Overview Eating disorders have traditionally been classified into two well-established categories. They are anorexia nervosa and bulimia nervosa. Eating disorders are rare in the general population, they are relatively common in teenagers and young women. The disorder is associated with substantial physiological disruption and symptom overlap with other psychiatric illnesses, especially mood and anxiety disorders. Although 90% of patients with an eating disorder are female, the incidence of diagnosed eating disorders in males appears to be increasing
Definition Eating Disorder Anorexia Nervosa Anorexia Nervosa - Restrictive Type: During the current episode of anorexia nervosa, the person has not regularly engaged in binge eating or purging behaviour (self induced vomiting, misuse of laxatives, diuretics, or enemas) Anorexia Nervosa Binge eating/purging type: during the current episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behaviour (ie. self induced vomiting or the misuse of laxatives, diuretics, or enemas) Bulimia Nervosa |
Mnemonic SCOFF to assess risk of eating disorder
Comorbidity is common. Mood, anxiety (especially social phobia) and substance use disorders occur most frequently
Clinical Presentation Anorexia Nervosa generally presents during adolescence or young adulthood and is characterized by a relentless and often intensifying pursuit of thinness, leading to behaviour that contributes to the maintenance of a low body weight.
Side note Most patients present late in the course of illness. Up to 50% of adults with anorexia nervosa may never seek treatment and people with bulimia nervosa present on average a decade or more after onset. |
Clinical Examination
Course of Anorexia Nervosa
In most cases, patients with an eating disorder will have normal laboratory results. However, it is important to assess electrolyte, hormonal imbalance as these change in eating disorders:
Anorexia Nervosa Diagnosis
The management of anorexia nervosa remains a major challenge for two reasons:
Multidisciplinary team
Management
Acute treatment Hospital treatment should be considered if there is immediate danger to life secondary to physical deterioration; suicide risk; no adequate outpatient treatment available or the patient has failed to progress despite appropriate outpatient treatment.
Admission criteria for eating disorders |
Bradycardia (resting heart rate <50 bpm) |
Orthostatic hypotention (>10 mmHg systolic) |
Hypothermia (temp. <35.5oC) |
Arrhythmia |
Severe electrolyte disturbances, eg. hypokalaemia (K <3.0 mmol/L) |
Acute dehydration from refusal of all food and fluids |
Remember Involving families in the treatment process is essential for better outcomes; family based therapy has the strongest evidence base for treatment in this age group. |
Complications due to Re-feeding
Complications of anorexia
Prognosis
Overview Bulimia nervosa involves the uncontrolled eating of an abnormally large amount of food in a short period, followed by compensatory behaviors, such as self-induced vomiting, laxative abuse, or excessive exercise
Side note Patients with eating disorders often engage in excessive physical activity despite bad weather, illness, or injury. |
Signs of Bulimia Nervosa
Management
Prognosis In 2-10 years:
Consent - VICKS
Consent and the Adolescent
There are some treatments or procedures (e.g., sterilization) for which parents cannot give consent, irrespective of the child’s age.
Confidentiality and the Adolescent
Adolescents have the legal right to confidentiality unless:
Prescribing to a minor The following must be met:
Overview Suicide is widespread across many age groups, and is associated with mental illness such as depression and other factors. Suicide is likely to be under-reported as deaths from suicide may be difficult to distinguish from accidental or intentional injury. It is important to note that suicide attempts are up to 20 times more frequent than completed suicide.
Side note Suicide among medical practitioners is higher than other professional groups in many industrialised countries, especially among female doctors. Risk factors for suicide are the same as the general population, however there is greater knowledge about how succeed and the availability of methods which may contribute to relatively high suicide rates. |
Definition Mental illness: A term referring to a group of conditions that significant affect how a person feels, thinks, behaves, and interacts. Mentally disordered person: A person (whether or not suffering from mental illness) whose behavior for the time being is so irrational as to justify a conclusion on reasonable grounds that temporary care, treatment, or control of the person is necessary |
Suicide risk assessment – Important to complete when dealing with all patients who have mental health problems. The aim is to evaluate the likelihood of suicide attempt in the period of assessment.
Self-harm assessment (brief)
RISK FACTORS AND PROTECTIVE FACTORS OF SUICIDE | ||
Groups at Risk of suicide | Risk Factors | Protective Factors |
History of attempt or self-harm | Male | Strong perceived social supports |
History of mental illness | Between 25-44yo | Family cohesion |
History of sexual or physical abuse/neglect | Older people | Peer group affiliation |
Domestic violence | Living in rural areas | Good coping and problem solving skills |
Substance abuse | Recent break-up | Positive values and beliefs |
Physical illness | Sexual identity conflicts | Ability to seek and access help |
Refugees, immigrants | Financial difficulties | |
Homeless | Impending legal prosecutions | |
Lack of support |
Involuntary treatment
Discharge following admission
“To lose confidence in one’s body is to lose confidence in oneself.”
― Simone de Beauvoir
"Every woman knows that, regardless of all her other achievements, she is a failure if she is not beautiful."
- Germaine Greer