Eating Disorders

Eating Disorders Indian Medical PG Question 1: Body dysmorphic disorder can be associated with all except

• A. Bulimia nervosa
• B. OCD
• C. Anxiety
• D. Mania (Correct Answer)

Eating Disorders Explanation: ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.

Eating Disorders Indian Medical PG Question 2: A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

• A. Increase the caloric intake from 1500 kcal to 2000 kcal per day
• B. Increase fluid intake
• C. Increase the dose of anxiolytics
• D. Observe patient for 2 hours after meal (Correct Answer)

Eating Disorders Explanation: ***Observe patient for 2 hours after meal*** - Patients with **anorexia nervosa** often engage in compensatory behaviors like **purging** or extensive exercise, which would counteract the effects of increased caloric intake and lead to a lack of weight gain despite consuming an "adequate" diet. - Observing the patient post-meal helps identify these behaviors and ensures that the ingested calories are actually being retained and utilized for weight restoration. *Increase the caloric intake from 1500 kcal to 2000 kcal per day* - Increasing caloric intake is a valid long-term strategy but is not the immediate next step when there's **no weight gain despite adequate intake**; the primary concern is identifying *why* the initial intake isn't leading to weight gain. - Doing so without addressing potential compensatory behaviors might only increase patient distress or lead to more intense purging/exercise. *Increase fluid intake* - While adequate **hydration** is important, it does not directly address the issue of **lack of weight gain** in anorexia nervosa, which is fundamentally a caloric deficit problem. - Increased fluid intake would not provide the necessary calories for weight restoration. *Increase the dose of anxiolytics* - Anxiolytics may help manage **anxiety** related to eating, but they do not directly promote **weight gain** or prevent compensatory behaviors. - This step does not address the core issue of why the recommended diet is not leading to weight gain.

Eating Disorders Indian Medical PG Question 3: Which eating disorder is characterized by episodes of binge eating while maintaining a normal weight?

• A. Anorexia nervosa
• B. Bulimia nervosa (Correct Answer)
• C. Binge eating disorder
• D. Night eating syndrome

Eating Disorders Explanation: ***Bulimia nervosa*** - This disorder is characterized by recurrent episodes of **binge eating** followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, or excessive exercise, while the individual generally maintains a **normal body weight**. - The key differentiator from anorexia nervosa is the **normal weight** and the cyclical pattern of binging and compensatory behaviors. - According to **DSM-5 criteria**, bulimia nervosa requires both binge eating episodes and inappropriate compensatory behaviors occurring at least once weekly for 3 months. *Anorexia nervosa* - This eating disorder is primarily characterized by an intense fear of gaining weight, leading to **severe restriction of food intake** and significantly **low body weight**. - Individuals with anorexia nervosa do not maintain a normal weight; rather, their weight is often **below minimally normal** (BMI < 18.5 kg/m² in adults). *Binge eating disorder* - This disorder involves recurrent episodes of **binge eating**, defined as consuming an unusually large amount of food in a short period with a sense of loss of control, but it does **not involve recurrent compensatory behaviors** like purging. - Individuals with binge eating disorder are often **overweight or obese**, contrasting with the normal weight seen in bulimia nervosa. *Night eating syndrome* - This disorder is characterized by recurrent episodes of **nighttime eating** (consuming food after evening meal or upon awakening from sleep) with full awareness. - Unlike bulimia nervosa, it does **not involve binge eating** in the classic sense, and there are **no compensatory behaviors** like purging or excessive exercise. - Individuals may maintain normal weight but the eating pattern is distinctly different from the binge-purge cycle.

Eating Disorders Indian Medical PG Question 4: Which of the following is the most likely explanation for the dental abnormalities in bulimia nervosa (BN)?

• A. self-induced vomiting (Correct Answer)
• B. excess cortisol levels
• C. osteoporotic changes
• D. self-induced physical trauma

Eating Disorders Explanation: ***self-induced vomiting*** - **Self-induced vomiting** leads to frequent exposure of teeth to highly acidic gastric contents, causing **dental erosion** (perimylolysis). - This erosion typically affects the **lingual surfaces** of the maxillary anterior teeth and can lead to tooth sensitivity, discoloration, and loss of tooth structure. *excess cortisol levels* - While patients with BN can have elevated cortisol due to stress, this is not directly linked to **dental erosion** or other dental abnormalities. - High cortisol primarily affects bone density, metabolism, and immune function, rather than directly damaging tooth enamel. *osteoporotic changes* - **Osteoporotic changes** can occur in BN due to nutritional deficiencies and hormonal imbalances, affecting bone density. - However, osteoporosis primarily affects bone tissue throughout the body, not directly causing the characteristic **dental erosion** seen in BN. *self-induced physical trauma* - **Self-induced physical trauma** in BN refers to injuries from non-vomiting behaviors and would not explain the widespread **dental erosion** patterns. - While some individuals might experience trauma from purging (e.g., calluses on knuckles), it does not account for the chemical damage to tooth enamel.

