Eating Disorder

“Abnormal eating habits that affect a person’s physical and/or mental health”

Classifications

• Anorexia Nervosa (AN)
• Bulimia nervosa (BN)
• Muscle dysmorphia
• Binge Eating Disorder (BED)
• Other Specified Feeding or Eating Disorder
• Orthorexia Nervosa

Risk Factors

• Biological:
  • Genetic component!
• Psychological:
  • Perfectionism
  • Body dysmorphic
  • OCD tendencies
• Social:
  • Weight stigma
  • Teasing/bullying
  • Appearance ideal internalisation
  • Trauma

Aetiology

Causes not clear, genetics seem to be an important contributing factor

Pathophysiology

• BN/BED:
  • The pursuit of Thinness/Fitness, Attempt to solve underlying issues through control over eating → Under Nutrition → Episode of overeating → Guilt and fear of weight gain, low self-esteem, social isolation
• AN:
  • Genetic theory: a period of famine (e.g. a diet) as a trigger: “Adaption to Flee Famine theory” + Attempt to solve underlying issues through control over eating → Starvation (+/- weight loss) → short term reward and increased self-esteem →  Starvation (+/- weight loss) become even more important, fear of weight gain increases, body dysmorphia increases

Clinical Presentation

• BN – Eating a large amount of food followed by vomiting/laxative abuse/excessive exercise:
  • Often normal weight
  • Symptoms associated with vomiting – teeth erosion, gastric reflux, electrolyte imbalance, Mallory-Weiss tears/Boerhaave syndrome, Russell´s sign
  • Psychological symptoms – a fixation on calories, weight, low self-esteem, self-harming/suicidal tendencies
• BED – similar to BN without purging:
  • Binge eating is the core symptom
  • Obesity is common → obesity-related health issues
• AN:
  • Food restriction leads to the patient being underweight (this can also be a weight under a person’s own set point weight and not underweight in line with the BMI chart)
• Malnutrition:
  • Hypokalaemia
  • Amenorrhea
  • Brittle hair
  • Jaundice
  • Chronic fatigue and irritability
• Psychological:
  • Obsession with calories
  • Food
  • Recipes
  • Personal weight → fear of weight gain
  • Depressive mood change

Investigations

• Psychological assessment
• Investigations dealing with the physical health aspects 

Management

• BE/BED:
  • CBT or FBT
• Medication:
  • Antidepressants, in BE: SSRI
• AN:
  • Weight restoration
  • Treatment of psychological disorders related to the illness
  • Reducing the behaviours/thoughts that originally to the disordered eating (CBT)
  • Sometimes antidepressants might help

Complications

• AN:
  • Osteoporosis
  • Serious implications on growth and pubertal maturation
  • Hepatic steatosis
  • Cardiac complications (!sudden cardiac death)
  • Relapse
  • Refeeding syndrome