13.05.10 Eating disorders
Over-activity fast becoming the dominant pattern, especially in men
Laxative abuse (only lose 3% of calories, but lots of water => rapid temporary loss)
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
Irrational fear of normal body weight
With pursuit of thinness
Must achieve and maintain normal BMI (>20) for a year to fix
Weak leg muscles
Normal but fluctuating weight
No anorectic psychopathology
Late onset (mean 18)
Movement away from normal foods (skip meals)
Compensation (fasting, vomiting)
Lack of control
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
Shop lifting (other than food)
Must address all three in therapy
Life at the bottom (hardest to address)
Anger, anxiety, sadness
Behaviours at the top
Binge eating, vomiting
Only mammal with differential fat distribution
=> Judged using vision
Growing "biological vacuum" between puberty and later childbirth
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"