Transcript Anorexia Nervosa and Bulimia - AETC National Resource Center

Special Issues for Adolescents with HIV:
Anorexia Nervosa and Bulimia
As a patient population, adolescents are at high risk for bulimia and anorexia nervosa. Primary care
practitioners must be aware of these disorders and appropriately screen for them in their patients. It
should be noted that eating disorders are not more prevalent in adolescents with HIV than the general
adolescent population. The clinician must differentiate an eating disorder from HIV-associated
anorexia or other infectious causes of weight loss.
Diagnostic Criteria for Anorexia Nervosa
•
Refusal to maintain body weight over a minimum
normal weight for age and height (i.e., weight loss
leading to body weight 15% below that expected or
failure to make expected weight gain during a period
of growth).
Diagnostic Criteria for Bulimia
•
Recurrent episodes of binge eating characterized by:
– Eating in a discrete period of time (i.e., a 2 hour period) an
amount of food that is definitely larger than most people
would eat during a similar period of time in similar
circumstances.
– A sense of lack of control over eating during the episode
(i.e., a feeling that one cannot stop eating or control what or
how much one is eating).
•
Intense fear of gaining weight or becoming fat even
though underweight.
•
Disturbance in the way in which one's body weight,
size or shape is experienced, undue influence of
body shape and weight on self-evaluation, and/or
denial of the seriousness of low body weight.
•
Recurrent inappropriate compensatory behavior in
order to prevent weight gain such as: self induced
vomiting, use of laxatives, diuretics or other
medications, fasting or excessive exercise.
•
In females, absence of at least three consecutive
menstrual cycles when otherwise expected to occur
(primary or secondary amenorrhoea).
•
A minimum average of two binge eating and
inappropriate compensatory behaviors per week for at
least three months.
•
Self evaluation is unduly influenced by body shape and
weight.
•
The disturbance does not occur exclusively during
episodes of anorexia nervosa.
Clinical Resource Guide
Condition
Adolescent
Anorexia
Nervosa
&
Bulimia
Signs = “objective”
indication(s) of a
medical
fact or quality that
can be
detected by a
clinician.
Symptoms =
“subjective”
experiences that a
patient
might report to a
clinician.
Prevalence
3% of adolescent and
adult women and 1% of
men have either bulimia,
anorexia nervosa, or a
binge eating disorder
(Harvard Eating
Disorders Center).
An adolescent woman
with anorexia is twelve
times more likely to die
as compared to
adolescents her own age
without anorexia
(Harvard Eating
Disorders Center).
Mortality for anorexia
nervosa may be as high
as 15%.
Approximately 90-95% of
those with anorexia
nervosa are female and
approximately 80% of
those with bulimia are
female (National Eating
Disorders Association).
Signs
• Weight 15% or
greater below expected
weight
• Inappropriate use of
laxatives, enemas, or
diuretics to loose
weight
• Skeletal muscle
atrophy and
loss of fatty tissue
• Low blood pressure
• Dental cavities
secondary to induced
vomiting
• Denial of eating
disorder
• Absence of
menstruation
• Blotchy or yellow skin
• Scarring on the backs
of knuckles may
indicate bulimia
Symptoms
Treatment
• Depression may be
present (see
complementary
depression tool)
• Long process, requiring team
approach (family, primary care
provider, nutrition specialist,
and mental health professional)
• Frequent
inappropriate
references to being
overweight or fat
• Hospitalization required if the
blood pressure is low or
electrolytes out of normal range
• Requesting
prescriptions for
diuretics, laxatives,
or “weight loss pills”
• Generalized lethargy
due to malnutrition or
electrolyte
disturbances
• Absence of
menstruation
• Weight gain should be initial
focus, but psychological
issues must be addressed at
the same time
• Psychotropic medications if
depressed or obsessivecompulsive behavior present
• Education about the disorder
• Behavioral techniques:
monitor food, reward weight
gain, involve patient in different
activities to alter behavior.
• Stress coping skills to
decrease relapse
References
1.
Diagnostic Criteria for Anorexia Nervosa, www.edauk.com/media/media_sub_diagnostic.htm
2.
Diagnostic Criteria for Bulimia, www.edauk.com/media/media_sub_diagnostic.htm
3.
Associated Features or Symptoms, www.medicineonline.com
4.
Harvard Eating Disorders Center, http://www.hedc.org
5.
National Eating Disorders Association, http://www.edap.org
Credits
This tool was developed by the Mental Health subset (Chair:
Linda Frank, PhD, MSN, ACRN, PA/MA AETC) of the AIDS
Education and Training Centers (AETC) National Resource
Center, Adolescent HIV/AIDS Workgroup (Chair: Marion
Donohoe, RN, MSN, CPNP, St. Jude Children’s Research
Hospital, ANAC and Ronald Wilcox, MD,FAAP, Delta Region
AETC). Collaborating members include Elizabeth Cabrera,
MEd (TX/OK AETC), Verita Ingram, MBA (TX/OK AETC),
Elise Johnson, MSW (Bickerstaff Pediatric Family Center),
Jennifer Scanlon, FNP (The Children's Hospital, Denver), and
Ronald Wilcox. The workgroup efforts were coordinated by
the AETC National Resource Center (Managing Editor: Megan
Vanneman, MPH).