Eating Disorders — MCQs

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 51: Binge eating disorder is characterized by?

A. Normal weight
B. Weight loss
C. Obesity (Correct Answer)
D. Self-induced vomiting

Explanation: **Explanation:** **Binge Eating Disorder (BED)** is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort) accompanied by a feeling of a loss of control. Unlike Bulimia Nervosa, BED is **not** associated with regular compensatory behaviors (purging). 1. **Why Obesity is Correct:** Because there are no compensatory mechanisms (like vomiting or excessive exercise) to offset the high caloric intake during binge episodes, most individuals with BED are **overweight or obese**. It is the most common eating disorder associated with metabolic syndrome and obesity-related comorbidities. 2. **Why Other Options are Incorrect:** * **Normal weight:** While possible in early stages, it is more characteristic of **Bulimia Nervosa** (where purging maintains weight) or Binge-Eating/Purging type of Anorexia. * **Weight loss:** This is the hallmark of **Anorexia Nervosa**. In BED, the positive energy balance leads to weight gain. * **Self-induced vomiting:** This is a compensatory "purging" behavior. Its presence would shift the diagnosis to **Bulimia Nervosa**. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Binge episodes must occur, on average, at least **once a week for 3 months**. * **Key Distinction:** BED = Binging + No Purging + Obesity; Bulimia = Binging + Purging + Normal Weight. * **Drug of Choice:** **Lisdexamfetamine** is the only FDA-approved medication for BED. SSRIs (like Fluoxetine) are also used to manage associated impulsivity and depression. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the first-line psychological treatment.

Question 52: Bulimia nervosa is associated with which of the following?

A. Impulsive behaviour (Correct Answer)
B. Obesity
C. Metabolic syndrome
D. Amenorrhea

Explanation: **Explanation:** **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, fasting, or excessive exercise). **Why Option A is Correct:** Patients with Bulimia Nervosa frequently exhibit **impulsive behavior** and poor impulse control. This is a high-yield association often tested in NEET-PG. BN is frequently comorbid with **Cluster B personality disorders** (especially Borderline Personality Disorder), substance abuse, self-harm, and shoplifting. Unlike Anorexia Nervosa (associated with high inhibitory control and perfectionism), Bulimia represents a "dyscontrol" pathology. **Why Other Options are Incorrect:** * **B. Obesity:** While patients with Binge Eating Disorder (BED) are often obese, patients with Bulimia Nervosa are typically of **normal weight or slightly overweight**. * **C. Metabolic Syndrome:** This is a complication of obesity and sedentary lifestyle, more commonly associated with BED or side effects of second-generation antipsychotics, rather than the purging cycles of BN. * **D. Amenorrhea:** This is a classic hallmark of **Anorexia Nervosa** (due to hypothalamic-pituitary-ovarian axis suppression from low body weight). In Bulimia, menstrual cycles are usually preserved, though they may be irregular. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the most common finding due to vomiting. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN (at a higher dose of 60mg). * **Contraindication:** **Bupropion** is strictly contraindicated in Bulimia due to an increased risk of seizures.

Question 53: Need for thinness despite being lean is a feature of which condition?

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

Explanation: **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a morbid fear of obesity and a distorted body image. Patients maintain a relentless pursuit of thinness and a refusal to maintain a minimally normal body weight, even when they are significantly underweight or emaciated. This "need for thinness despite being lean" is the hallmark of the disorder, often accompanied by a "body image disturbance" where the patient perceives themselves as fat despite objective evidence to the contrary. **Analysis of Options:** * **Bulimia Nervosa:** While these patients are also over-concerned with weight and shape, they typically maintain a **normal or slightly above-normal weight**. The condition is characterized by binge eating followed by compensatory behaviors (purging). * **Metabolic Syndrome:** This is a cluster of physical conditions (hypertension, high blood sugar, excess body fat around the waist) that increase the risk of heart disease and stroke; it has no primary psychiatric component related to the "need for thinness." * **Binge Eating Disorder:** Patients experience episodes of losing control over eating but, unlike Bulimia, they do not engage in compensatory behaviors. These patients are often **overweight or obese** and do not typically exhibit the drive for thinness seen in AN. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for AN:** 1. Restriction of energy intake leading to significantly low body weight; 2. Intense fear of gaining weight; 3. Disturbance in the way one’s body weight/shape is experienced. * **Subtypes:** Restricting type and Binge-eating/purging type. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and amenorrhea (though amenorrhea is no longer a mandatory criterion in DSM-5). * **Russell’s Sign:** Calluses on the knuckles (seen in the purging subtype of AN and Bulimia).

