Eating Disorders

A lecture looking at anorexia nervosa, bulimia nervosa and the interesting 'eating disorder not otherwise specified'.

 

Lecture by

Video Duration: 9 minutes

  • Bulimia Nervosa
    Created by Eve Fordyce
    General
    Epidemiology

    Disordered eating, characterised by periods of excessive binging, followed by compensatory purging behaviour.

    Most frequently seen in young Caucasian women, with a slightly later average age of onset than Anorexia nervosa.

    Although approximately 1 in 10 sufferers are male.

    Pathology

    None


    Top three causes

    Commonly associated with difficult social circumstances in youth.

    1. History of physical, emotion or sexual abuse.
    2. Family history of eating disorder
    3. Family history of psychological disturbances


    Clinical Features
    Symptoms

    This illness is characterised by three core features:

    1. Pre-occupation with food. Food never far from thoughts, periods of starvation cause extreme irritability.
    2. Bouts of binging, where an abnormally large amount of food is eaten in a short period of time.
    3. Compensatory behaviour, this is in the form of purging. Purging does not necessarily mean vomiting. Can also be carried out through; forced starvation, excessive exercise, abuse of laxitives, appetite suppressants and duiretics
    Signs

    On examination the patient may not display obvious signs, unlike in anorexia nervosa they may be of normal BMI. However it is important to think about:

    • State of dentition (repeated vomiting can cause dental problems)
    • Fluid status, they may be dehydrated, or conversely have oedema if abusing certain medication.
    • Look for Russel's sign, this is the formation of callouses on the back of the hands as a result of the patient inducing vomiting

    Note that eating disorders often go hand in hand with the likes of: General anxiety disorder, obsessive compulsive disorder, and depression. So consider these when seeing patients. Additionally rule out physical illness first.

    Investigations
    Cultures

    None

    Bloods

    Although Bulimia is a purely clinical diagnosis, it may be worthwhile taking and FBC to check for the likes of iron deficiency anaemia, and testing blood glucose.

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    CBT has an evidence base in treating Bulimia. Where possible it is advised to involve the family in care and providing support for the patient, it may then be suitable to offer family therapy.

    Medical

    There is an evidence base for the use of Fluoxetine (40-60mg) for the treatment of Bulimia. However, think twice about the use of anti-depressants in adolescants.

    Surgical

    None

  • Anorexia Nervosa
    Created by Kate Bull
    General
    Epidemiology

    Epidemiology: 18-20 years, F>M, Caucasian

    ICD 10 Classification:

    • BMI < 17.5/85% expected weight - belief they are fat
    • Self Induced Weight Loss (Restrictive/Purging)
    • Fear of fatness (Overvalued Idea)
    • Amenorrhoea/Delayed Puberty
    Pathology

    Pre-morbid Characteristics: Anxiety, obesity, perfectionism, low self esteem, early menarche.

    Pre-morbid experiences: Adverse parenting, sexual abuse, family dieting, criticism about eating.

    Top three causes
    • Female
    • Western World
    • Caucasian
    Clinical Features
    Symptoms
    • GI Symptoms
    • Dizziness
    • Amenorrhoea
    • Sensitivity to cold
    • Poor sleep
    Signs
    • Lanugo hair
    • Poorly developed secondary sex characteristics
    • Bradycardia
    • Hypotension
    • Arrythmias
    • Emaciation
    • Dry skin
    • Cold extremities
    Investigations
    Cultures

    None

    Bloods

    None

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Intensive multiprofessional management.

    Psychological:

    • Psychotherapy
    • Family therapy

    Nutritional Counselling: 3500 calories a day split into 3 meals and 3 snacks

    • Soft milky food
    • Half portions
    • Full portions

    Inpatient treatment if:

    • BMI < 13.5
    • Risk to life
    • Failed management as outpatient
    Medical

    Psychological:

    • Antidepressant if depressed
    • Low dose Olanzapine for anxiety around eating

    Physical:

    • Medical supplementation
    Surgical

    None