Eating Disorders
Anorexia Nervosa
BMI < 17.5. They tend to carry out behaviours that leads to weight loss, including:
Dietary restriction
Over-activity
Self-induced Vomiting
Laxative misuse
Diuretic misuse
A key characteristic that these patients have is Psychopathology; an irrational fear (phobia) of a normal body weight.
Clinical Features
Endocrine dysfunction – Low Sex hormone levels (FSH/LH/Oestrogen/Testosterone), Secondary Amenorrhoea, Menstrual irregularity, Loss of libido
Hypotension
Bradycardia
Hypokalaemia
Cardiac complications – Arrhythmia, Cardiac atrophy
In anorexic patients, their body begins to take muscle from many organs for energy e.g. heart, gut (Constipation), muscle
Osteoporosis
Lanugo hair (fine hair covering skin)
Mood changes, anxiety, depression
Severe and Enduring Anorexia (SE-AN):
After 7 years, the anorexia becomes:
Persistent – If starvation is less marked, the psychopathology remains, w/o any periods of remission of psychopathology
Resistant to change
Severe – Mixed feelings about change, Ego-synchronically attached to low weight, and Behaviour/beliefs/emotions are in harmony with the illness and not reality
Management:
Aim is to get back to a normal weight. However, the intake shouldn’t be resumed too quickly as it can lead to Refeeding syndrome – Rapidly increasing insulin leads to shifts of potassium, magnesium and phosphate into cells.
Bulimia Nervosa
Differs from Anorexia Nervosa as patients:
Often have a normal BMI – body weight tends to fluctuate
Lack of Psychopathology i.e. no irrational fear of normal body weight
Has a later onset
It's highly associated with PCOS.
Clinical Features:
Binge-eating - Eating binge foods very quickly whether hungry or not and person eats in a “dazed state” – They eat to a point of being uncomfortably full
Purging – Patient wants to undo all the “damage” from their binge via vomiting, laxatives, diuretics, fasting• Normal weight but major fluctuations
Low self-esteem
Self-evaluation unduly influenced by body-shape & weight (BUT no phobia)
Lack of control
Anger, anxiety & depression
Physical features:
Teeth erosion, Alkalosis, Mouth ulcers, Swollen salivary glands – Due to recurrent vomiting
Russell’s sign – Calluses of knuckles where they’ve been scraped across teeth to induce vomiting
Gastro-oesophageal reflux and irritation
