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Questions and Answers
Anorexia nervosa is characterized by a severe food restriction and a distorted body image.
Anorexia nervosa is characterized by a severe food restriction and a distorted body image.
True (A)
Individuals with anorexia nervosa typically see themselves as underweight.
Individuals with anorexia nervosa typically see themselves as underweight.
False (B)
The estimated incidence of anorexia nervosa is approximately 10 per 100,000 people.
The estimated incidence of anorexia nervosa is approximately 10 per 100,000 people.
False (B)
Amenorrhea, or loss of menstruation, is one of the symptoms of anorexia nervosa.
Amenorrhea, or loss of menstruation, is one of the symptoms of anorexia nervosa.
Anorexia nervosa is diagnosed more frequently in men than in women.
Anorexia nervosa is diagnosed more frequently in men than in women.
Studies indicate that around 40% of individuals with anorexia nervosa recover their eating habits.
Studies indicate that around 40% of individuals with anorexia nervosa recover their eating habits.
Anorexia nervosa has a higher mortality rate than many other psychiatric disorders.
Anorexia nervosa has a higher mortality rate than many other psychiatric disorders.
A familial component with a heritability of 28-74% is associated with anorexia nervosa.
A familial component with a heritability of 28-74% is associated with anorexia nervosa.
Anorexia nervosa rarely affects individuals under the age of 13.
Anorexia nervosa rarely affects individuals under the age of 13.
The condition is thought to be more common in children than adolescents.
The condition is thought to be more common in children than adolescents.
Eating disorders are influenced mainly by perceptions of weight and shape.
Eating disorders are influenced mainly by perceptions of weight and shape.
Obesity is recognized as a psychiatric disorder related to eating behaviors.
Obesity is recognized as a psychiatric disorder related to eating behaviors.
Until the late 1970s, eating disorders were considered common and well-recognized.
Until the late 1970s, eating disorders were considered common and well-recognized.
The majority of individuals with bulimia nervosa are untreated.
The majority of individuals with bulimia nervosa are untreated.
ICD-10 includes a category for 'binge eating disorder'.
ICD-10 includes a category for 'binge eating disorder'.
ICD-11 is expected to align more closely with DSM-5 classifications.
ICD-11 is expected to align more closely with DSM-5 classifications.
Only 25% of cases of anorexia nervosa are detected in primary care.
Only 25% of cases of anorexia nervosa are detected in primary care.
Individuals who meet criteria for anorexia nervosa never transition to criteria for bulimia nervosa.
Individuals who meet criteria for anorexia nervosa never transition to criteria for bulimia nervosa.
Functional neuroimaging shows involvement of brain regions only in responses related to sensory stimuli and not food rewards.
Functional neuroimaging shows involvement of brain regions only in responses related to sensory stimuli and not food rewards.
Restrictive eating in anorexia nervosa is an adaptive response related to serotonergic and dopaminergic imbalances in the brain.
Restrictive eating in anorexia nervosa is an adaptive response related to serotonergic and dopaminergic imbalances in the brain.
Cultural factors significantly contribute to the development of anorexia nervosa in affluent societies.
Cultural factors significantly contribute to the development of anorexia nervosa in affluent societies.
Low self-esteem and perfectionism have been shown to be protective factors in the development of anorexia nervosa.
Low self-esteem and perfectionism have been shown to be protective factors in the development of anorexia nervosa.
Minuchin et al. proposed that family relationships can play a significant role in the causation of anorexia nervosa.
Minuchin et al. proposed that family relationships can play a significant role in the causation of anorexia nervosa.
Epidemiological studies indicate that people who develop anorexia nervosa do not generally have any childhood adversities.
Epidemiological studies indicate that people who develop anorexia nervosa do not generally have any childhood adversities.
Most patients with anorexia nervosa are eager to change their behavior and seek psychiatric help immediately.
Most patients with anorexia nervosa are eager to change their behavior and seek psychiatric help immediately.
Bruch argued that individuals with anorexia nervosa are in a struggle for control and identity through their pursuit of thinness.
Bruch argued that individuals with anorexia nervosa are in a struggle for control and identity through their pursuit of thinness.
Understanding the early feeding habits of children is irrelevant in assessing anorexia nervosa.
Understanding the early feeding habits of children is irrelevant in assessing anorexia nervosa.
Demographic surveys show that dieting is less common among female students in affluent societies than other groups.
Demographic surveys show that dieting is less common among female students in affluent societies than other groups.
Emaciation is a physical sign indicative of anorexia nervosa.
