Chapter 7: Eating Disorder

Anorexia nervosa (AN) usually affects girls or young women.

Excessive weight loss and fear of getting fat
Defined as refused of maintaining body weight,
amenorrhea, or absence of at least 3 menstrual cycles
Bulimia nervosa (BN) frequent binge-eating causing selfvomiting to avoid weight gain.
DSM-5 defines frequency to be weekly (used to be
twice weekly)

Anorexia Nervosa
Nonpharm
Nutritional supplements
Exercise limited
Require need of family assistance if possible
Management:
1) For psychiatric and medical assessment if suicidal
ideation, pregnancy, syncope
2) Counsel regarding diagnosis, increase food intake and
normalize eating and nutrition: thiamine x5, oral zinc.
May try try prokinetic agents, olanzapine, or
cyproheptadine. Watch for improvement x1-2 months
Pharmacologic choices
Prokinetic agents:
Domperidone and metoclopramide reduce the
feeling of fullness.
Work by intestinal motility.
Domperidone is preferred because lower EPS, unless
required antinausea effect
Risks: QTc prolongation, HoK, HoBG
Cisapride removed from market d/t dysrhythmia and
death
Prucalopride (newer 5-HT4 receptor agonist) help to
normalize colonic function and treat constipation
o No QTc prolongation

o
Zinc

Initiate at 2mg dose and 1mg PO daily after 12mo

gluconate
can increase the rate of weight gain
100mg QD x2mo
Take with food to reduce nausea effects

Olanzapine (2nd generation antipsychotic)

Decreases anorexic rumination resulting in improved
motivation
2.5-5mg PO daily (max 20mg/day)
3 months of trial until BMI of 17 kg/m2. Longer use can
cause increase appetite and weight gain and
dyslipidemia
Cyproheptadine
4-16 mg qHS may be useful for chronic AN
Modest weight gain and a hypnotic
Anxiety
Clonazepam for severe anxiety (0.25-0.5mg BID)
Quetiapine to manage anxiety and used if
dependence issue
Fluoxetine used for coexistent depression. Give thiamine
100mg PO daily for 5 days. Ondansetron is not effective in
N/V for eating disorder.
Therapeutics
Weight gain 0.6-1.4kg per week in hospitalized, 0.20.5kg per week in outpatient settings
Hypoglycemia may occur because of depleted
glycogen storage
Body fat must be normalized for proper brain function
Refeeding syndrome is a big concern electrolyte
imbalance

Bulimia Nervosa
Nonpharm

Assess suicidal ideation and depression

CBT,IPT, and psychoeducation are helpful
Various forms of self-help therapy

Pharm
Antidepressants
Effective in reducing binge-eating disorders > 50% in
2/3 of patients
SSRIs, venlafaxine, or trazodone can be used
Fluoxetine is supported by most evidence
TCAs, MAOIs, and bupropion are not recommended
More than 1 antidepressants are not recommended.
When effective, trial 6-12 months

Pregnancy and Breastfeeding

Amenorrhic patients can still get pregnant without oral

contraceptives
Eating disorder symptoms improve during 2/3 of
patients, 1/3 will worsen
Delivery is usually normal and newborn is healthy
Breast milk production can be affected
Children are often aware of their mothers eating
disorder and may take on a caregivers role within the
first few years of life and may take on the disorder as
well.