Eating Disorders Practice Questions

Q: A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -

Bulimia nervosa. ***Bulimia nervosa*** - This condition is characterized by recurrent episodes of **binge eating** followed by inappropriate compensatory behaviors like **purging (e.g., laxative use)**, self-induced vomiting, excessive exercise, or fasting. - The patient's presentation of repeated overeating followed by purging with laxatives directly aligns with the diagnostic criteria for **bulimia nervosa**. *Binge eating disorder* - While it involves recurrent episodes of **binge eating**, it **does not include** the regular use of inappropriate compensatory behaviors such as purging. - Individuals with binge eating disorder typically experience significant distress about their binging but do not attempt to undo the caloric intake. *Schizophrenia* - This is a severe mental disorder characterized by **distortions in thinking, perception, emotions, language, sense of self, and behavior**, such as hallucinations and delusions. - It is a **psychotic disorder** and does not involve specific eating patterns or purging behaviors. *Anorexia nervosa* - This eating disorder is characterized by a persistent restriction of energy intake leading to a **significantly low body weight**, an intense **fear of gaining weight**, and a distorted body image. - Although some individuals with anorexia nervosa may engage in binge-purging type behavior, the primary defining feature is **significantly low body weight**, which is not mentioned in the patient's presentation.

Q: Which of the following is FALSE regarding Anorexia Nervosa:

Decreased appetite. ***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.

Q: Which of the following is least characteristic of anorexia nervosa? a) Lowered vital signs when the weight is low b) Decreased physical activity c) History of obesity d) Denial of illness

b and c. ***bc (Correct Answer)*** **b) Decreased physical activity** is generally *not* characteristic of anorexia nervosa. Rather, many individuals with anorexia engage in **excessive exercise** despite their emaciated state as part of their compulsive behaviors to lose weight. **c) History of obesity** is also *not typical* of anorexia nervosa. The typical onset involves deliberate and progressive weight loss from a normal or slightly above-average weight, not from obesity. *Incorrect Options:* **a) Lowered vital signs** - This IS characteristic of anorexia nervosa. Bradycardia, hypotension, and hypothermia are common and serious consequences of significant weight loss and malnutrition. **d) Denial of illness** - This IS a hallmark feature of anorexia nervosa. Patients often lack insight into the severity of their condition, reflecting the ego-syntonic nature of their disordered eating behaviors and distorted body image, and they typically resist treatment. **Clinical Note:** The question asks for features that are LEAST characteristic. Both decreased physical activity and history of obesity are atypical, making "bc" the correct combination.

Q: Which of the following conditions is characterised by episodes of excessive and uncontrolled eating?

Bulimia nervosa. **Bulimia nervosa** - This condition is characterized by recurrent episodes of **binge eating**, which involve consuming an unusually large amount of food in a short period and feeling a lack of control over eating during the episode. - These episodes are followed by inappropriate compensatory behaviors to prevent weight gain, such as **self-induced vomiting**, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. *Body dysmorphobia* - This is a mental disorder characterized by a persistent and intrusive preoccupation with an imagined or slight defect in one's **physical appearance**. - It does not involve episodes of excessive and uncontrolled eating, but rather focuses on perceived flaws that are often unnoticeable to others. *Anorexia nervosa* - This eating disorder is characterized by an intense fear of gaining weight and a **distorted body image**, leading to severe restriction of food intake. - While there may be episodes of binge eating in a subtype of anorexia nervosa (binge-eating/purging type), the primary characteristic is a persistent restriction of energy intake leading to a significantly low body weight. *All of the options* - This is incorrect as only bulimia nervosa is primarily characterized by episodes of excessive and uncontrolled eating. - The other conditions listed do not fit this description.

Q: True about anorexia nervosa is all except ?

Binge eating is common. ***Binge eating is common*** - **Binge eating** is NOT common in all cases of anorexia nervosa - It occurs only in the **binge-eating/purging subtype**, which represents approximately **50% of cases** - The **restricting subtype** (the other ~50%) does NOT involve binge eating episodes - Characterizing binge eating as "common" in anorexia nervosa overall is **inaccurate** and misleading *Amenorrhea starts before severe loss of weight* - This statement is **TRUE** - amenorrhea can and often does occur **before or concurrently** with significant weight loss in anorexia nervosa - **Hypothalamic-pituitary-gonadal axis dysfunction** occurs early in the disease process - Studies demonstrate that **hormonal changes** leading to amenorrhea can precede marked weight loss - DSM-5 removed amenorrhea as a required diagnostic criterion partly due to variable timing *More common in females than males* - **TRUE** - Anorexia nervosa has significantly higher prevalence in **females** compared to males - Female-to-male ratio is approximately **10:1** - This gender disparity is consistent across various populations *Self-induced vomiting* - **TRUE** - Self-induced vomiting is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa - Used to prevent weight gain and maintain control over body weight - Represents a purging behavior alongside laxative/diuretic abuse and excessive exercise

Q: Which of the following is not true about bulimia nervosa?

