Eating Disorders
(11-9-07)

The SCOFF questions*

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a 3 month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

*One point for every "yes"; a score of 2 indicates a likely case of anorexia nervosa or bulimia

The SCOFF questionnaire: assessment of a new screening tool for eating disorders
John F Morgan, Fiona Reid, and J Hubert Lacey (1999)
British Medical Journal; 319: 1467-1468. [Full text]

Eating Disorders

Problems with amount eaten:

1. Obesity

overeating/inadequate exercise leads to unhealthy body weight

2. Anorexia Nervosa

a. morbid fear of being overweight

b. self-starvation to unhealthy body weight

AN may not be as lethal as previously considered--previously reported death rates of 50% or higher may reflect the most severe and chronic forms of the disorder. A follow-up of individuals with less severe patterns found lower than expected rates of death (Korndorfer S.R., et al., 2003. Long-term survival of patients with Anorexia Nervosa: A population-based study in Rochester, Minnesota. Mayo Clinic Proceedings, 78, 278-284.)

3. Bulimia Nervosa

a. episodic loss of control over eating [binge]

b. inappropriate/dangerous weight control mechanisms [purge]

(1) self-induced vomiting

(2) abuse of emetics, laxatives, diuretics

(3) excessive exercise

Disorders possibly related to Bulimia Nervosa (c.f., Cooper, 2002):

Depression
Obsessive Compulsive Disorder
Posttraumatic Stress Disorder
Social Phobia
Dissociative Identity Disorder
Substance abuse disorders
Borderline Personality Disorder

Both depressive symptoms and depressive disorders have been reported in association with BN; the view of BN as a variant of mood disorder has not generally been supported; depression is often secondary to the eating disorder; this has been the guarded conclusion with respect to most of the other frequently reported comorbid conditions. One possible exception is Social Phobia, which often has developed prior to the eating disorder. Caution may be prudent in making Axis II diagnoses in patients with active eating disorders--Ames-Frankel et al. 1992 found that some patients lost their "personality disorder" following effective treatment for the eating disorder (Cooper, 2002)

Problems with substance eaten:

1. Pica (L for magpie: the old Romans thought the bird would eat anything. Pica referred to eating nonfood substances, but usually excluded behavior motivated by starvation or belief system. Current use of the term is often synonymous with the more general expression: scavenging behavior.

Scavenging Behavior: generic term for eating nonfood substances, regardless of reason.

Pica/scavenging behavior is common in very young children, usually outgrown.

Major concern in risk of lead poisoning if child consumes paints, plaster, or similar material.

a. Geophagia: eating earthy substances

b. Trichlophagia: eating hair

c. Corprophagia: eating feces

Risk factors

Despite operating as a general risk factor for psychopathology among adolescent girls (as well as a risk factor for depression and for substance abuse), early menarche does not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder (Stice, Presnell, & Bearman, 2001)

Follow-up of adolescents diagnosed with eating disorders

Striegel-Moore, Seeley, & Lewinsohn (2003) followup up a sample of female adolescents diagnosed with eating disorder into young adulthood: found significant impairments in health, self-image, and important areas of social functioning.

Followup of patients with anorexia nervosa in an outpatient treatment center

Korndorfer, Lucas, Suman, Crowson, Krain, & Melton (2003) found long term survival rates not different from community comparisons in a group of 208 patients followed up between 1935 and 1989 (193 female, 15 male)--probably relatively mild cases (few had been hospitalized, most had not seen a psychiatrist)