Eating Disorders

 

Anorexia Nervosa and Bulimia Nervosa are two distinct yet related eating disorders characterized by abnormal eating behaviours, distorted body image, and an intense fear of gaining weight. Both conditions can have serious physical and psychological consequences.

Anorexia Nervosa
Anorexia Nervosa is marked by significant weight loss due to self-imposed restrictions on food intake, excessive exercise, or the use of methods like self-induced vomiting, laxatives, or diuretics. It is associated with an intense drive for thinness and an irrational fear of gaining weight, even when underweight.

Key Features
i. Behavioural: Severe restriction of food, intense fear of gaining weight, excessive exercise, and possible purging through vomiting or laxative/diuretic misuse.
ii. Physical signs: Thickened calluses on the back of hands from self-induced vomiting (known as Russell’s sign), low body weight with BMI <17.5 kg/m².

Bulimia Nervosa
Bulimia Nervosa is characterized by repeated episodes of uncontrolled binge eating, followed by feelings of guilt and subsequent compensatory behaviours such as fasting, excessive exercise, self-induced vomiting, or the misuse of laxatives and diuretics.

Key Features
i. Behavioural: Binge eating episodes followed by compensatory weight loss mechanisms due to guilt.
ii. Physical signs: Parotid gland swelling, calluses on the back of the hands (from inducing vomiting), and typically maintaining a BMI >17.5 kg/m².

Treatment for Anorexia Nervosa

Psychosocial Interventions
i. Family-Based Treatment (FBT): This is the first-line treatment, particularly for children and adolescents, and involves family members in helping the patient eat healthily and restore their weight.
ii. Cognitive Behavioural Therapy (CBT-E): Particularly used for adults, CBT-E focuses on addressing distorted beliefs around weight, shape, and eating. It also helps with developing healthier eating habits.

Nutritional Rehabilitation
i. Structured meal plans are used to support weight restoration and nutritional health.
ii. A multidisciplinary team approach includes input from dietitians to ensure a balanced diet.

Medical Monitoring
i. Regular monitoring of weight, physical health, and potential complications like electrolyte imbalance.
ii. Hospitalization may be needed for severe cases, especially when there are significant medical complications or extremely low BMI.

Pharmacological Treatment
i. There is limited evidence for pharmacological treatment in Anorexia Nervosa. Medications may be used to treat co-existing conditions such as anxiety, depression, or obsessive-compulsive disorder (OCD).

Treatment for Bulimia Nervosa

Psychosocial Interventions
i. Cognitive Behavioural Therapy (CBT-E): This is the first-line treatment for Bulimia Nervosa and focuses on reducing binge-purge cycles, improving body image, and developing healthier eating patterns.
ii. Interpersonal Psychotherapy (IPT): This may also be used if CBT-E is not available or not preferred, targeting interpersonal issues that contribute to disordered eating.

Nutritional Counselling
i. Education on healthy eating patterns and reducing binge-purge behaviours is crucial.

Medical Monitoring
ii. Regular monitoring of electrolytes, physical health, and other complications due to purging behaviours is essential.

Pharmacological Treatment
i. Fluoxetine  is the medication most commonly prescribed, with evidence supporting its effectiveness in reducing binge-purge episodes.

Admission Criteria for Eating disorder patients

Medical Admissions
Medical admission is indicated for patients with eating disorders who are at a significant risk of physical harm or death due to starvation or severe malnutrition. The criteria include:

i. Severe anorexia nervosa with very low weight or high risk of refeeding syndrome.
ii. Medically unstable bulimia nervosa.
iii. Comorbid physical disorders (e.g., diabetes) that require medical management.
iv. Acute malnutrition needing nasogastric refeeding or urgent refeeding under medical observation​.

Psychiatric Ward Admission Criteria
Psychiatric admission is considered for:

. Patients with severe weight loss (e.g., <75% BMI) who do not require immediate medical admission but need structured psychiatric care.
. Those who need inpatient psychiatric treatment due to psychiatric comorbidity.
. Patients requiring a 24-hour structured refeeding and stabilization program.
. Those who failed to respond adequately to outpatient and day-patient​.

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