Invariable weight loss with endocrine disorder. ***Invariable weight loss with endocrine disorder*** - **Bulimia nervosa** is characterized by episodes of binge eating followed by compensatory behaviors, which often lead to **weight fluctuations** or the maintenance of a **normal weight**, not invariable weight loss. - While endocrine abnormalities can sometimes occur due to the disordered eating, they are not a defining or **invariable characteristic** of the diagnosis itself. *Recurrent episodes of binge eating* - This is a core diagnostic criterion for bulimia nervosa, involving eating a large amount of food in a short period with a **sense of lack of control**. - These episodes are typically accompanied by feelings of **distress** and guilt. *Recurrent self - induced vomiting* - **Self-induced vomiting** is a common **inappropriate compensatory behavior** used to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, fasting, or **excessive exercise**. *Occurrence of both binge eating and inappropriate compensatory behaviors* - The co-occurrence of **recurrent binge eating** and **recurrent inappropriate compensatory behaviors** is a defining feature of bulimia nervosa. - This distinguishes it from other eating disorders like **anorexia nervosa** (which involves significant underweight) or **binge eating disorder** (which lacks compensatory behaviors).

Q: All of the following are true about bulimia except

Significant weight loss similar to anorexia nervosa. ***Significant weight loss similar to anorexia nervosa*** - While individuals with bulimia nervosa may experience some weight fluctuations, they do not exhibit the **significant underweight status** characteristic of anorexia nervosa. - The diagnosis of bulimia nervosa requires that the individual's weight remain within the **normal range or be overweight**, distinguishing it from anorexia nervosa. - This is the key differentiating feature between the two eating disorders. *Recurrent compensatory behaviors* - **Inappropriate compensatory behaviors** to prevent weight gain are a defining diagnostic criterion of bulimia nervosa. - These include self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - Such behaviors occur at least once weekly for 3 months per DSM-5 criteria. *Body image disturbance* - A core diagnostic criterion for bulimia nervosa is a significant **disturbance in the perception of one's body shape or weight**, heavily influencing self-evaluation. - This distorted body image often fuels the binge-purge cycle. - Patients' self-worth is excessively influenced by body shape and weight. *Binge eating* - **Recurrent episodes of binge eating** are a hallmark symptom of bulimia nervosa, involving consumption of a large amount of food in a discrete period with a sense of loss of control. - These episodes are followed by compensatory behaviors. - Must occur at least once weekly for 3 months to meet diagnostic criteria.

Q: A 25-year-old woman presents with a fear of gaining weight and significantly restricts her food intake despite being underweight. What is the most likely diagnosis?

Anorexia nervosa. ***Anorexia nervosa*** - This diagnosis is characterized by a significant **restriction of energy intake** leading to a significantly low body weight, an intense **fear of gaining weight**, and a disturbance in the way one's body weight or shape is experienced. - The patient's presentation with fear of gaining weight and significant food restriction despite being underweight perfectly aligns with the diagnostic criteria for **anorexia nervosa**. *Bulimia nervosa* - This disorder involves recurrent episodes of **binge eating**, followed by compensatory behaviors such as **purging** (e.g., self-induced vomiting, misuse of laxatives) or excessive exercise. - While there is a fear of gaining weight, the primary feature missing from the patient's description is the **binge-purge cycle**. *Binge eating disorder* - This condition is defined by recurrent episodes of **binge eating** without the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa. - The patient's description does not include episodes of binge eating; instead, it highlights **chronic restriction** of food intake. *Body dysmorphic disorder* - This disorder involves a preoccupation with **one or more perceived flaws** in physical appearance that are not observable or appear slight to others. - While there can be concern about body shape, the primary focus is on a specific perceived defect, and it does not typically involve the severe **food restriction** and **underweight status** seen in the patient.

Q: A 25-year-old female presents with recurrent episodes of binge eating followed by self-induced vomiting. What is the most appropriate treatment?

