🔑 Key Learning

  • Anorexia nervosa presents with low BMI, menstrual disturbance, and electrolyte abnormalities
  • Bulimia nervosa involves binge-purge cycles
  • CBT-ED is the cornerstone of therapy for both anorexia and bulimia
  • Fluoxetine may be used in bulimia nervosa, but not as monotherapy
  • Body dysmorphic disorder is distinct from eating disorders and involves a fixation on imagined defects

🧊 Anorexia Nervosa

👀 Clinical Features

  • Low BMI or rapid, unintentional weight loss
  • Electrolyte imbalance or hypoglycaemia without obvious cause
  • Oligomenorrhoea or amenorrhoea
  • Vital signs: bradycardia, hypotension
  • Examination findings:
    • Parotid or salivary gland enlargement
    • Cold extremities
    • Lanugo hair (fine body hair in severe cases)

💊 Management

  • Psychological interventions:
    • CBT-ED (Cognitive Behavioural Therapy for Eating Disorders)
      • Involves up to 40 sessions over 40 weeks, starting with twice-weekly sessions
      • Support healthy eating habits and achieving a healthy weight
      • Address nutrition, cognition, mood, social skills, body image, self-esteem, and relapse prevention
      • Develop a personalised plan targeting factors that maintain disordered eating
  • MANTRA (Maudsley Anorexia Nervosa Treatment for Adults)
  • Family-based therapy in adolescents
  • Monitor for re-feeding syndrome in underweight patients starting nutritional support

🤮 Bulimia Nervosa

📋 Diagnosis (DSM-5)

  • Recurrent episodes of binge eating
  • Compensatory behaviours to avoid weight gain (purging):
    • Self-induced vomiting
    • Excessive exercise
    • Laxative or diuretic use

💊 Management (NICE)

  • First-line: Bulimia nervosa-focused guided self-help
  • Second-line:
    • CBT-ED
    • Family therapy (FT-BN) in children and young people
  • Pharmacological:
    • Fluoxetine may be considered in combination with psychological therapy
    • Not used as monotherapy

🪞 Body Dysmorphic Disorder (BDD)

👀 Clinical Features

  • Preoccupation with an imagined or minor defect in appearance
  • Causes significant distress or impairment
  • Does not meet criteria for anorexia or bulimia
  • May lead to repetitive behaviours (e.g. mirror checking, excessive grooming)
  • Often comorbid with depression or anxiety

📝 Exam Clues & Clinchers

  • Young woman with amenorrhoea + low BMI + hypotension → think anorexia nervosa
  • Parotid swelling + normal weight + enamel erosion → think bulimia nervosa
  • Pharmacological management of bulimia → Fluoxetine, used with psychological therapy 
  • MANTRA = psychological treatment model specific to anorexia nervosa
  • Preoccupation with body image + normal eating pattern → consider BDD
  • Re-feeding syndrome = hypophosphataemia + cardiac risk after nutrition starts

🔗 Useful Links and References