Eating Disorders Overview

Questions and Answers

Anorexia nervosa is characterized by a severe food restriction and a distorted body image.

True

Individuals with anorexia nervosa typically see themselves as underweight.

False

The estimated incidence of anorexia nervosa is approximately 10 per 100,000 people.

False

Amenorrhea, or loss of menstruation, is one of the symptoms of anorexia nervosa.

True Signup and view all the answers

Anorexia nervosa is diagnosed more frequently in men than in women.

False Signup and view all the answers

Studies indicate that around 40% of individuals with anorexia nervosa recover their eating habits.

False Signup and view all the answers

Anorexia nervosa has a higher mortality rate than many other psychiatric disorders.

True Signup and view all the answers

A familial component with a heritability of 28-74% is associated with anorexia nervosa.

True Signup and view all the answers

Anorexia nervosa rarely affects individuals under the age of 13.

True Signup and view all the answers

The condition is thought to be more common in children than adolescents.

False Signup and view all the answers

Eating disorders are influenced mainly by perceptions of weight and shape.

True Signup and view all the answers

Obesity is recognized as a psychiatric disorder related to eating behaviors.

False Signup and view all the answers

Until the late 1970s, eating disorders were considered common and well-recognized.

False Signup and view all the answers

The majority of individuals with bulimia nervosa are untreated.

True Signup and view all the answers

ICD-10 includes a category for 'binge eating disorder'.

False Signup and view all the answers

ICD-11 is expected to align more closely with DSM-5 classifications.

True Signup and view all the answers

Only 25% of cases of anorexia nervosa are detected in primary care.

False Signup and view all the answers

Individuals who meet criteria for anorexia nervosa never transition to criteria for bulimia nervosa.

False Signup and view all the answers

Functional neuroimaging shows involvement of brain regions only in responses related to sensory stimuli and not food rewards.

False Signup and view all the answers

Restrictive eating in anorexia nervosa is an adaptive response related to serotonergic and dopaminergic imbalances in the brain.

False Signup and view all the answers

Cultural factors significantly contribute to the development of anorexia nervosa in affluent societies.

True Signup and view all the answers

Low self-esteem and perfectionism have been shown to be protective factors in the development of anorexia nervosa.

False Signup and view all the answers

Minuchin et al. proposed that family relationships can play a significant role in the causation of anorexia nervosa.

True Signup and view all the answers

Epidemiological studies indicate that people who develop anorexia nervosa do not generally have any childhood adversities.

False Signup and view all the answers

Most patients with anorexia nervosa are eager to change their behavior and seek psychiatric help immediately.

False Signup and view all the answers

Bruch argued that individuals with anorexia nervosa are in a struggle for control and identity through their pursuit of thinness.

True Signup and view all the answers

Understanding the early feeding habits of children is irrelevant in assessing anorexia nervosa.

False Signup and view all the answers

Demographic surveys show that dieting is less common among female students in affluent societies than other groups.

False Signup and view all the answers

Emaciation is a physical sign indicative of anorexia nervosa.

True Signup and view all the answers

Low levels of luteinizing hormone indicate an endocrine abnormality related to anorexia nervosa.

True Signup and view all the answers

Individuals with anorexia nervosa typically exhibit increased energy expenditure.

False Signup and view all the answers

Bradycardia is a common cardiovascular abnormality in anorexia nervosa.

True Signup and view all the answers

Lanugo is a sign of excessive hair growth seen in individuals with anorexia nervosa.

False Signup and view all the answers

Hypophosphatemia can be exaggerated during re-feeding in anorexia nervosa patients.

True Signup and view all the answers

Dizziness and syncope are two potential gastrointestinal symptoms of anorexia nervosa.

False Signup and view all the answers

Increased grey matter volume in the orbitofrontal cortex is a neurobiological finding associated with anorexia nervosa.

True Signup and view all the answers

Peripheral edema is a rare sign associated with anorexia nervosa.

False Signup and view all the answers

Hypercholesterolemia is a possible metabolic abnormality seen in individuals with anorexia nervosa.

True Signup and view all the answers

Anorexia nervosa was first named in 1868 by the American physician William Gull.

False Signup and view all the answers

Patients with anorexia nervosa commonly set daily calorie limits of 1000 to 1200 kcal.

False Signup and view all the answers

In the ICD-10, amenorrhoea is included as a criterion for anorexia nervosa.

True Signup and view all the answers

The main features of anorexia nervosa include an extreme concern about dietary fiber intake.

False Signup and view all the answers

Binge eating in patients with anorexia nervosa is defined as eating a moderate amount of food in a controlled manner.

False Signup and view all the answers

The majority of patients with anorexia nervosa are young women.

True Signup and view all the answers

Inducing vomiting can be a method used by anorexia nervosa patients to lose weight.

True Signup and view all the answers

The pursuit of thinness in anorexia nervosa patients often results in the enjoyment of food and cooking elaborate meals.

True Signup and view all the answers

The overvalued ideas about body shape and weight are a central psychological feature in anorexia nervosa.

True Signup and view all the answers

Anorexia nervosa can only begin in young adulthood.

False Signup and view all the answers

A body mass index (BMI) of less than 14 kg/m2 is considered an abnormality requiring urgent follow-up in anorexia nervosa.

True Signup and view all the answers

An increase in heart rate of more than 20 beats per minute upon standing is termed bradycardia.

