) and serotonergic function (serotonin may be involved with mood, impulse control, and obsessional behaviour)

In a nut shell, patients with anorexia are preoccupied with their weight, body image and being thin. They often have a disturbed perception of their body image. Patients with anorexia often have obsessive-compulsive personality traits and patients will know the exact caloric intake they have per day.Anorexia: preoccupation with food, are hungry but will continually starve them self, obsessive-compulsive personality traits (planning when to eat, what to eat exact proportions), many anorexics will know how many calories they consumer per day and the exact amount of calories for each food they eat.

Increased incidence anxiety, depressive disorders and obsessive-compulsive disorders

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The Alliance for Eating Disorder Awareness, 2013AN has the highest mortality rate of any psychiatric illness it is estimated that 10% of individuals with AN will die within 10 years of the onset of the disorder.Sullivan, P. (2002). Course and outcome of anorexia nervosa and bulimia nervosa. In Fairburn, C. G. & Brownell, K. D. (Eds.).Eating Disorders and Obesity(pp. 226-232). New York, New York: Guilford.20% all cause mortatility; observational studies. Retrospective showed closer to national averages15DSM V CriteriaRestriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.Significantly low weightis defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.

Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Core features of AN are: persistent restriction of energy intake that leads to an abnormally low body weight; intense fear of gaining weight or behaviours that prevent from gaining weight, distorted perception of body weight and shape

Amenorrhea commonly occurs in anorexia nervosa and was a diagnostic criterion in DSM-IV-TR [20]. However, DSM-5 eliminated amenorrhea as a criterion because patients who menstruate but otherwise meet criteria for anorexia nervosa have similar outcomes to patients who do not menstruate [21]. Additional information about the diagnosis is discussed separately.

More specifically, Anorexia can be diagnosed when a person induces weight loss leading to a body weight less than 85% of a healthy norm or refuses to gain appropriately when growing taller. These patients have an intense fear of gaining weight even though theyre underweight and the have a disturbed perception of their shape or weight. These patients BMI are usually less than 17.5 (25 is healthy) and in postmenarcheal females there should be amenorrhea.16DSM V Criteria Restricting type:During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas.) This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. Binge-eating/purging type:During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas.Amenorrhea commonly occurs in anorexia nervosa and was a diagnostic criterion in DSM-IV-TR [20]. However, DSM-5 eliminated amenorrhea as a criterion because patients who menstruate but otherwise meet criteria for anorexia nervosa have similar outcomes to patients who do not menstruate [21]. Additional information about the diagnosis is discussed separately.

More specifically, Anorexia can be diagnosed when a person induces weight loss leading to a body weight less than 85% of a healthy norm or refuses to gain appropriately when growing taller. These patients have an intense fear of gaining weight even though theyre underweight and the have a disturbed perception of their shape or weight. These patients BMI are usually less than 17.5 (25 is healthy) and in postmenarcheal females there should be amenorrhea.17DSM V CriteriaMild:BMI 17 kg/m2

Moderate:BMI 16 to 16.99 kg/m2Severe:BMI 15 to 15.99 kg/m2 Extreme:BMI