Cognitive-behavioral therapy. ***Cognitive-behavioral therapy*** - **CBT** is the most established and effective psychotherapy for **bulimia nervosa**, targeting the dysfunctional thoughts and behaviors associated with binge eating and purging. - It helps patients identify triggers, develop coping mechanisms, and normalize eating patterns. *Interpersonal therapy* - **IPT** focuses on improving interpersonal relationships and social functioning, which can indirectly help with eating disorders but is **less directly effective** than CBT for bulimia nervosa. - While it may be helpful for some patients, it is not considered the **first-line treatment** for this condition. *Family-based therapy* - **FBT** (Maudsley Method) is primarily used for **anorexia nervosa** in adolescents, involving parents in the re-feeding process. - While family dynamics can play a role in eating disorders, FBT is **not the primary intervention** for an adult with bulimia nervosa. *Dialectical behavior therapy* - **DBT** is highly effective for conditions involving **emotion dysregulation** and **impulsivity**, such as borderline personality disorder. - While some aspects of DBT, like emotion regulation skills, might be helpful, it is **not the primary evidence-based treatment** for bulimia nervosa.

Q: A 19-year-old woman with bulimia nervosa is likely to exhibit which of the following behaviors?

Frequent binge eating followed by purging. ***Frequent binge eating followed by purging*** - **Bulimia nervosa** is characterized by recurrent episodes of **binge eating**, which is consuming an amount of food much larger than most people would eat in a similar period under similar circumstances, accompanied by a sense of lack of control. - These binge episodes are followed by **compensatory behaviors** such as self-induced vomiting (purging), misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. *Significant weight loss and refusal to eat* - This description is more indicative of **anorexia nervosa**, characterized by restriction of energy intake leading to a significantly low body weight. - Individuals with bulimia nervosa typically maintain a normal weight or are overweight, and their compensatory behaviors are aimed at preventing weight gain after binge eating. *Excessive fasting and exercise without binging* - While excessive exercise and fasting can be compensatory behaviors in bulimia nervosa, the absence of **binge eating** suggests a different eating disorder or a subthreshold presentation. - This pattern may be seen in some forms of **anorexia nervosa** (restricting type) but lacks the hallmark binge-purge cycle of bulimia. *Normal eating patterns with occasional overeating* - **Occasional overeating** is common and does not meet the diagnostic criteria for an eating disorder. - **Bulimia nervosa** involves a recurrent and distressing pattern of binge eating and inappropriate compensatory behaviors that significantly impacts quality of life.

Question 1

A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -

Accepted Answer

Bulimia nervosa

Answer

Binge eating disorder

Answer

Schizophrenia

Answer

Anorexia nervosa

Question 2

Which of the following is FALSE regarding Anorexia Nervosa:

Accepted Answer

Decreased appetite

Answer

Body image distortion

Answer

Vigor exceeding physical ill being

Answer

Weight loss

Question 3

Which of the following is least characteristic of anorexia nervosa?

a) Lowered vital signs when the weight is low
b) Decreased physical activity
c) History of obesity
d) Denial of illness

Accepted Answer

b and c

Answer

a and b

Answer

b and d

Answer

c and d

Question 4

Which of the following conditions is characterised by episodes of excessive and uncontrolled eating?

Accepted Answer

Bulimia nervosa

Answer

Body dysmorphobia

Answer

Anorexia nervosa

Answer

All of the options

Question 5

True about anorexia nervosa is all except ?

Accepted Answer

Binge eating is common

Answer

Amenorrhea starts before severe loss of weight

Answer

More common in females than males

Answer

Self-induced vomiting

Question 6

Which of the following is not true about bulimia nervosa?

Accepted Answer

Invariable weight loss with endocrine disorder

Answer

Recurrent episodes of binge eating

Answer

Occurrence of both binge eating and inappropriate compensatory behaviors

Answer

Recurrent self-induced vomiting

Question 7

All of the following are true about bulimia except

Accepted Answer

Significant weight loss similar to anorexia nervosa

Answer

Recurrent compensatory behaviors

Answer

Body image disturbance

Answer

Binge eating

Question 8

A 25-year-old woman presents with a fear of gaining weight and significantly restricts her food intake despite being underweight. What is the most likely diagnosis?

Accepted Answer

Anorexia nervosa

Answer

Bulimia nervosa

Answer

Binge eating disorder

Answer

Body dysmorphic disorder

Question 9

A 25-year-old female presents with recurrent episodes of binge eating followed by self-induced vomiting. What is the most appropriate treatment?

Accepted Answer

Cognitive-behavioral therapy

Answer

Interpersonal therapy

Answer

Family-based therapy

Answer

Dialectical behavior therapy

Question 10

A 19-year-old woman with bulimia nervosa is likely to exhibit which of the following behaviors?

Accepted Answer

Frequent binge eating followed by purging

Answer

Significant weight loss and refusal to eat

Answer

Excessive fasting and exercise without binging

Answer

Normal eating patterns with occasional overeating

Eating Disorders — MCQs

Eating Disorders — MCQs

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