Feeding and eating disorders

Anorexia Nervosa

Deliberate ↓ BMI from fear of weight gain (despite low body weight)
Body image disturbance and lack of awareness of seriousness
Disorder within reward system
Genetic component
Associated with trauma hx, OCD, anxiety, mood/personality disorders
Restricting type
- Excessive dieting, exercise, or fasting (no binging/purging over 3mo)
Binge-eating/purging type
- Vomiting, diuretic or laxative abuse, or enemas

Severity

>20yo
- Mild: BMI 17-18
- Mod: BMI 16-17
- Severe: BMI 15-16
- Extreme: BMI < 15

Weight gain via psychotherapy (CBT) and nutritional rehabilitation
- Olanzapine if acutely ill and not gaining weight despite psycho/nutritional therapy
- ± antidepressants to help with anxiety or comorbid conditions
- Avoid bupropion and tricyclics (↑ risk of seizures)
Admit if:
- Brady <40 or prolonged QTc
- Hypotensive/orthostatic/markedly dehydrated
- BMI <14 or <70% ideal body weight
BOLO refeeding syndrome
- Restoring weight too rapidly and/or aggressively is potentially fatal
- Insulin dump in malnourished pt ➔ hypophosphatemia and hypokalemia
  - Edema, tachy, seizures
  - TX by repleting K and Mg

Both are present at least 1/wk for 3mo:
- Binge eating
  - More than normal amount AND sense of loss of control
- Compulsive behavior to counteract weight gain from binging
  - Vomiting, laxatives, starvation, exercise
Self-worth influenced by physical appearance

Severity

BMI usually normal or elevated
Teeth and salivary gland issues from vomiting
- Russel sign (calluses on knuckles)

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