NURS 355 Exam 2 Questions and Answers| New Update with 100% Correct Answers
Diagnostic Criteria for Anorexia Nervosa A. Restriction of energy intake relative to
requirements, leading to significantly low body weight in terms of age, sex, developmental
trajectory and physical health
B. Intense fear of gaining weight or becoming fat *OR* persistent behavior that interferes with
weight gain.
C. Disturbances in the way body weight or shape is experienced
SEVERITY is based on BMI as well as other clinical features such as functional impairment or
physical complications
SUBTYPES:
-Restricting
-Has not engaged in binge/purge behaviors in lat 3 months
-Purging during last 3 months has engaged in binge/purge behaviors
Diagnostic Criteria for Bulimia Nervosa -Recurrent episodes of binge eating
-Recurrent, inappropriate compensatory behaviors in order to prevent weight gain, such as self
induced vomiting, misuse of laxatives, and etc.
-Purging
-Self evaluation is unduly influenced by body shape and weight
-Binge eating and compensatory behaviors occur, on average *once a week for 3 months*
Severity: based on frequency of behaviors
Binges -Large to enormous amounts of food eaten in a discrete period of time
-Food is eaten rapidly without appreciation for taste, texture, temperature, or quality of food
,-Terminated by stomach distention, social interruption, loss of consciousness, or running out of
food
-Binges are followed by: guilt, shame, feeling out of control, and usually, compensatory
behaviors
Avoidant/Restrictive Food Intake Disorder Most common contributory factors include:
sensory characteristics of food (texture, color), fear of consequence from eating (pain,
vomiting) or lack of interest in eating
Diagnostic Criteria for ARFID Persistent pattern of disordered eating or feeding
characterized by:
-Lack of interest in food or poor appetite.
-Fears about negative consequences of eating (e.g., vomiting, choking, allergic reaction).
-Selective or picky eating.
The pattern of disordered eating is also accompanied by at least one of the following:
-Significant weight loss or failure to gain weight/grow as expected.
-Nutritional deficiency (e.g., anemia).
-Dependence on nutritional supplements or tube feeding.
-Impairment in psychosocial functioning.
Disordered eating is not due to cultural practice or lack of available resources
No significant body image distortion or fear of weight gain
Binge Eating Disorder -Binges occur , on average, at least once per week for 3 months
-Marked distress regarding binge eating is present
-Binges are NOT followed by an inappropriate compensatory behaviors and DOES NOT occur
during an episode of Anorexia or Bulimia Nervosa
,Eating Disorders in Males -Males currently make up approximately 10% of patients with
AN/BN and 30-40% of patients with BED.
-Body image concerns primarily are for muscular physique- especially in abdomen and excessive
exercise is core behavioral manifestation (up to 84% of patients).
-Less likely to be recognized and diagnosed; less likely to seek treatment and tend to receive
shorter duration of treatment.
-Mortality rates and medical complications are similar for males and females.
Difficulties with ED Diagnosis -The diagnosis of Anorexia takes precedence over Bulimia
since the presence of one excludes the other
-Many patients have "overlapping" diagnosis Patients with BN often have history of AN
-Up to 62% of patients with AN will develop bulimic behaviors at some point during illness.
Majority of crossover occurs within 5 years
-Incomplete or absent assessments at primary or specialty providers.
-Many patients report and receive care for physicals symptoms without revealing ED behaviors
ED Complications of Cardiovascular Hypotension, bradycardia, arrhythmias, tachycardia
ED Complications of GI constipation; GERD; delayed gastric emptying; hematemesis
ED Complications of Renal/Hepatic Kidney and liver damage; apoptosis leading to increased
AST/ALT
ED Complications of Integumentary/musculoskeletal lanugo; cold extremities; osteoporosis;
muscle wasting
ED Complications of Neurological brain shrinkage and decrease in cerebral blood flow
, ED Complications of Oral cavities, perimylolysis, xerostomia, cheirosas, parotid gland
enlargement, trauma to mucus membranes
ED Complications of Gynecologic -7.6% of women seen in infertility clinics had AN/BN and
scored >20 on EAT-26. This is 2-4x higher than would be predicted in the general population
-73% of patients who were below GWR spontaneously conceived once weight was restored
-VLC diets (800-1000 cals) for 6 weeks disrupt menstrual cycles for 3-6 months even after the
cessation of dieting
-Osteoporosis results from decreased estrogen and increased cortisol and occurs within 6
months of starvation.
Functional Issues Resulting from Eating Disorders -Impaired meal preparation and social
eating skills
-Interpersonal conflict and isolation
-Occupational and educational limitations
-Maladaptive social activities
ED's and other Psychiatric Illnesses -Affective disorders (especially depression) occurs in 50-
80% of patients with both Anorexia and Bulimia Nervosa.
-Anxiety disorders (especially OCD and social phobias) occur in 30-65% of patients with both
Anorexia and Bulimia Nervosa.
-It is important to delineate "true" OCD from eating disordered rituals and obsessions.
-Personality disorders occurs in 20-50% of patients with both disorders.
Substance Abuse and Eating Disorders -Up to 50% of individuals with ED abuse alcohol or
illicit drugs as compared to 9% in general population. (CASA, 2003).
-Up to 35% of individuals who abuse alcohol or illicit drugs have an ED as compared to 3% in
general population. (CASA, 2003).
-Most commonly abused substances are alcohol, marijuana, nicotine, caffeine, amphetamines,
heroin and cocaine.