Question 54: All of the following are features of Anorexia Nervosa except?

A. Predominantly seen in females
B. Body Mass Index is higher than normal population
C. Amenorrhea is rare (Correct Answer)
D. Malabsorption Syndrome is the most common cause

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significantly low body weight. **Why "Amenorrhea is rare" is the correct answer:** In the ICD-10 criteria for Anorexia Nervosa, **amenorrhea** (absence of at least three consecutive menstrual cycles) was a hallmark diagnostic feature in post-pubertal females. It occurs due to hypothalamic-pituitary-gonadal axis dysfunction triggered by low body fat and emotional stress. While DSM-5 removed amenorrhea as a mandatory diagnostic criterion to include males and those on contraceptives, it remains a **very common** clinical finding, not a rare one. **Analysis of other options:** * **A. Predominantly seen in females:** This is correct. The female-to-male ratio is approximately 10:1. * **B. Body Mass Index (BMI) is higher than normal:** This is **incorrect** (making the question technically have two false statements, but "Amenorrhea is rare" is the classic "except" choice in standard medical exams). In AN, BMI is characteristically **low** (typically <17.5 kg/m²). * **D. Malabsorption Syndrome:** While not the *cause* of AN, it is often a differential diagnosis. However, the question likely implies that the weight loss is due to voluntary restriction, not primary malabsorption. **NEET-PG High-Yield Pearls:** 1. **Two Types:** Restricting type and Binge-eating/purging type. 2. **Lanugo hair:** Fine, downy hair found on the body is a classic physical sign. 3. **Refeeding Syndrome:** The most dangerous complication during treatment, characterized by **Hypophosphatemia**. 4. **Russell’s Sign:** Calluses on knuckles from self-induced vomiting (more common in Bulimia). 5. **Treatment:** Family-based therapy (Maudsley approach) is the first-line for adolescents; SSRIs (Fluoxetine) are only effective *after* weight restoration.

Question 55: A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

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

Explanation: ***Bulimia nervosa***- Involves recurrent episodes of **binge eating** followed by inappropriate **compensatory behaviors** (like self-induced **vomiting**, excessive exercise, or laxative use).- Unlike **anorexia nervosa**, patients with bulimia nervosa typically maintain a body weight that is normal or overweight (BMI $\geq$ 18.5), which aligns with the given BMI of 27.*Anorexia nervosa*- The primary criterion requires the patient to have a weight that is significantly low for their age and height (e.g., BMI $\leq$ 17.5 in adults).- This diagnosis is excluded because the patient's BMI is 27, placing her in the **overweight** category.*Binge eating disorder*- Characterized by recurrent episodes of **binge eating** without inappropriate use of **compensatory behaviors** (purging).- This patient engages in **vomiting** after eating, which is a compensatory behavior that rules out a diagnosis of simple binge eating disorder.*OCD*- Involves the presence of **obsessions** (recurrent, intrusive thoughts) and/or **compulsions** (repetitive behaviors) that cause significant distress.- While eating disorders can feature obsessive elements, the core presentation of binging followed by compensatory purging is specific to **bulimia nervosa**, not Obsessive-Compulsive Disorder.

Question 56: Indoor management of anorexia nervosa is done on priority patients with:-

A. Depression
B. Amenorrhea
C. Binging episodes
D. Weight for height less than 75% of normal (Correct Answer)

Explanation: ***Weight for height less than 75% of normal*** - A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care. - This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death. *Depression* - While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**. - **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight. - Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications. *Binging episodes* - While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission. - The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.

Question 57: Which of the following disorders is more common in females?

