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"