Emaciation is a physical sign indicative of anorexia nervosa.
Low levels of luteinizing hormone indicate an endocrine abnormality related to anorexia nervosa.
Low levels of luteinizing hormone indicate an endocrine abnormality related to anorexia nervosa.
Individuals with anorexia nervosa typically exhibit increased energy expenditure.
Individuals with anorexia nervosa typically exhibit increased energy expenditure.
Bradycardia is a common cardiovascular abnormality in anorexia nervosa.
Bradycardia is a common cardiovascular abnormality in anorexia nervosa.
Lanugo is a sign of excessive hair growth seen in individuals with anorexia nervosa.
Lanugo is a sign of excessive hair growth seen in individuals with anorexia nervosa.
Hypophosphatemia can be exaggerated during re-feeding in anorexia nervosa patients.
Hypophosphatemia can be exaggerated during re-feeding in anorexia nervosa patients.
Dizziness and syncope are two potential gastrointestinal symptoms of anorexia nervosa.
Dizziness and syncope are two potential gastrointestinal symptoms of anorexia nervosa.
Increased grey matter volume in the orbitofrontal cortex is a neurobiological finding associated with anorexia nervosa.
Increased grey matter volume in the orbitofrontal cortex is a neurobiological finding associated with anorexia nervosa.
Peripheral edema is a rare sign associated with anorexia nervosa.
Peripheral edema is a rare sign associated with anorexia nervosa.
Hypercholesterolemia is a possible metabolic abnormality seen in individuals with anorexia nervosa.
Hypercholesterolemia is a possible metabolic abnormality seen in individuals with anorexia nervosa.
Anorexia nervosa was first named in 1868 by the American physician William Gull.
Anorexia nervosa was first named in 1868 by the American physician William Gull.
Patients with anorexia nervosa commonly set daily calorie limits of 1000 to 1200 kcal.
Patients with anorexia nervosa commonly set daily calorie limits of 1000 to 1200 kcal.
In the ICD-10, amenorrhoea is included as a criterion for anorexia nervosa.
In the ICD-10, amenorrhoea is included as a criterion for anorexia nervosa.
The main features of anorexia nervosa include an extreme concern about dietary fiber intake.
The main features of anorexia nervosa include an extreme concern about dietary fiber intake.
Binge eating in patients with anorexia nervosa is defined as eating a moderate amount of food in a controlled manner.
Binge eating in patients with anorexia nervosa is defined as eating a moderate amount of food in a controlled manner.
The majority of patients with anorexia nervosa are young women.
The majority of patients with anorexia nervosa are young women.
Inducing vomiting can be a method used by anorexia nervosa patients to lose weight.
Inducing vomiting can be a method used by anorexia nervosa patients to lose weight.
The pursuit of thinness in anorexia nervosa patients often results in the enjoyment of food and cooking elaborate meals.
The pursuit of thinness in anorexia nervosa patients often results in the enjoyment of food and cooking elaborate meals.
The overvalued ideas about body shape and weight are a central psychological feature in anorexia nervosa.
The overvalued ideas about body shape and weight are a central psychological feature in anorexia nervosa.
Anorexia nervosa can only begin in young adulthood.
Anorexia nervosa can only begin in young adulthood.
A body mass index (BMI) of less than 14 kg/m2 is considered an abnormality requiring urgent follow-up in anorexia nervosa.
A body mass index (BMI) of less than 14 kg/m2 is considered an abnormality requiring urgent follow-up in anorexia nervosa.
An increase in heart rate of more than 20 beats per minute upon standing is termed bradycardia.
An increase in heart rate of more than 20 beats per minute upon standing is termed bradycardia.
Antipsychotics are widely recommended due to their clear effects in treating anorexia nervosa.
Antipsychotics are widely recommended due to their clear effects in treating anorexia nervosa.
Hypoglycaemia is considered a relevant metabolic abnormality in the assessment of anorexia nervosa.
Hypoglycaemia is considered a relevant metabolic abnormality in the assessment of anorexia nervosa.
Patients with anorexia nervosa who are under 18 years old require less caution when prescribing medications.
Patients with anorexia nervosa who are under 18 years old require less caution when prescribing medications.
Neoplasia is included as a medical disorder in the differential diagnosis of anorexia nervosa.
Neoplasia is included as a medical disorder in the differential diagnosis of anorexia nervosa.
Focal psychodynamic psychotherapy is not considered a psychological intervention for anorexia nervosa.
Focal psychodynamic psychotherapy is not considered a psychological intervention for anorexia nervosa.
