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13.05.10 Eating disorders

Anorexia
  • Behaviours
    • Over-activity fast becoming the dominant pattern, especially in men
    • Laxative abuse (only lose 3% of calories, but lots of water => rapid temporary loss)
    • Diet restriction
  • Endocrine changes
    • Progressive decrease in FSH, LH, E2, down to zero at 41 kg
  • The 41 kg cutoff
    • Don't respond to GnRH at all below this level
    • Below this, girls are "unaware of their body"
      • Don't blush, sit like men
      • Completely unsexualised, but also "un-adulted"
      • Don't understand jazz!
    • End up trapped by the 41 kg ceiling, above which they start to have "adult" feelings again
  • Pathognomonic psychopathology
    • Irrational fear of normal body weight
    • With pursuit of thinness
  • Must achieve and maintain normal BMI (>20) for a year to fix
  • Physical features
    • Emaciated
    • Dry skin
    • Lanugo hair
    • Dependent oedema
    • Bloatedness
    • Weak leg muscles


Bulimia

  • Features
    • Normal but fluctuating weight
    • No anorectic psychopathology
    • Late onset (mean 18)
    • Movement away from normal foods (skip meals)
    • Russel's sign
    • Compensation (fasting, vomiting)
  • Effects
    • ANGER
    • Low self-esteem
    • Lack of control
    • Depression
    • Anxiety
  • Physical
    • Parotid/submandibular swelling
    • Eroded teeth
    • Polycystic ovaries
      • Found in 75% cf 21% normal population
      • Caused by insulin resistance?
      • Or maybe PCOS => Weight gain, hirsutism, acne => Bulimia
      • Adaptive, to stop conceiving??
  • Multi-impulsive bulimia - Extra behaviours, all associated with the same sense of lack of control
    • Suicidal attempts
    • Severe autoaggression
    • Shop lifting (other than food)
    • Alcohol abuse
    • Drug abuse
    • Sexual promiscuity


Three-layer model
  • Must address all three in therapy
    • Life at the bottom (hardest to address)
    • Emotions above
      • Anger, anxiety, sadness
    • Behaviours at the top
      • Binge eating, vomiting


Triggers
  • Women
    • Only mammal with differential fat distribution
    • => Judged using vision
  • Adolescence
    • Growing "biological vacuum" between puberty and later childbirth
  • Western/modernising cultures

Notes
  • Recovery
    • 25% bulimia
    • 16% anorexia
  • NHS says BMI of 19 is normal ??
  • Neurosis = Class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms
  • Parotid + submandibular swelling is because the acid gets into the ducts
  • No requirement for amenorrhoea for anorexia diagnosis in DSM V
  • "Sexually disinhibited" rather than "promiscuous"
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