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• 1 Eating Disorders

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• Biopsychosocial Model for Aetiology

  Genetics show 58%.
  
  Psychological show low self-esteem or wanting to be an independent sexual being. Also maintain dependency on family.
  
  Social is the pressures to be thin. Models, athletes and dancers are at a higher risk. Higher risk of BM if history of obesity. 50% have suffered AN. Child abuse can also play a factor. Enmeshment relationships in families can occur for AN.

• Four diagnostic points of Anorexia nervosa

  BMI < 17.5 (or weight less than 15% as expected)
  
  Deliberate weight loss with extreme methods.
  
  Distorted body image.
  
  Endocrine dysfunction. Amenorrhoea in women and impotence in men. Libido lost in both sexes. 

• Cardiovascular problems in Anorexia nervosa

  Bradycardia
  Postural hypotension
  Arrhythmias (secondary to hypokalaemia)
  Mitral valve dysfunciton

• GI Problems in Anorexia nervosa

  Constipation
  Ulcers
  Oesophageal tears
  Gastric rupture
  Delayed gastric emptying (feel bloadted after eating small amounts of food)
  Hepatitis in 1/3 (low serum protein; raised biliruben; lactate dehydrogenase; alkaline phosphate)

• Differential Diagnosis of Weight Loss

  Medical causes (cancer; Hyperthyroid; GI disease; Addison's; AIDs)
  Depression
  Bulimia (will occur but patient does not have a fear of normal weight)
  EDNOS
  BDD
  Psychosis

• Investigations in Eating disorders

  Height; weight so can get BMI
  Squat test (might have proximal myopathy)
  Blood tests (ESR; TFT to rule out organic causes; FBC; U&E to evaluate nutritional state)
  ECG (can have a long QT interval, arrhythmias and bradycardia)
  DEXA scans

• Metabolic problems in eating disorders

  Hypercholesterolaemia
  Hypercarotenaemia

• Blood problems in eating disorders

  Pancytopenia (bone marrow hypoplasia)
  Anaemia
  Leucopenia
  Thrombocytopenia (decrease in platelets)
  Infections from decreased immunity

• Management of Anorexia nervosa

  Engagement of initial interview. Will take a long time. Family present if possible.
  Psycho-education on nutrition and health
  Treat co-morbidities (depression, OCD and substance misuse)
  Nutritional management and weight restoration (0.5-1kg/week, have a target weight and eating plan)
  Psychotherapties (Motivational interviewing; family therapy; interpersonal therapy; CBT)
  Medical treatment (if physical complications or BMI < 13.5)
  Inpatient treatment if BMI < 13 or high suicide risk
  Can enable MHA for compulsory feeding.

• Clinical Presentation of Bulimia nervosa

  Binge eating - Irresistible cravings --> lose control --> eat a lot of 'forbidden food'. Can have thousands of calories. 
  
  Purging - Shame/guilt from binge. Can be vomiting; laxatives; fasting; excessive exercise
  
  Body image distortion - Preoccupied with shape and weight. Hate their body.
  
  BMI > 17.5 - Usually normal weight and have periods of slightly increased weight. Will also have periods