Psychiatry >
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

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