Diagnostic Criteria for Anorexia Nervosa A. Restriction of energy intake relative to
requirements, leading to significantly low body weight in terms of age, sex, developmental
trajectory and physical health
B. Intense fear of gaining weight or becoming fat *OR* persistent behavior that interferes with
weight gain.
C. Disturbances in the way body weight or shape is experienced
SEVERITY is based on BMI as well as other clinical features such as functional impairment or
physical complications
SUBTYPES:
-Restricting
-Has not engaged in binge/purge behaviors in lat 3 months
-Purging during last 3 months has engaged in binge/purge behaviors
Diagnostic Criteria for Bulimia Nervosa -Recurrent episodes of binge eating
-Recurrent, inappropriate compensatory behaviors in order to prevent weight gain, such as self
induced vomiting, misuse of laxatives, and etc.
-Purging
-Self evaluation is unduly influenced by body shape and weight
-Binge eating and compensatory behaviors occur, on average *once a week for 3 months*
Severity: based on frequency of behaviors
Binges -Large to enormous amounts of food eaten in a discrete period of time
-Food is eaten rapidly without appreciation for taste, texture, temperature, or quality of food
,-Terminated by stomach distention, social interruption, loss of consciousness, or running out of
food
-Binges are followed by: guilt, shame, feeling out of control, and usually, compensatory
behaviors
Avoidant/Restrictive Food Intake Disorder Most common contributory factors include:
sensory characteristics of food (texture, color), fear of consequence from eating (pain,
vomiting) or lack of interest in eating
Diagnostic Criteria for ARFID Persistent pattern of disordered eating or feeding
characterized by:
-Lack of interest in food or poor appetite.
-Fears about negative consequences of eating (e.g., vomiting, choking, allergic reaction).
-Selective or picky eating.
The pattern of disordered eating is also accompanied by at least one of the following:
-Significant weight loss or failure to gain weight/grow as expected.
-Nutritional deficiency (e.g., anemia).
-Dependence on nutritional supplements or tube feeding.
-Impairment in psychosocial functioning.
Disordered eating is not due to cultural practice or lack of available resources
No significant body image distortion or fear of weight gain
Binge Eating Disorder -Binges occur , on average, at least once per week for 3 months
-Marked distress regarding binge eating is present
-Binges are NOT followed by an inappropriate compensatory behaviors and DOES NOT occur
during an episode of Anorexia or Bulimia Nervosa
,Eating Disorders in Males -Males currently make up approximately 10% of patients with
AN/BN and 30-40% of patients with BED.
-Body image concerns primarily are for muscular physique- especially in abdomen and excessive
exercise is core behavioral manifestation (up to 84% of patients).
-Less likely to be recognized and diagnosed; less likely to seek treatment and tend to receive
shorter duration of treatment.
-Mortality rates and medical complications are similar for males and females.
Difficulties with ED Diagnosis -The diagnosis of Anorexia takes precedence over Bulimia
since the presence of one excludes the other
-Many patients have "overlapping" diagnosis Patients with BN often have history of AN
-Up to 62% of patients with AN will develop bulimic behaviors at some point during illness.
Majority of crossover occurs within 5 years
-Incomplete or absent assessments at primary or specialty providers.
-Many patients report and receive care for physicals symptoms without revealing ED behaviors
ED Complications of Cardiovascular Hypotension, bradycardia, arrhythmias, tachycardia
ED Complications of GI constipation; GERD; delayed gastric emptying; hematemesis
ED Complications of Renal/Hepatic Kidney and liver damage; apoptosis leading to increased
AST/ALT
ED Complications of Integumentary/musculoskeletal lanugo; cold extremities; osteoporosis;
muscle wasting
ED Complications of Neurological brain shrinkage and decrease in cerebral blood flow
, ED Complications of Oral cavities, perimylolysis, xerostomia, cheirosas, parotid gland
enlargement, trauma to mucus membranes
ED Complications of Gynecologic -7.6% of women seen in infertility clinics had AN/BN and
scored >20 on EAT-26. This is 2-4x higher than would be predicted in the general population
-73% of patients who were below GWR spontaneously conceived once weight was restored
-VLC diets (800-1000 cals) for 6 weeks disrupt menstrual cycles for 3-6 months even after the
cessation of dieting
-Osteoporosis results from decreased estrogen and increased cortisol and occurs within 6
months of starvation.
Functional Issues Resulting from Eating Disorders -Impaired meal preparation and social
eating skills
-Interpersonal conflict and isolation
-Occupational and educational limitations
-Maladaptive social activities
ED's and other Psychiatric Illnesses -Affective disorders (especially depression) occurs in 50-
80% of patients with both Anorexia and Bulimia Nervosa.
-Anxiety disorders (especially OCD and social phobias) occur in 30-65% of patients with both
Anorexia and Bulimia Nervosa.
-It is important to delineate "true" OCD from eating disordered rituals and obsessions.
-Personality disorders occurs in 20-50% of patients with both disorders.
Substance Abuse and Eating Disorders -Up to 50% of individuals with ED abuse alcohol or
illicit drugs as compared to 9% in general population. (CASA, 2003).
-Up to 35% of individuals who abuse alcohol or illicit drugs have an ED as compared to 3% in
general population. (CASA, 2003).
-Most commonly abused substances are alcohol, marijuana, nicotine, caffeine, amphetamines,
heroin and cocaine.