Eating Disorders Indian Medical PG Question 5: What is considered the most effective treatment for Borderline Personality Disorder?

• A. Combination of DBT and pharmacotherapy
• B. Cognitive Behavioural Therapy (CBT)
• C. Pharmacotherapy alone
• D. Dialectical Behaviour Therapy (DBT) (Correct Answer)

Eating Disorders Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy

Eating Disorders Indian Medical PG Question 6: Which of the following criteria are used for detecting a child with severe acute malnutrition according to WHO guidelines? 1. Bilateral pitting oedema 2. Weight for height Z-score less than minus three SD 3. Mid upper arm circumference of less than 11.5 cm (115 mm) Select the correct answer using the code given below:

• A. 1 and 2 only
• B. 1 and 3 only
• C. 1, 2 and 3 (Correct Answer)
• D. 2 and 3 only

Eating Disorders Explanation: ***1, 2 and 3*** - According to **WHO guidelines**, Severe Acute Malnutrition (SAM) in children aged 6-59 months is diagnosed by the presence of **ANY ONE** of these three criteria: - **Bilateral pitting oedema** (nutritional edema) - indicates kwashiorkor - **Weight-for-height Z-score (WHZ) < -3 SD** - indicates severe wasting - **Mid-Upper Arm Circumference (MUAC) < 11.5 cm (115 mm)** - indicates severe wasting - All three are **independent diagnostic criteria** for SAM, meaning any single criterion is sufficient for diagnosis - These criteria are used in **community screening**, **facility-based assessment**, and **nutritional rehabilitation programs** *1 and 2 only* - This incorrectly excludes **MUAC < 11.5 cm**, which is a valid and widely used WHO criterion for SAM diagnosis - MUAC is particularly useful for **community-based screening** as it's simple and doesn't require complex equipment *2 and 3 only* - This incorrectly excludes **bilateral pitting oedema**, which is a critical criterion for diagnosing **kwashiorkor** (edematous malnutrition) - Oedema can occur even when weight-for-height appears normal due to fluid retention masking tissue wasting *1 and 3 only* - This incorrectly excludes **weight-for-height Z-score < -3 SD**, which is the **gold standard anthropometric measure** for severe wasting - WHZ is essential for facility-based diagnosis and monitoring treatment response

Eating Disorders Indian Medical PG Question 7: What is the diagnosis in a young lady who presents with repeated episodes of excessive eating followed by purging behaviors, specifically using laxatives?

• A. Bulimia nervosa (Correct Answer)
• B. Binge eating disorder
• C. Schizophrenia
• D. Anorexia nervosa

Eating Disorders Explanation: ***Bulimia nervosa*** - This condition is characterized by recurrent episodes of **binge eating**, which is consuming an abnormally large quantity of food in a short period, followed by inappropriate **compensatory behaviors** to prevent weight gain. - The use of **laxatives for purging** is a classic compensatory behavior seen in bulimia nervosa. *Binge eating* - While binge eating is a component, **binge eating disorder** specifically lacks the recurrent compensatory behaviors (like purging) that are present in bulimia nervosa. - Individuals with binge eating disorder do not regularly engage in **purging behaviors** or excessive exercise to counteract their binges. *Schizophrenia* - This is a severe mental disorder characterized by **distortions in thought, perception, emotions, language, sense of self, and behavior**. - Its core symptoms, such as **hallucinations, delusions, and disorganized speech**, are entirely unrelated to eating patterns and purging behaviors. *Anorexia nervosa* - Anorexia nervosa is primarily defined by a **restriction of energy intake** leading to significantly low body weight, accompanied by an intense fear of gaining weight and a distorted body image. - While some individuals with anorexia nervosa may engage in binge-purging subtype behaviors, the defining characteristic is **significantly low body weight**, which is not mentioned as a primary feature in the given scenario.

Eating Disorders Indian Medical PG Question 8: Which of the following is not seen in anorexia nervosa?

