Anorexia Nervosa 

Clinical features

  • Low BMI or rapid weight loss
  • Unexplained electrolyte imbalance or hypoglycaemia 
  • Oligo- amenorrhoea
  • Observations: bradycardia, hypotension
  • On examination: Parotid / salivary gland enlargement 

Management

  • Psychological treatments - include: eating disorder focussed CBT (CBT-ED), Maudsley Anoxrexia Nervosa Treatment Adults (MANTRA). 

 

Bulimia Nervosa

Diagnosis

  • Bulimia nervosa is diagnosed according to the DSM-5. 
  • Key features include
    • Binge eating
    • Followed by purging – excess exercise, laxative use, self-induced vomiting
  • Management: 
    • 1st Line:  Bulimia-nervosa focussed guided self help
    • 2nd line: (if BN-self help is ineffective or unacceptable) -  Eating disorder focussed CBT (CBT-ED)
    • Children & young people: Bulimia nervosa focussed family therapy (FT-BN)
    • Pharmacological: Fluoxetine can be used in combination with therapy, but not alone. 

 

Body dysmorphic disorder

Clinical features

  • A preoccupation with an imagined defect in appearance resulting in distress (and does not fit diagnostic criteria of anorexia nervosa or bulimia nervosa).