Weight restoration is the sole focus in managing anorexia nervosa.
Weight restoration is the sole focus in managing anorexia nervosa.
Psychotherapy for anorexia nervosa has always been based on cognitive behavioural therapy (CBT).
Psychotherapy for anorexia nervosa has always been based on cognitive behavioural therapy (CBT).
Family therapy is considered ineffective for children and adolescents with anorexia nervosa.
Family therapy is considered ineffective for children and adolescents with anorexia nervosa.
The NICE guidelines for anorexia nervosa were first published in 2004.
The NICE guidelines for anorexia nervosa were first published in 2004.
Patients with anorexia nervosa often report feelings of guilt or self-disgust related to their condition.
Patients with anorexia nervosa often report feelings of guilt or self-disgust related to their condition.
Deep brain stimulation is a well-established treatment for anorexia nervosa with substantial evidence supporting its effectiveness.
Deep brain stimulation is a well-established treatment for anorexia nervosa with substantial evidence supporting its effectiveness.
Patients with anorexia nervosa can easily eat in front of others without anxiety.
Patients with anorexia nervosa can easily eat in front of others without anxiety.
Weight control or eating restriction is not a concern for individuals with anorexia nervosa.
Weight control or eating restriction is not a concern for individuals with anorexia nervosa.
Binge eating episodes in anorexia nervosa can be characterized as objectively large.
Binge eating episodes in anorexia nervosa can be characterized as objectively large.
There is a significant evidence base supporting the use of various psychotherapeutic interventions for anorexia nervosa as of 2023.
There is a significant evidence base supporting the use of various psychotherapeutic interventions for anorexia nervosa as of 2023.
Patients with anorexia nervosa do not restrict fluids as part of their eating behaviors.
Patients with anorexia nervosa do not restrict fluids as part of their eating behaviors.
Bulimia nervosa was first described by Russell in 1989.
Bulimia nervosa was first described by Russell in 1989.
The DSM-5 specifies that bulimic behaviors must occur at least once a week for 6 months.
The DSM-5 specifies that bulimic behaviors must occur at least once a week for 6 months.
Patients with bulimia nervosa are typically underweight and have a BMI lower than 18.5.
Patients with bulimia nervosa are typically underweight and have a BMI lower than 18.5.
Self-induced vomiting is one of the extreme measures used to control body weight in bulimia nervosa.
Self-induced vomiting is one of the extreme measures used to control body weight in bulimia nervosa.
Russell's sign refers to the presence of callouses on the knuckles caused by frequent vomiting.
Russell's sign refers to the presence of callouses on the knuckles caused by frequent vomiting.
The frequency of inappropriate compensatory behaviors classifies the severity of bulimia nervosa in DSM-5.
The frequency of inappropriate compensatory behaviors classifies the severity of bulimia nervosa in DSM-5.
Episodes of binge eating bring prolonged relief from tension for patients.
Episodes of binge eating bring prolonged relief from tension for patients.
Depressive symptoms in bulimia nervosa typically remit after the eating disorder improves.
Depressive symptoms in bulimia nervosa typically remit after the eating disorder improves.
Physical health issues from bulimia nervosa are most commonly caused by overeating alone.
Physical health issues from bulimia nervosa are most commonly caused by overeating alone.
Bulimia nervosa is more common in men than in women according to recent epidemiological studies.
Bulimia nervosa is more common in men than in women according to recent epidemiological studies.
Psychological therapies for anorexia nervosa include only cognitive behaviour therapy (CBT) and family interventions.
Psychological therapies for anorexia nervosa include only cognitive behaviour therapy (CBT) and family interventions.
Dietary counselling alone is suggested as the sole treatment for anorexia nervosa.
Dietary counselling alone is suggested as the sole treatment for anorexia nervosa.
A reasonable aim during weight restoration for people with anorexia nervosa is to increase weight by 0.5 kg every two weeks.
A reasonable aim during weight restoration for people with anorexia nervosa is to increase weight by 0.5 kg every two weeks.
Compulsory treatment for anorexia nervosa is commonly practiced and legally accepted.
Compulsory treatment for anorexia nervosa is commonly practiced and legally accepted.
Inpatient care is indicated in cases of acute suicidal ideation or serious physical health risks.
Inpatient care is indicated in cases of acute suicidal ideation or serious physical health risks.
It is good practice to agree on a target weight lower than a BMI of 18.5 in severe cases of anorexia nervosa.
It is good practice to agree on a target weight lower than a BMI of 18.5 in severe cases of anorexia nervosa.
