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"