False Signup and view all the answers

Antipsychotics are widely recommended due to their clear effects in treating anorexia nervosa.

False Signup and view all the answers

Hypoglycaemia is considered a relevant metabolic abnormality in the assessment of anorexia nervosa.

True Signup and view all the answers

Patients with anorexia nervosa who are under 18 years old require less caution when prescribing medications.

False Signup and view all the answers

Neoplasia is included as a medical disorder in the differential diagnosis of anorexia nervosa.

True Signup and view all the answers

Focal psychodynamic psychotherapy is not considered a psychological intervention for anorexia nervosa.

False Signup and view all the answers

Weight restoration is the sole focus in managing anorexia nervosa.

False Signup and view all the answers

Psychotherapy for anorexia nervosa has always been based on cognitive behavioural therapy (CBT).

False Signup and view all the answers

Family therapy is considered ineffective for children and adolescents with anorexia nervosa.

False Signup and view all the answers

The NICE guidelines for anorexia nervosa were first published in 2004.

True Signup and view all the answers

Patients with anorexia nervosa often report feelings of guilt or self-disgust related to their condition.

True Signup and view all the answers

Deep brain stimulation is a well-established treatment for anorexia nervosa with substantial evidence supporting its effectiveness.

False Signup and view all the answers

Patients with anorexia nervosa can easily eat in front of others without anxiety.

False Signup and view all the answers

Weight control or eating restriction is not a concern for individuals with anorexia nervosa.

False Signup and view all the answers

Binge eating episodes in anorexia nervosa can be characterized as objectively large.

True Signup and view all the answers

There is a significant evidence base supporting the use of various psychotherapeutic interventions for anorexia nervosa as of 2023.

True Signup and view all the answers

Patients with anorexia nervosa do not restrict fluids as part of their eating behaviors.

False Signup and view all the answers

Bulimia nervosa was first described by Russell in 1989.

False Signup and view all the answers

The DSM-5 specifies that bulimic behaviors must occur at least once a week for 6 months.

False Signup and view all the answers

Patients with bulimia nervosa are typically underweight and have a BMI lower than 18.5.

False Signup and view all the answers

Self-induced vomiting is one of the extreme measures used to control body weight in bulimia nervosa.

True Signup and view all the answers

Russell's sign refers to the presence of callouses on the knuckles caused by frequent vomiting.

True Signup and view all the answers

The frequency of inappropriate compensatory behaviors classifies the severity of bulimia nervosa in DSM-5.

True Signup and view all the answers

Episodes of binge eating bring prolonged relief from tension for patients.

False Signup and view all the answers

Depressive symptoms in bulimia nervosa typically remit after the eating disorder improves.

True Signup and view all the answers

Physical health issues from bulimia nervosa are most commonly caused by overeating alone.

False Signup and view all the answers

Bulimia nervosa is more common in men than in women according to recent epidemiological studies.

False Signup and view all the answers

Psychological therapies for anorexia nervosa include only cognitive behaviour therapy (CBT) and family interventions.

False Signup and view all the answers

Dietary counselling alone is suggested as the sole treatment for anorexia nervosa.

False Signup and view all the answers

A reasonable aim during weight restoration for people with anorexia nervosa is to increase weight by 0.5 kg every two weeks.

False Signup and view all the answers

Compulsory treatment for anorexia nervosa is commonly practiced and legally accepted.

False Signup and view all the answers

Inpatient care is indicated in cases of acute suicidal ideation or serious physical health risks.

True Signup and view all the answers

It is good practice to agree on a target weight lower than a BMI of 18.5 in severe cases of anorexia nervosa.

False Signup and view all the answers

Following inpatient treatment, regular monitoring of both physical and psychological risk is unnecessary.

False Signup and view all the answers

Most cases of anorexia nervosa can be treated on an outpatient or day-patient basis within a specialist service.

True Signup and view all the answers

Patients should be educated about anorexia nervosa immediately after diagnosis for better outcomes.

True Signup and view all the answers

Psychological treatment for anorexia nervosa should only focus on eating behavior.

False Signup and view all the answers

The mortality rate for bulimia nervosa is approximately quadrupled compared to anorexia nervosa.

False Signup and view all the answers

Childhood obesity and early menarche are risk factors specifically associated with bulimia nervosa.

True Signup and view all the answers

Perfectionism is considered a strong risk factor for developing bulimia nervosa.

False Signup and view all the answers

The use of stimulant laxatives in bulimia nervosa may lead to chronic constipation.

True Signup and view all the answers

CBT-E is specifically tailored for treating anorexia nervosa only.

False Signup and view all the answers

Those with bulimia nervosa have generally better outcomes than those with anorexia nervosa after 5-10 years.

True Signup and view all the answers

Epistaxis and subconjunctival hemorrhage are complications of bulimia nervosa related to vomiting.

True Signup and view all the answers

Guided self-help using CBT is effective for all individuals with bulimia nervosa.

False Signup and view all the answers

Myopathy and cardiomyopathy are unrelated to bulimia nervosa.

False Signup and view all the answers

There is strong evidence for effective psychological treatments for bulimia nervosa compared to anorexia nervosa.

True Signup and view all the answers

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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the various eating disorders characterized by abnormal eating patterns and attitudes towards weight and body shape. Learn about the core psychopathology shared among these disorders and understand how they impact self-worth. Challenge your knowledge about these critical mental health issues.