Lec 2

• Eating Disorders are psychiatric illnesses marked by disordered eating behaviours, disordered food intake, disordered eating attitudes, and often inadequate methods of weight control
• Disordered Eating


  The full spectrum of eating-related problems from simple dieting to clinical Eating Disorders
• Main Eating Disorders


  • Anorexia nervosa
  • Bulimia nervosa
  • Eating disorders not otherwise specified
• Anorexia nervosa (AN)


  • Serious weight loss, refusal to eat, and a disturbance in the way in which one's body weight or shape is experienced
• Who is affected by AN

  • 10 times more common in females than in males
  • In young women, the risk of developing anorexia is 0.5 to 1 percent, and mortality is estimated at 4 to 10 percent
  • Affects adolescents and young adults
  • Affects all ethnicities but most common among whites in industrialized nations
• What causes AN


  • The media tells us we're not thin enough, not happy enough and not in control enough
  • Anorexia is a way of coping with what's going on in a teen's life (stress, pain, anger, acceptance, confusion and fear)
  • Family members can play a huge role (over protective and smothering, criticise weight or other areas, rigid and even abusive)
• A combination of genetic, biological, psychological, family, environmental, and social factors probably contribute to developing an eating disorder
• There is no consensus regarding the causes of eating disorders
• How AN is diagnosed

  • Patients use caloric restriction
  • BMI <17.5 kg/m2
  • Excessive exercise to control emotional need or pain, and they are terrified of becoming overweight
• Effects of AN on organ systems

  • Constitution/whole body - Cachexia and low body mass index, Arrested growth, Hypothermia
  • Cardiovascular - Myocardial atrophy, Bradycardia, Arrhythmias which may cause sudden death, Hypotension
  • Gynecologic and reproductive – Amenorrhea, Infertility
  • Endocrine - Osteoporosis and pathologic stress fractures
  • Gastrointestinal - Gastroparesis (delayed gastric emptying), Constipation, Gastric dilatation, Increased colonic transit time, Hepatitis
  • Renal and electrolytes - Decreased glomerular filtration rate, Renal calculi, Impaired concentration of urine, Dehydration, Hypokalemia, Hypomagnesemia, Hypophosphatemia
  • Pulmonary - Respiratory failure
  • Hematologic - Anemia, Leukopenia, Thrombycytopenia
  • Neurologic - Cerebral atrophy, Cognitive impairment, Peripheral neuropathy
  • Dermatologic Xerosis (dry skin) Lanugo hair (fine, downy, dark hair)
  • Muscular - Muscle wasting
  • Vitamin deficiencies
• Treatment of AN


  • Early detection
  • Interdisciplinary team approach (Medical provider, Dietician - nutritional rehabilitation, Mental health professional)
  • Cognitive-behavioral therapy (CBT)
  • Psychodynamic psychotherapy
  • Motivational interviewing
  • Family therapy
• Refeeding syndrome - complications that occur as a result of fluid and electrolyte shifts during nutritional rehabilitation, including hypophosphatemia and volume overload leading to heart failure and arrhythmias
• Judiciously limiting the amount of calories and fluid provided in the early stages of refeeding is important to avoid refeeding syndrome
• No specific drugs for the treatment of anorexia nervosa, and no compelling data that adjunctive antidepressants help restore body weight
• Bulimia nervosa (BN)


  • Marked by presence of binge eating episodes, followed by compensatory behaviors (e.g., vomiting or use of laxatives)
• Diagnostic Criteria for BN

  • Recurrent episodes of binge eating (eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat under similar circumstances, with a sense of lack of control)
  • Compensatory behaviors to prevent weight gain
• Who gets BN


  • Mainly affects women aged 16-40
  • Most commonly starts around the age of 19 years
  • Women 10 times more likely to develop bulimia than men
• Treatment of BN


  • Multidisciplinary
  • Cognitive Behavioural Therapy (CBT)
  • Other psychotherapies
  • Antidepressant medication (SSRI)
  • Combination treatment
• Eating Disorders Not Otherwise Specified (ED-NOS)


  Patients with clearly aberrant eating patterns and weight management habits who do not meet the criteria for AN and BN, including binge eating disorder, night eating syndrome, sleep related eating disorder, and purging disorder
• Binge-eating disorder


  • Eating an amount of food in a discrete period of time that is definitely larger than most people would eat in a similar period of time under similar circumstances, at least twice a week for at least six months, with a lack of control and distress over the eating, but without inappropriate compensatory behaviors
• Effects of binge-eating disorder

  • Obesity, hypercholesterolemia
• Treatment of binge-eating disorder

  • Psychotherapy > Behavioral weight loss therapy > Pharmacotherapy
• 2.4% of adolescent females attending secondary school in Trinidad reported having a medical diagnosis for an eating disorder
• 51% of adolescent females attending secondary school in Trinidad had a negative body image perception
• The prevalence of bulimic disorders in Caribbean schoolgirls is still very low, but they are a population at increasing risk since they share the western ideals of slimness and engage in dieting behaviours
• Females were much more likely than males to have higher levels of eating disorders, and self esteem was equally strongly negatively correlated with eating disorders for both males and females in Trinidad
• 4.2% of university students in the West Indies reported to have been diagnosed with an eating problem, and females were significantly more likely to choose body silhouettes that were underweight and engage in dieting behaviours
• HEADS Framework for assessing adolescents

  Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety
• SCOFF questionnaire


  A useful screening tool for eating disorders, with two or more positive answers prompting a more detailed history