A Practical Review of Eating Disorders 9/19/2019

Eating disorders are among the most dangerous psychiatric conditions. It is important to recognize and treat them as early as possible to prevent medical sequelae. The good news is that there are effective interventions, and here in San Diego, we have some of the most cutting-edge eating disorder treatment programs in the country. Here is some basic information to help with understanding and recognition of these illnesses.

 Prevalence: Eating disorders are more common than previously thought, impacting up to 4% of the population. Approximately 10 % of people with Anorexia or Bulimia are male. Onset typically occurs during teen years through early twenties, but Avoidant Restrictive Food Intake Disorder (ARFID), often occurs in school-age youth.

 Biology: There is an emerging body of research showing a genetic component to eating disorders. Numerous studies show increased rates of eating disorders among first degree relatives. More recent FMRI (functional magnetic resonance imaging) data may show differences between healthy controls and individuals with anorexia in the insular cortex, possibly relating to a decreased response to hunger experienced by people with this eating disorder.

Criterion:   The following information is drawn from DSM 5 criteria. In each instance, the symptoms interfere with daily functioning.

ARFID: An eating or feeding disturbance manifested by persistent failure to meet appropriate nutritional and/or energy needs which is associated with either significant weight loss , failure to achieve expected weight gain, significant nutritional deficiency, or dependence on enteral feeding or oral nutritional supplements. Risk factors for ARFID include people with autism spectrum disorders, ADHD and intellectual disabilities and children who don’t outgrow “picky eating”. Individuals with ARFID often have a co-occurring anxiety disorder and are high risk for other psychiatric disorders.

 Anorexia: Relative restriction of energy intake relative to requirements leading to a markedly low body weight in the context of age, sex, developmental trajectory, and physical health. Markedly low is defined as less than minimally normal, or, for children and adolescents, less than that minimally expected for age and height. Includes Intense fear of gaining weight or becoming fat, even though underweight OR persistent behaviors that prevent weight gain, even though at a significantly low weight. There is also disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

 Bulimia: Includes Recurrent episodes of binge eating including both eating an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, with a sense of lack of control over eating during the episode. Also, recurrent inappropriate compensatory behavior, which could be Self-induced vomiting Misuse of laxatives etc., fasting or excessive exercise

 Warning Signs That a Patient Might Have Anorexia: Rigid/restricted eating patterns, presence of food rituals, avoidance of social situations involving food; avoidance of eating in public, excessive, compulsive exercise, compulsive working or studying, water loading, checking weight frequently, comments about weight and body shape, wearing oversized clothing.

Warning Signs That a Patient Might Have Bulimia: Secretive eating, refusal to eat with friends, disappearance to the bathroom after meals, ability to eat large amount of food without weight gain, compulsive exercise.

Medical Consequences: Eating disorders can impact multiple systems. There is up to a 10% mortality risk.

Cardiovascular: Responsible for 1/3 deaths, often from arrhythmias. Severe bradycardia can and hypotension can occur.

Endocrine/Metabolic: Fatigue, cold intolerance

Electrolyte abnormalities: Often due to purging

Reproductive: Arrested development or regression in normal maturation, Infertility issues. Estrogen/Testosterone can be similar to a child or person in menopause, and Loss of menses leading to bone loss can occur.

Treatment: There are several treatment modalities that have been shown to be effective. Family Based Treatment, Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are all supported in the literature. When possible, the Family Based approach appears to have the strongest evidence. Effective therapists will have experience in working with eating disorders. A team approach to treatment is always preferred. A typical team should include the patient and his or her family, primary care, therapist, nutritionist and possibly a psychiatrist. The role of psychopharmacologic medication is primarily to treat co-morbid psychiatric illness, though there is be a role for SSRIs in the treatment of bulimia (fluoxetine is FDA approved for adults for this indication) and may be a role for other medications in severe cases of anorexia.

Seek Emergency Evaluation If there is concern for or evidence of food restriction, purging, laxative abuse, over-exercising with a recent history of falls, altered mental status, significant weight loss in a short amount of time, chest pain or shortness of breath

Call SmartCare for eating disorder resources.

858-880-6405   Provider Line   858-956- 5900 Parent Line




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