Psychiatry
Psychosomatic and Eating Disorders
Psychosomatic and eating disorders for MBBS and NEET-PG: anorexia and bulimia nervosa, complications, refeeding syndrome and cognitive behavioural therapy, mapped to NMC codes PS12.
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Psychosomatic and Eating Disorders
Psychosomatic and eating disorders for MBBS and NEET-PG: anorexia and bulimia nervosa, complications, refeeding syndrome and cognitive behavioural therapy, mapped to NMC codes PS12.
This chapter covers psychosomatic disorders, where psychological factors shape a genuine physical illness, and the eating disorders that sit within this group. It contrasts anorexia and bulimia nervosa, sets out their complications including refeeding syndrome, and explains the leading role of psychological therapy in management.
High-yield: Psychosomatic and Eating Disorders
- Psychosomatic disorders are physical illnesses in which psychological factors have a significant influence on onset, course or severity.
- Conditions in which stress and emotion can worsen a genuine physical disease include asthma, peptic ulcer, hypertension, eczema and irritable bowel syndrome.
- The distinction from somatoform disorders is that in psychosomatic disorders there is a real, demonstrable physical disease.
- Eating disorders are an important group of psychosomatic conditions with high morbidity.
- Anorexia nervosa features deliberate weight loss, a body mass index below 17.5, an intense fear of gaining weight and a distorted body image.
- Amenorrhoea and features of starvation such as lanugo hair, bradycardia and hypotension are characteristic of anorexia nervosa.
- Anorexia nervosa carries the highest mortality of any psychiatric disorder, from both physical complications and suicide.
- Bulimia nervosa features recurrent binge eating followed by compensatory behaviour such as self-induced vomiting, with a normal or near-normal weight.
- Repeated vomiting in bulimia causes hypokalaemia, dental erosion, parotid swelling and Russell's sign, callused knuckles.
- Refeeding syndrome, with a dangerous fall in phosphate, is a risk when nutrition is restarted too quickly in a starved patient.
- Cognitive behavioural therapy is the first-line psychological treatment for bulimia nervosa.
- Management of anorexia nervosa prioritises restoring weight and treating medical complications alongside psychological therapy.
- Fluoxetine has a place in bulimia nervosa, but medication is secondary to psychological treatment in eating disorders.
- Family involvement is especially important when eating disorders present in adolescence.
Anorexia versus bulimia nervosa
- **Anorexia nervosa:** Weight loss, body mass index below 17.5, amenorrhoea. Highest mortality in psychiatry.
- **Bulimia nervosa:** Binge and purge cycles at near-normal weight. Hypokalaemia, dental erosion, Russell's sign.
- **Refeeding syndrome:** Falling phosphate when nutrition restarts too fast in a starved patient.
- **Treatment:** Psychological therapy first; CBT for bulimia; weight restoration in anorexia.
NMC competencies in this chapter
- **PS12.1:** Magnitude and aetiology of psychosomatic disorders
- **PS12.2:** Clinical features of psychosomatic and eating disorders
- **PS12.3:** Indications and interpretation of investigations
- **PS12.4:** Treatment including behavioural methods
- **PS12.5:** Family education in psychosomatic disorders
- **PS12.6:** Pharmacological basis and side effects of therapies
- **PS12.7:** Conditions for specialist referral
Frequently Asked Questions
What is a psychosomatic disorder?
It is a genuine physical illness in which psychological factors significantly influence onset, course or severity, such as stress worsening asthma, peptic ulcer or hypertension.
Why is anorexia nervosa so serious?
Anorexia nervosa carries the highest mortality of any psychiatric disorder, from starvation complications such as cardiac arrhythmia and electrolyte disturbance and from suicide.
What is refeeding syndrome?
It is a dangerous shift in electrolytes, especially a fall in phosphate, when nutrition is restarted too quickly in a severely malnourished patient, so refeeding must be gradual and monitored.
How is bulimia nervosa treated?
Cognitive behavioural therapy is the first-line treatment. Fluoxetine can help, but medication is secondary to psychological therapy in the eating disorders.
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