Eating Disorders

QUESTIONS

1. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), all of the following are the characteristic features of anorexia nervosa except:

A. body mass index (BMI) of less than 19

B. intense fear of gaining weight

C. body image disturbance

D. amenorrhea

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1. Answer: A. The essential features of anorexia nervosa are that the individual refuses to maintain a minimal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body. Amenorrhea is noted in postmenarcheal females. A BMI of less than 17.5 (or less than 85% of weight for the height) is considered as one of the features of anorexia nervosa.

2. According to the DSM-IV, all of the following are the characteristic features of bulimia nervosa except:

A. recurrent episodes of binge eating

B. recurrent inappropriate compensatory behavior to prevent weight gain

C. binge eating and compensatory behaviors occur at least twice a week for 6 months

D. self-evaluation unduly influenced by body weight and shape

E. the disturbance does not occur exclusively during episodes of anorexia nervosa

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2. Answer: C. The essential features of bulimia nervosa are binge eating and inappropriate compensatory methods to prevent weight gain. The self-evaluation of individuals is excessively influenced by body shape and weight. The binge eating and compensatory behaviors must occur, on average, at least twice a week for 3 months.

3. All of the following are the characteristic features of binge eating disorder except:

A. recurrent episodes of binge eating for at least 2 days per week in the last 6 months

B. absence of inappropriate compensatory behavior to prevent weight gain

C. binge eating episodes are associated with marked distress

D. BMI greater than 40

E. the disturbance does not occur exclusively during episodes of anorexia nervosa

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3. Answer: D. Binge eating disorder is characterized by recurrent episodes of binge eating in the absence of inappropriate compensatory behaviors. The binge eating episodes are associated with marked distress. Although many of these individuals are overweight or obese, there is no BMI criteria for this disorder.

4. A 23-year-old female with anorexia nervosa is admitted to the hospital for the third time in the past 12 years for electrolyte imbalance. Her worried parents want to know more about the course of the disorder and the mortality rate for anorexia nervosa. Which of the following is NOT TRUE about eating disorders?

A. The annual mortality rate for anorexia nervosa is 5%.

B. Full recovery in anorexia nervosa is 50%.

C. Full recovery in bulimia nervosa is 50%.

D. Twenty percent of patients with an eating disorder have a chronic course.

E. Patients with a binge eating disorder have a more favorable outcome compared to patients with other eating disorders.

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4. Answer: A. The annual mortality rate for anorexia nervosa is 0.6%. About 50% of individuals with anorexia nervosa and bulimia nervosa make a full recovery. About 30% make partial recovery, and the other 20% follow a chronic course.

5. All of the following electrolyte abnormalities are commonly found in anorexia nervosa except:

A. hyperchloremia

B. hypokalemia

C. elevated blood urea nitrogen

D. hypomagnesemia

E. hypophosphatemia

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5. Answer: A. Several electrolyte abnormalities are commonly found in patients with anorexia nervosa. Low zinc levels are also found. Hypochloremia (not hyperchloremia) is noted because of induced vomiting causing loss of hydrochloric acid.

6. A 19-year-old female’s parents are worried that the physicians have made an incorrect diagnosis of anorexia nervosa. They insist that their daughter’s weight loss is because of something “neurological” because they believe the weight loss occurred only after she had a head injury 3 years ago. However, the patient has all the characteristic features of anorexia nervosa, and the treating physician orders a brain magnetic resonance imaging (MRI) scan just to make sure he is not missing anything. What is the most likely finding on a brain MRI in patients with anorexia nervosa?

A. No abnormalities on brain MRI

B. Atrophy of appetite center in hypothalamus

C. Hypertrophy of satiety center in hypothalamus

D. Increased ventricular-brain ratio

E. Frontal lobe atrophy

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6. Answer: D. An increase in ventricular-brain ratio secondary to starvation is often seen in patients with anorexia nervosa.

7. All of the following are true regarding anorexia nervosa except:

A. mean age of onset is 17 years

B. prevalence in late adolescence and early adulthood is 0.5% to 1.0%

C. about 70% of anorexia nervosa patients are females

D. genetic and environmental factors are responsible

E. more common in industrial countries

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7. Answer: C. Anorexia nervosa is more prevalent in industrial countries where attractiveness for females is linked to being thin. The mean age of onset is 17 years, and it is rare over the age of 40 years. Anorexia nervosa is mainly seen in females, and in fact, more than 90% of the patients are female.

8. All of the following are true about bulimia nervosa except:

A. usually begins in adolescence or early adult life

B. prevalence in adolescence and young adult females is 1% to 3%

C. about 90% of bulimia nervosa patients are female

D. patients are typically obese

E. two subtypes: purging and nonpurging type

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8. Answer: D. Bulimia nervosa is more common than anorexia nervosa and typically begins in adolescence or early adult life. It is far more common in females than in males. Patients with bulimia nervosa are typically in the normal weight range, although some may be slightly underweight or overweight.

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