Following inpatient treatment, regular monitoring of both physical and psychological risk is unnecessary.
Following inpatient treatment, regular monitoring of both physical and psychological risk is unnecessary.
Most cases of anorexia nervosa can be treated on an outpatient or day-patient basis within a specialist service.
Most cases of anorexia nervosa can be treated on an outpatient or day-patient basis within a specialist service.
Patients should be educated about anorexia nervosa immediately after diagnosis for better outcomes.
Patients should be educated about anorexia nervosa immediately after diagnosis for better outcomes.
Psychological treatment for anorexia nervosa should only focus on eating behavior.
Psychological treatment for anorexia nervosa should only focus on eating behavior.
The mortality rate for bulimia nervosa is approximately quadrupled compared to anorexia nervosa.
The mortality rate for bulimia nervosa is approximately quadrupled compared to anorexia nervosa.
Childhood obesity and early menarche are risk factors specifically associated with bulimia nervosa.
Childhood obesity and early menarche are risk factors specifically associated with bulimia nervosa.
Perfectionism is considered a strong risk factor for developing bulimia nervosa.
Perfectionism is considered a strong risk factor for developing bulimia nervosa.
The use of stimulant laxatives in bulimia nervosa may lead to chronic constipation.
The use of stimulant laxatives in bulimia nervosa may lead to chronic constipation.
CBT-E is specifically tailored for treating anorexia nervosa only.
CBT-E is specifically tailored for treating anorexia nervosa only.
Those with bulimia nervosa have generally better outcomes than those with anorexia nervosa after 5-10 years.
Those with bulimia nervosa have generally better outcomes than those with anorexia nervosa after 5-10 years.
Epistaxis and subconjunctival hemorrhage are complications of bulimia nervosa related to vomiting.
Epistaxis and subconjunctival hemorrhage are complications of bulimia nervosa related to vomiting.
Guided self-help using CBT is effective for all individuals with bulimia nervosa.
Guided self-help using CBT is effective for all individuals with bulimia nervosa.
Myopathy and cardiomyopathy are unrelated to bulimia nervosa.
Myopathy and cardiomyopathy are unrelated to bulimia nervosa.
There is strong evidence for effective psychological treatments for bulimia nervosa compared to anorexia nervosa.
There is strong evidence for effective psychological treatments for bulimia nervosa compared to anorexia nervosa.
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Study Notes
Eating Disorders Overview
- Eating disorders involve abnormal eating patterns and attitudes toward weight and shape, significantly impacting self-worth.
- Core psychopathology is an overevaluation of weight and shape, leading to distress.
- Key disorders include anorexia nervosa and bulimia nervosa, with obesity not classified as a psychiatric disorder.
- The rise in eating disorders diagnosis since the late 1970s raises questions about true incidence versus increased detection.
- Approximately 50% of anorexia nervosa and even fewer bulimia nervosa cases are detected in primary care.
Classification of Eating Disorders
- DSM-5 recognizes conditions like binge eating disorder, while ICD-10 uses "atypical" prefixes to classify unspecified disorders.
- Patients may exhibit signs of multiple eating disorders without meeting full diagnostic criteria, complicating classification.
Anorexia Nervosa
- Defined by intense fear of weight gain, distorted body image, and severe food restriction.
- Common symptoms include:
- Fear of weight gain even at healthy weight.
- Distorted perception of body weight.
- Severe restriction of food intake leading to low body weight.
- Psychological symptoms: amenorrhea, anxiety, depression, obsessive thoughts, mood lability, and lack of sexual interest.
Physical and Medical Consequences
- Potential complications from starvation impact multiple body systems.
- As BMI decreases, symptoms and complications may escalate, including cardiovascular issues and electrolyte imbalances.
Onset, Course, and Prognosis
- Illness often shows cycles of exacerbation and remission.
- Recovery involves weight normalization in approximately 60% of cases, with about 50% normalizing eating habits.
- Poor prognosis linked to early onset, long illness duration, personality disorders, substance misuse, and childhood obesity.
Epidemiology
- Estimated incidence of anorexia nervosa is 5 per 100,000, with higher prevalence in the general population.
- Prevalence among women ranges from 0.9% to 4%, with men typically lower at about 10:1 female-to-male ratio.
- Rarely diagnosed in children under 13, more prevalent in adolescents and young adults.
Aetiology
- Genetic factors play a significant role, with heritability estimates between 28%-74%.
- Shared genetic links exist between anorexia nervosa and disorders like OCD and schizophrenia.
