EATING DISORDERS

Anorexia nervosa
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Etiology/Pre-disposing factors

Biological
1. Genetics: esp female 1st degree relatives
Gender/ethnicity
Family history
Twin studies
2. Cerebral abnormalities: due to tumor involving the hypothalamus
3. Serotonin dysregulation: Serotonin (5HT) plays a role in appetite, mood,
anxiety, impulse control
4. Zn deficiency
Psychological
1. Personality traits: Obsessive-compulsive thoughts and behaviours, clinical
perfectionism, high levels of personal restraint
2. Influence of parental eating disorders: Anorexic mothers can extend their
abnormal concerns with weight and shape and food to their children
3. Previous adverse experience: loss of a parent, divorce, family illness,
difficulties at school; males w/ AN have sexual problems and they are relieved
by loss of libido occurring w/ weight loss
4. Childhood sexual abuse
Social
1. Childhood upbringing and environment: overprotective parents who are rigid
in thoughts and actions and who place high expectations on their children
(personal, sporting, musical, academic) strong risk factor
Tend to be close families with strong relationships between family members
2. Societal pressures & cult of thinness
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Precipitating factors (in a vulnerable individual)

These include: bereavement, parental divorce, change of school/move to uni,

academic stress with exams, serious physical illness to patient /family, bullying,
physical/sexual abuse.
In some cases no such trigger or obvious stress can be found.
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Maintaining factors

1. Starvation
2. Precipitating factors of illness may be ongoing e.g. sequelae of sexual abuse
3. Denial

4. Transdiagnostic model all eating disorders share the same psychopathology

5. AN becomes part of the patient and they cant envisage themselves without
it.

Poor prognostic factors

Long length of illness @ first presentation
BMI < 14 @ diagnosis
Older age of onset
Bulimic features e.g. binging & purging
P/o anxious/obsessive/dependent traits in childhood
Personality disorder
Rship difficulties w/ family
Anxiety when eating w/ others
Male sex

High risk groups

Adolescent females esp from higher SE classes
Ballet dancers
Gymnasts
Models
Type 1 DM patients
Medical students & doctors

PHYSICAL EXAMINATION
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Weigh patient in underclothes after having used the toilet they can hide
weights in clothes/water load before weighing
Calculate BMI
Look at the way patient walks, climbs stairs, rises from a chair
Squat & stand test Ask patient to squat on floor and then get up
patients w/ proximal myopathy wont be able to do so without using their
hands
Take pulse, BP, temperature
Full physical examination: look specifically for bradycardia, arrhythmias,
dehydration, peripheral edema, lanugo, anemia
Check for signs of regular vomiting: swollen parotid glands, poor
dentition, calluses on dorsal aspect of knuckles (Russels sign)

INVESTIGATIONS
Blood tests:
FBC
U&E

TFTs
LFTs
Lipids
Cortisol
Sex hormones
ABG
ECG
Urinalysis
Blood glucose
DEXA
MANAGEMENT
- Best if family is involved
- Psychoeducation of family and patient
- Agree on a clear treatment plan
- Dietary advice plan a target weight to be gradually achieved
- Psychological therapies: CBT
- Pharmacological therapies:
* Depression, OCD, anxiety disorders as with other patients
antidepressants starting w/ SSRI
* Binge-purge behaviors maybe reduced with high-dose SSRIs
* Prokinetics & laxatives may be useful in the early stages of re-feeding
* Daily multivitamin supplements
* Insomnia Mirtazapine (sedating anti-depressants)