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Eating Disorders

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  1. Eating Disorders Zaid B. Malik, MD University Of Arkansas for Medical Sciences.

  2. Overview • Types • Diagnostic Criteria • Etiology • Complications • Rx

  3. Types ??

  4. What does she remind you of?

  5. And this ?

  6. And this…

  7. Or this…

  8. DSM-IV-TR Eating Disorder • Anorexia Nervosa • Bulimia Nervosa • Binge- eating Disorder ( classified as Eating Disorder NOS)

  9. Basic Concept of ED • Disordered pattern of eating, accompanied bydistress, disparagement, preoccupation and / or distortion associated with one’s eating, weight or body shape.

  10. Etiology • Multi factorial, with both genetic and environmental contributing risk factors. • Genetic , Biological ( Serotonin, Nor epinephrine, dopamine, hypothalamic dysfunction, and thyroid dysfunction. • Social ( dysfunctional family system as whole, can involve sexual abuse hx.

  11. Western society promote a drive for thinness, participation in sports that emphasize weight restriction

  12. Individual use of obsessive eating behavior as a replacement for normal adolescent pursuits of social and sexual functioning. • Individual feeling under excessive control of their parents.

  13. Individuals are unable to interpret body hunger signal because of early experience of inappropriate feeding.

  14. Course ?

  15. Course….. • 50 % of individuals with Anorexia and Bulimia nervosa make a full recovery where as 30% partially recover and 20 % follow a chronic course. • * Individuals with BED have a slightly favorable outcome. • * Mortality rate with AN is 0.6 % annually.

  16. Epidemiology • Which one is more prevalent?? AN or BN or BED

  17. EPIDEMIOLOGY….. • PREVELENCE: AN is the least prevalent ED, affecting aprox. 0.3 % young adult females. BN affect aprox. 1 % of young adult females and BED affect aprox. 2.6 % of young adults.

  18. Demographics • Which gender is more likely to have which ED…

  19. DEMOGRAPHICS • Typically affect young adult females with 85 to 95 % of cases of AN and BN and approximately 60 % of cases of BED occurring among females.

  20. Onset • What start early, AN / BN / BED

  21. ONSET • AN is slightly earlier than BN, both generally begin in adolescence, however both can occur at much older age. • Onset of BED tends to be slightly later, generally beginning in late adolescent or early twenties.

  22. Mean age of onset for AN is 17 with a bimodal peak at ages, 12 and 18, onset after 40 is un common.

  23. SOCIOCULTURAL FACTORS. • Reported all over the globe, but more prevalent in industrialized and or/ Westernized societies. Several epidemiologic studies have linked immigration, modernization and urbanization to risk.

  24. Anorexia Nervosa

  25. DIAGNOSTIC FEATURES OF AN • Refusal to maintain a body weight at or above a minimally normal weight for age and height.( Below 80th %tile) • Intense fear of gaining weight or becoming fat, even though underweight. • Disturbance in a way in which one’s body weight or shape is experienced.

  26. In postmenarcheal females, amenorrhea ( i.e absence of at least three consecutive menstrual cycles)

  27. YOU HAVE TO HAVE ALL OF THESE TO DIAGNOSE ANOREXIA NERVOSA OR THE DIAGNOSIS IS…..

  28. ED NOS

  29. What are subtypes ?

  30. SUBTYPES • RESTRICTING TYPE: Person not regularly engaged in binge- eating or purging behavior) • BINGE-EATING/ PURGING TYPE: Person has regularly engaged in binge eating or purging behavior.

  31. ** Individuals typically have a normal appetite until the illness progresses to dangerous level of emaciation. Food restriction represents a drug of choice. Self worth often become tied to the ability to achieve and maintain an emaciated state.

  32. Typical Anorexic Feast….

  33. Alternating b/w the restricting and binge eating type is possible.

  34. Physical and Lab findings • What do you expect, from head to toe and lab work up??

  35. PHYSICAL AND LAB FINDINGS • VITAL SIGNS: Bradycardia, hypotension, hypothermia. • CVS: QTc widening, CHF, Edema, Dehydration, Orthostasis, Impaired perephral circulation. • GI : Impaired motility, Elevated LFT’s, Elevated serum amylase, Erosion of tooth, Mallory Weiss Syndrome.

  36. Hematological : Pancytopenia, leukopenia, anemia) • Renal: Calculi, Elevated BUN • Endocrine: Decreased T 3 and T 4, Decreased Estrogen in females and Testosterone in males. • Musculoskeletal : Osteoporosis, wasting.

  37. Dermatological: Dry yellow skin, lanugo hair, hair loss, calluses on dorsum of hand ( Russell Sign). • Nutritional Changes: Electrolyte disturbances, parotid gland enlargement. ( Chickmuck face )

  38. WORKUP • Complete physical and psychiatric exam. • Lab studies • Psychological Testing ( MMPI, Eating Attitudes Test, Eating Disorder Inventory )

  39. Co morbidity • Which diagnostic spectrum do you think will be most common with AN??

  40. COMORBIDITY • BN ( variable ) • Substance Use ( 26%) • MDD ( 50- 75 %) • Anxiety ( 50- 75 %) • Personality D/O ( up to 50 % )

  41. TREATMENT • GOALS: Restore and maintain at least a minimal adequate body weight, reduce complicating factors, improve the willingness to correct the anorexia through therapy.

  42. Consider HOSPITALIZATION, if weight below 20 to 30 % normal, sever medical complications. • No medications are FDA approved. Prozac, Thorazine, Zyprexa, Periactin, ReVia, ECT may be helpful.

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