Eating disorders

Dr Vishal DhimanAssoc. Professor

Department of PsychiatryAIIMS Rishikesh

Eating disorders

• Marked disturbance in eating behavior• Bulimia nervosa• Anorexia nervosa• Term ‘anorexia’ – misnomer

Classification

Feeding and eating disorders• Pica• Rumination disorder• Avoidant/Restrictive food intake disorder• Anorexia nervosa• Bulimia nervosa• Binge-eating disorder• Other specified feeding or eating disorder• Unspecified feeding or eating disorder

Ref: ICD-10 and DSM of mental disorders

Anorexia nervosa

• Disturbed body image• Intense fear of gaining weight or becoming fat• Refusal to maintain adequate body weight• Dieting• Malnutrition• Amenorrhea

Anorexia nervosa (ctd.)

Types:

1. Restricting type (no binge eating)2. Binge eating or purging type

Epidemiology

• 0.5-3%• Onset: 10-30 years• M:F – 1:10 to 1:20• More in professionals like media, etc.

Etiology

1. Genetic2. Biological3. Psychological4. Socio-cultural

Management

Physical examination

• Hypotension• Bradycardia• Dry skin• Lanugo hair• Peripheral edema (ankles)• Hypertrophy of salivary glands

(parotid)• Erosion of dental enamel

Management (ctd.)

Laboratory investigations:• Anemia• Leukopenia

• Elvated BUN• Elevated LFTs• Elevated s. bicarbonate• Hypercarotenemia• Hyperaldosteronism

• Hypercholesterolemia• Hypokalemia• Hypochloremic alkalosis• Occult blood in stool

• ECG: Sinus bradycardia, ventricular dysrhythmia, prolonged QT)• Low basal metabolic rate

Management (ctd.)

• Admission• Goal - Wt. gain, monitoring and treatment of potentially life-

threatening effects of starvation• Supervised meals• Food supplementation

Management (ctd.)

A. PharmacologicalB. Non-pharmacological• Psychoeducation• Supportive psychotherapy• Family therapy• Individual psychodynamic psychotherapy• CBT

Bulimia nervosa

• Episodic• Uncontrolled• Compulsive• Binge eating • Binging followed by self-induced vomiting,

purging, etc.• Usually of normal weight• Considerable overlap with anorexia, in up

to 50%

Bulimia nervosa: types

1. Purging type 2. Non-purging type

Epidemiology

• (F) 1-4%• Onset 16-18 years• Uncommon among men

Etiology

1. Genetic2. Biological3. Psychological4. Socio-cultural

Differential diagnosis

• Epilepsy• CNS tumors• Kluver-Bucy syndrome• Kleine-Levin syndrome• Borderline personality disorder• May present in other PDs• Major depressive disorder

Management

A. HospitalizationB. Pharmacological

oAntidepressants C. Non-pharmacological

o Individual psychotherapyoCBToGroup psychotherapy

Thanks!

vishal.psyc@aiimsrishikesh.edu.in