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