• A. Avoidance of food
• B. Decreased appetite (Correct Answer)
• C. Purging episodes
• D. Significantly reduced weight

Eating Disorders Explanation: ***Decreased appetite*** - Patients with **anorexia nervosa** often experience a **normal or even increased appetite** but intentionally restrict food intake due to an intense fear of gaining weight. - The hallmark of the disorder is self-imposed starvation, not a physiological lack of hunger. *Avoidance of food* - **Avoidance of food** is a central feature of anorexia nervosa, driven by a pervasive **fear of weight gain** and a distorted body image. - Patients actively employ various strategies to **restrict their caloric intake**, including rigid dieting, skipping meals, and meticulously counting calories. *Purging episodes* - **Purging behaviors**, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas, can be observed in the **binge-eating/purging type** of anorexia nervosa. - These behaviors are compensatory actions aimed at preventing weight gain after perceived overeating or even after consuming small amounts of food. *Significantly reduced weight* - A core diagnostic criterion for anorexia nervosa is a significantly **low body weight** for age, sex, developmental trajectory, and physical health, often defined as a body mass index (BMI) below 17.5 kg/m². - This weight loss is a direct consequence of the severe **food restriction** and compensatory behaviors.

Eating Disorders Indian Medical PG Question 9: Which of the following is FALSE regarding Anorexia Nervosa:

• A. Decreased appetite (Correct Answer)
• B. Body image distortion
• C. Vigor exceeding physical ill being
• D. Weight loss

Eating Disorders Explanation: ***Decreased appetite*** - Patients with anorexia nervosa typically experience **increased hunger** and **preoccupation with food**, despite efforts to restrict intake, rather than a decreased appetite. - The sensation of hunger often intensifies due to severe caloric restriction, making the statement "decreased appetite" false. *Body image distortion* - This is a core diagnostic criterion of anorexia nervosa, where individuals perceive themselves as **overweight** even when they are severely underweight. - The distorted body image drives their relentless pursuit of thinness and fear of weight gain. *Vigor exceeding physical ill being* - Patients with anorexia nervosa often display surprising **energy and hyperactivity** despite severe physical debilitation and malnutrition. - This "vigor" can be a mechanism to burn calories, suppress hunger, or avoid rest, exceeding what would be expected given their poor health status. *Weight loss* - **Significant weight loss** or failure to gain weight during growth is a defining characteristic of anorexia nervosa. - This weight loss is intentionally achieved through severe dietary restriction, excessive exercise, or purging behaviors.

Eating Disorders Indian Medical PG Question 10: Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

• A. History of post-partum psychosis (Correct Answer)
• B. Primiparity
• C. Undesired pregnancy
• D. Unmarried status

Eating Disorders Explanation: ***History of post-partum psychosis*** - A **prior episode of postpartum psychosis** is the strongest risk factor for recurrence, with recurrence rates estimated to be as high as 50-70%. - This indicates a heightened **biological vulnerability** to the hormonal and psychosocial stresses of the postpartum period. *Primiparity* - While primiparity can be associated with increased stress, it is a **less significant risk factor** for postpartum psychosis compared to a history of the condition. - The stress of a first pregnancy and childbirth can contribute to other perinatal mood disorders, but does not carry the same high recurrence risk as previous psychosis. *Undesired pregnancy* - An undesired pregnancy is often associated with **increased maternal stress, anxiety, and depression**, but it is generally a **weaker predictor** of postpartum psychosis than a personal history of the disorder. - While it can complicate the perinatal period, it doesn't confer the same high risk for a severe psychotic episode. *Unmarried status* - Unmarried status may increase the risk of **postpartum depression** due to lack of social support or increased stress, but it is **not a primary risk factor** for postpartum psychosis itself. - The familial and social support systems are important for overall well-being, but a previous psychotic episode is a much stronger predictor.

Eating Disorders Flashcard 1 of 7

Question: Bulimia nervosa is associated with _____ and enamel erosion due to excessive vomiting

Answer: parotitis

Eating Disorders Flashcard 2 of 7

Question: For diagnosing bulimia nervosa, binge eating and inappropriate compensatory behaviors both should occur, at least _____ a week for 3 months.

Answer: once

Eating Disorders Flashcard 3 of 7

Question: _____ is defined as excessive dieting, exercise, or binge eating/purging with BMI < 18.5 kg/m2

Answer: Anorexia nervosa

Eating Disorders Flashcard 4 of 7

Question: Which eating disorder is characterised by excessive exercise?_____

Answer: Anorexia nervosa

Eating Disorders Flashcard 5 of 7

Question: Anorexia nervosa is separated into _____ and binge/purge subtypes

Answer: restricting

Eating Disorders Flashcard 6 of 7

Question: Patients with anorexia nervosa present with _____cardia, hypotension, and decreased bowel sounds

Answer: brady

Eating Disorders Flashcard 7 of 7

Question: Anorexia nervosa is associated with _____ bone density and metatarsal stress fractures

Answer: decreased