Physical symptoms reflect degree of malnutrition Amenorrhea Stomach

Physical symptoms reflect degree of malnutrition

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Physical symptoms reflect degree of malnutrition - Amenorrhea - Stomach pain/constipation - Fatigue - Cold intolerance - Light headedness - Signs of emotional cognitive blunting Factors that can leads to eating disorders - Diets gone bad, many people diet, few develop bulimia, anorexia - Binge eating disorder is most common Emotional dysregulation cycle - Triger emotional dysregulation/ anxiety binge eating, restricting, purging self harm ect temporary belief goes back to emotional regulation and the cycle continue Delayed discounting studies - Split between coming in hungry or they just ate o Presented them with task where they can get immediate reward are delayed reward When hungry wanted immediate reward When anorexic -> decreased reward sensitivity, wanted delayed reward. They aren’t satisfied with food like other people Bulimic Had increased response in insula and wanted immediate response o REPEATED with money found like the same results except bulimics only altered when not food Assessment of ED - Exam, inventory, binge rating form, trait mood affect questionnaire - History of eating patters, body image concerns, life events, previous treatment, reason for seeking treatment - Menstrual history, high/low lifetime weight, recent gain/loss - Fear associated with weight/ food - Eating in public - Family history - Use of drugs - Actions in school/social ect
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- Bleeding with purging, dizziness, chest pain - Suicidal, self-harm, homicidal Treatment flow chart - Inpatient residential 10 hour PHP 6 hour PHP IOP 5 day IOP 3 day -> output - Outpatient transition back to school/ work, more meals and snacks outside program - Partial hospitalization 5-6 days per week, high structure, supervised meals snacks, DBT, FBT, RD, MD Restricting anorectics (AN-R) - appear more over-controlled, anhedonic, and constricted. - Those who engaged in binging and purging behavior [both BN and AN-BP] appear to be more under-controlled, volatile, and emotionally labile (eg., Westen & Harnden-Fischer, 2001) Medication to target co-occurring disorders - Mood, anxiety, affective dysregulation and impulse disorders Dopamine and serotonin - SSRI’s help anorexia - Atypical antipsychotics - Appetite stimulant - AN appear to be hyper serotonergic Medication for Bulimia and binge eating - Patients without co-occurring disorders o SSRI’s o Topiramate o Vyvanse for Binge eating o Stimulants Medication for ARFID - Mirtazapine - Mostly need to treat comorbid disorders Neurocircuitry of Anorexia, bulimia, binge eating overlap with psychiatric illnesses - Eating disorders can be unhealthy attempts at coping Corticolimbic system - Learning and memory, processing emotions, reward anticipation, impulse control, motivation and executive function Most frequent co morbid disorders - Mood, anxiety, personality, substance use Mood disorders - Major depressive disorders o Diagnosed in 50-70% of all eating disorders - Bipolar mood disorder o More so in bulimia Anxiety disorders - OCD, social phobia, GAD, PTSD more common in bulimia, panic disorder o Avoid benzodiazepines
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