A. ADHD
B. Eating disorders (Correct Answer)
C. Conduct disorder
D. Autism

Explanation: ***Eating disorders*** - **Eating disorders**, particularly **anorexia nervosa** and **bulimia nervosa**, are significantly more prevalent in females than in males, with female-to-male ratios ranging from **3:1 to 10:1**. - Sociocultural factors (body image expectations, media influence), biological factors (hormonal influences), and psychological vulnerabilities contribute to this **gender disparity**. - This is the **only option** in this list that is more common in females. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is diagnosed more frequently in **males** than in females, with a male-to-female ratio of approximately **2:1 to 3:1** in childhood. - Although females with ADHD may present with more inattentive symptoms (which can be underdiagnosed), the overall prevalence remains higher in males. *Conduct disorder* - **Conduct disorder** is substantially more common in **males**, with a male-to-female ratio typically ranging from **2:1 to 4:1**. - Males tend to exhibit more overtly aggressive behaviors (physical aggression, property destruction), while females might present with more covert forms (relational aggression, rule-breaking). *Autism* - **Autism spectrum disorder (ASD)** is diagnosed more frequently in **males**, with a male-to-female ratio of approximately **4:1**. - This difference may be partly due to diagnostic biases and presentation differences, as females often present with less recognized or "camouflaged" symptoms and better social mimicry.

Question 58: Which of the following eating disorders is most common?

A. Bulimia Nervosa
B. Binge eating disorder (Correct Answer)
C. Anorexia nervosa
D. All have same prevalence

Explanation: ***Binge eating disorder*** **Binge eating disorder (BED)** is the **most common eating disorder**, with a lifetime prevalence of approximately 2-3% in the general population. It is characterized by: - Recurrent episodes of eating large quantities of food - A sense of lack of control during binge episodes - Significant distress following binge episodes - **Absence of regular compensatory behaviors** (unlike bulimia nervosa) *Bulimia Nervosa* **Bulimia nervosa** is less common than binge eating disorder, with a lifetime prevalence of approximately 1-1.5%. It is characterized by recurrent binge eating episodes followed by inappropriate compensatory behaviors (self-induced vomiting, laxative misuse, excessive exercise, or fasting). While bulimia is a significant public health concern, its prevalence is definitively lower than that of BED. *Anorexia nervosa* **Anorexia nervosa** is the least common of the major eating disorders, with a lifetime prevalence of approximately 0.3-1%. It is characterized by intense fear of weight gain, distorted body image, and severe food restriction leading to significantly low body weight. Despite its lower prevalence, anorexia nervosa has the **highest mortality rate** among all psychiatric disorders. *All have same prevalence* The prevalence rates of eating disorders vary significantly. Epidemiological studies consistently show that **binge eating disorder** has substantially higher prevalence than both bulimia nervosa and anorexia nervosa.

Question 59: Avoidance of food is seen in

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

Explanation: ***Anorexia nervosa*** - Individuals with anorexia nervosa restrict their food intake significantly, often to the point of **starvation**, driven by an intense fear of gaining weight. - This eating disorder is characterized by a **distorted body image** where the person sees themselves as overweight even when severely underweight. - **Food avoidance and restriction** are the core features of this disorder. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, accompanied by a feeling of loss of control. - Unlike anorexia, there are no regular compensatory behaviors, and the primary issue is **overconsumption**, not avoidance. *Bulimia nervosa* - Bulimia nervosa involves recurrent episodes of **binge eating followed by compensatory behaviors** like self-induced vomiting, excessive exercise, or laxative misuse. - While there is concern about weight, the pattern is one of binging and purging, rather than consistent food avoidance. *Pica* - Pica involves **persistent eating of non-nutritive substances** (e.g., soil, chalk, paper) for at least one month. - This is not characterized by food avoidance, but rather inappropriate consumption of non-food items.

Question 60: 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

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.

Practice by Chapter

Anorexia Nervosa

Practice Questions

Bulimia Nervosa

Practice Questions

Binge Eating Disorder

Practice Questions

Avoidant/Restrictive Food Intake Disorder

Practice Questions

Pica and Rumination Disorder

Practice Questions

Medical Complications of Eating Disorders

Practice Questions

Inpatient Management

Practice Questions

Outpatient Treatment Approaches

Practice Questions

Family-Based Treatment

Practice Questions

Cognitive-Behavioral Therapy for Eating Disorders

Practice Questions

Pharmacotherapy

Practice Questions

Prevention Strategies

Practice Questions

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