- Cognitive dysfunctions may involve impaired task switching and strategic planning.
Neurobiological Insights
- Brain imaging studies indicate structural and functional abnormalities.
- Alterations in the serotonin system and grey matter volume in specific brain areas may be present.
Sociocultural and Psychological Factors
- Cultural pressures emphasize thinness as desirable, particularly in affluent societies.
- Psychological factors include low self-esteem, perfectionism, and control struggles, seen more frequently in those with anorexia nervosa.
Family Dynamics
- Disturbed family relationships, including enmeshment and rigidity, may contribute to the disorder.
- Childhood adversities and poor parental relationships are common among individuals with anorexia nervosa.
Assessment Techniques
- Building a trusting relationship is crucial for effective assessment.
- Comprehensive history of eating habits and psychological issues is essential.
- Multiple interviews may be necessary to understand the patient's condition fully.
Treatment Approaches
- Treatment primarily involves psychotherapy, with cognitive-behavioral therapy (CBT) being prominent.
- Family therapy is encouraged, considering family dynamics’ role in the disorder’s development.
- Current exploration of deep brain stimulation for severe cases, although more research is needed.### Family-Based Treatment
- Family-based treatments focusing on eating disorders are more effective for children and adolescents than broader family process treatments.
Anorexia Nervosa Urgent Concerns
- General abnormalities: BMI < 14 kg/m², Temperature < 35.5°C.
- Cardiovascular issues: Bradycardia (< 50 bpm), Blood pressure < 80/50 mmHg, Postural hypotension > 20 mmHg, Postural tachycardia (> 20 bpm increase), Arrhythmia, QTc > 50 msec.
- Blood tests revealing urgency: Hypokalaemia (< 3.0 mmol/l), Hypophosphataemia (< 0.5 mmol/l), Hypoglycaemia, Neutropenia.
Differential Diagnosis
Medical Disorders
- Possible conditions: Neoplasia (gastrointestinal, hypothalamic), Inflammatory bowel disease, Malabsorption syndromes, Hyperthyroidism, Chronic infections, Diabetes mellitus, Pituitary failure, Cystic fibrosis.
Psychiatric Disorders
- Consider other eating disorders, Depression, Somatoform disorders, Obsessive-Compulsive Disorder (OCD).
Treatment Overview
- Anorexia nervosa is challenging; patients often resist treatment and may be unresponsive.
- Antidepressants and antipsychotics are utilized, but antidepressants lack clear benefits for weight gain or psychological symptoms.
- Caution is needed when prescribing to those under 18, due to high complication risks.
Management Strategy
- Establishing a good rapport with patients is crucial; clear dietary plans and weight gain are emphasized.
Bulimia Nervosa Characteristics
- Defined by binge eating, preoccupation with food, loss of control, use of extreme weight control measures.
- Binge episodes involve consuming large amounts of food rapidly, typically over 2000 kcal, often alone, followed by guilt and compensatory behaviors like vomiting.
Diagnosis and Symptoms
- DSM-5 classification requires binge behaviors at least once a week for 3 months.
- Patients usually have a normal weight (BMI 18.5-25), but there is significant loss of control over eating.
Physical Consequences of Bulimia Nervosa
- Common issues include menstrual irregularities, gastrointestinal symptoms, and dental damage from vomiting (perimyolysis).
- Severe complications are rare and include cardiac arrhythmias, esophageal tears, gastric rupture.
Aetiology of Bulimia Nervosa
- Contributing factors include family history, adverse childhood experiences, and social factors promoting dieting.
- Perfectionism is less predictive compared to anorexia nervosa.
Treatment Approaches
- Treatment has substantial evidence supporting effective psychotherapy, particularly Cognitive Behavioral Therapy (CBT).
- Guided self-help can be beneficial for some, while formal treatment is often required.
Treatment Outcomes
- Early treatment response is a strong predictor of long-term success, with low relapse rates observed.
- Most patients achieve significant improvements with the right therapeutic approach.
NICE Guidelines for Anorexia Nervosa
- Outpatient care is the recommended approach, with various psychological therapies highlighted.
- Dietary counseling should not be the sole treatment.
- Regular monitoring of both physical and psychological health is essential during treatment.
Patient Weight Restoration
- Aim for gradual weight gain of 0.5 kg per week, requiring 500-1000 extra calories daily.
- Avoid rapid re-feeding strategies; target BMI should exceed 18.5.
- Continuous assessment and intervention for any weight-reducing behaviors are critical.
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