EATING DISORDERSEATING DISORDERS

Dr. Y R BhattaraiDr. Y R Bhattarai

TMUTMU

Introduction to eating Introduction to eating disordersdisorders

• Eating disorders are characterized by disturbances in eating behaviors and an over concern with body image or size.

• Principal diagnostic distinction is based on ideal body weight.

• If body weight is maintained in the presence of abnormal eating disorder, a diagnosis of bulimia nervosa is made. If body weight falls down, diagnosis of anorexia nervosa is made.

Anorexia nervosaAnorexia nervosa• Definition: characterized by failure to maintain a

normal body weight, fear and preoccupation with gaining weight, unrealistic self evaluation as overweight, and amenorrhea for three cycles or more.

• Refusal to keep body weight at greater than 85% of ideal.

• Patients with anorexia nervosa generally don't have a loss of appetite.

• Sub types-Restrictive type-Binge eating/purging type

Prevalence & etiologyPrevalence & etiology• 0.5% , occurs at a 1:10 male to female ratio.• Common in industrial societies and higher

socioeconomic classes.• History of past physical or sexual abuse.• Social opinion of attractiveness in low body weight

drives women to develop eating disorders.• Common in dancers and models.• Psychological risk factors include emotional conflicts

concerning family control and sexuality.• Biological factors like prior amenorrhoea.• Genetic factors

onsetonset

• Average age is 17 years.• Very late onset anorexia

nervosa has a poorer prognosis.

• Onset is often associated with emotional stressors, particularly conflicts with parents about independence and sexual conflicts.

Key symptomsKey symptoms• Restricted food intake and maintaining diets of

low calorie foods. Weight loss may be achieved through purging( vomiting or taking laxatives) and exercise.

• Great concern with appearance; significant amount of time spent examining for perceived signs of excess weight.

• With binge eating/purging: self induced vomiting, laxatives abuse.

Anorexia Anorexia nervosanervosa

Associated symptomsAssociated symptoms• Obsessive compulsive symptoms• Depression symptoms

Physical examinationPhysical examination• Signs of malnutrition: emaciation,

hypotension, bradycardia, lanugo and peripheral edema

• Signs of purging: eroded dental enamel caused by emesis and scarred or scratched hands from self gagging.

COURSE AND OUTCOMECOURSE AND OUTCOME• Some individuals recover after a

single episode, and others develop a waxing and waning course.

• Long term mortality rate of hospitalized patients of anorexia nervosa is 10% from starvation or suicide.

Diagnostic testsDiagnostic tests• Signs of malnutrition: normochromic

normocytic anemia, elevated liver enzymes, low estrogen and testosterone level, sinus bradycardia, and abnormal EEG.

• Signs of purging: metabolic alkalosis, hypochloremia and hypokalemia.

Differential diagnosisDifferential diagnosis• Major rule outs are bulimia nervosa• General medical conditions that

causes weight loss• Major depressive disorder• OCD• Body dysmorphic disorder.

MANAGEMENTMANAGEMENT• Initial treatment of the medical complications

due to starvation and purging.• Supervised meals, weight and electrolyte

monitoring.• Behavioral therapy should be initiated, with

rewards or punishment based on absolute weight.

• Family therapy designed to reduce conflicts about control by parents is often helpful.

• Antidepressants especially SSRIs when comorbid depression is present.

BULIMIA NERVOSABULIMIA NERVOSA

BULIMIA NERVOSABULIMIA NERVOSA• Bulimia nervosa is an eating disorder

characterized by binge eating with the maintenance of body weight.

• Types-Purging: self induced vomiting or use

of laxatives

-Non purging: fasting or exercise, but no purging during bulimic episodes.

Prevalence / etiologyPrevalence / etiology• 2% in young adult females. Occur at a 1:9

male to female ratio.• Psychological conflicts regarding guilt,

helplessness, self control and body image may predispose.

• Biologic factors : association with mood disorders.

• Abnormal serotonin metabolism is thought to play more of a role in bulimia nervosa.

Key symptomsKey symptoms• Recurrent episodes of binge eating:

obsession with dieting but followed by binge eating of high calorie foods.

• Recurrent , inappropriate compensatory behavior: after a binge, attempts to prevent weight gain through self induced vomiting, misuse of laxatives, fasting or excessive exercise.

• Self evaluation is unduly influenced by body shape and weight

Associated problemsAssociated problems• Depressive symptoms• Substance abuse• Impulsivity (kleptomania)

examinationsexaminations• Physical examination: evidence of

purging• Diagnostic tests: evidence of

laxatives.

Course and outcomeCourse and outcome• Course: may be chronic or

intermittent• Outcome:70% of cases have

remitted after 10 years. Co existent substance abuse is associated with a poorer prognosis.

Differential diagnosisDifferential diagnosis• Major depression with atypical

features• Borderline personality• Differentiate from binge eating and

purging subtype of anorexia nervosa.

ManagementManagement• Similar to that of anorexia nervosa• No medical complications of starvation

present.• Psychotherapy for controlling eating

behaviors• Cognitive therapy may be useful in

treating over concern with body images.• Antidepressants, particularly SSRIs, are

usually given.

Thank you!Thank you!