Eating Disorders Practice Questions

Q: Which of the following eating disorders is most common?

Binge eating disorder. ***Binge eating disorder*** **Binge eating disorder (BED)** is the **most common eating disorder**, with a lifetime prevalence of approximately 2-3% in the general population. It is characterized by: - Recurrent episodes of eating large quantities of food - A sense of lack of control during binge episodes - Significant distress following binge episodes - **Absence of regular compensatory behaviors** (unlike bulimia nervosa) *Bulimia Nervosa* **Bulimia nervosa** is less common than binge eating disorder, with a lifetime prevalence of approximately 1-1.5%. It is characterized by recurrent binge eating episodes followed by inappropriate compensatory behaviors (self-induced vomiting, laxative misuse, excessive exercise, or fasting). While bulimia is a significant public health concern, its prevalence is definitively lower than that of BED. *Anorexia nervosa* **Anorexia nervosa** is the least common of the major eating disorders, with a lifetime prevalence of approximately 0.3-1%. It is characterized by intense fear of weight gain, distorted body image, and severe food restriction leading to significantly low body weight. Despite its lower prevalence, anorexia nervosa has the **highest mortality rate** among all psychiatric disorders. *All have same prevalence* The prevalence rates of eating disorders vary significantly. Epidemiological studies consistently show that **binge eating disorder** has substantially higher prevalence than both bulimia nervosa and anorexia nervosa.

Q: Avoidance of food is seen in

Anorexia nervosa. ***Anorexia nervosa*** - Individuals with anorexia nervosa restrict their food intake significantly, often to the point of **starvation**, driven by an intense fear of gaining weight. - This eating disorder is characterized by a **distorted body image** where the person sees themselves as overweight even when severely underweight. - **Food avoidance and restriction** are the core features of this disorder. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, accompanied by a feeling of loss of control. - Unlike anorexia, there are no regular compensatory behaviors, and the primary issue is **overconsumption**, not avoidance. *Bulimia nervosa* - Bulimia nervosa involves recurrent episodes of **binge eating followed by compensatory behaviors** like self-induced vomiting, excessive exercise, or laxative misuse. - While there is concern about weight, the pattern is one of binging and purging, rather than consistent food avoidance. *Pica* - Pica involves **persistent eating of non-nutritive substances** (e.g., soil, chalk, paper) for at least one month. - This is not characterized by food avoidance, but rather inappropriate consumption of non-food items.

Q: Bulimia nervosa is associated with

alkalosis. ***Alkalosis*** - **Recurrent self-induced vomiting** in bulimia nervosa causes loss of gastric HCl (hydrochloric acid) - This results in **metabolic alkalosis** with hypochloremia and hypokalemia - Elevated blood pH with compensatory hypoventilation is characteristic - **Directly related to the pathophysiology** of purging behaviors *Acidosis* - Would require excessive acid load or bicarbonate loss - Not typical in bulimia where gastric acid is lost through vomiting - Opposite acid-base disturbance from what occurs *Obesity* - Bulimics are typically **normal weight or slightly overweight** - Binge-purge cycle prevents substantial weight gain - Distinguishes bulimia from binge eating disorder *Decreased sexual drive* - Not a primary physiological association of bulimia nervosa - Sexual function is variable and depends on multiple psychological factors - Amenorrhea is less common than in anorexia nervosa

Q: Which of the following is not seen in anorexia nervosa?

Decreased appetite. ***Decreased appetite*** - Patients with **anorexia nervosa** often experience a **normal or even increased appetite** but intentionally restrict food intake due to an intense fear of gaining weight. - The hallmark of the disorder is self-imposed starvation, not a physiological lack of hunger. *Avoidance of food* - **Avoidance of food** is a central feature of anorexia nervosa, driven by a pervasive **fear of weight gain** and a distorted body image. - Patients actively employ various strategies to **restrict their caloric intake**, including rigid dieting, skipping meals, and meticulously counting calories. *Purging episodes* - **Purging behaviors**, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas, can be observed in the **binge-eating/purging type** of anorexia nervosa. - These behaviors are compensatory actions aimed at preventing weight gain after perceived overeating or even after consuming small amounts of food. *Significantly reduced weight* - A core diagnostic criterion for anorexia nervosa is a significantly **low body weight** for age, sex, developmental trajectory, and physical health, often defined as a body mass index (BMI) below 17.5 kg/m². - This weight loss is a direct consequence of the severe **food restriction** and compensatory behaviors.

Q: False regarding anorexia nervosa:

Decreased appetite is a feature. ***Decreased appetite is a feature*** - Anorexia nervosa is characterized by a **distorted body image** and an intense fear of gaining weight, leading to **intentional restriction** of food intake, not necessarily a lack of appetite. - Patients often experience hunger but **actively suppress** it due to their psychological drive to lose weight. *Weight loss is a feature* - **Significant weight loss** or failure to gain weight during a growth period is a core diagnostic criterion for anorexia nervosa. - This weight loss is **self-imposed** and often extreme, leading to a body weight that is significantly below normal for age and height. *Excessive exercising can be a feature* - Many individuals with anorexia nervosa engage in **excessive physical activity** as a means to burn calories and further reduce weight. - This compulsion to exercise often becomes **rigid and ritualistic**, contributing to energy deficit and weight loss. *Psychiatric symptoms such as depression may be associated* - **Comorbid psychiatric conditions** like **depression**, anxiety disorders, and obsessive-compulsive traits are very common in individuals with anorexia nervosa. - These symptoms can either **precede or be exacerbated** by the physiological and psychological impact of starvation and the disorder itself.

Q: A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

Observe patient for 2 hours after meal. ***Observe patient for 2 hours after meal*** - Patients with **anorexia nervosa** often engage in compensatory behaviors like **purging** or extensive exercise, which would counteract the effects of increased caloric intake and lead to a lack of weight gain despite consuming an "adequate" diet. - Observing the patient post-meal helps identify these behaviors and ensures that the ingested calories are actually being retained and utilized for weight restoration. *Increase the caloric intake from 1500 kcal to 2000 kcal per day* - Increasing caloric intake is a valid long-term strategy but is not the immediate next step when there's **no weight gain despite adequate intake**; the primary concern is identifying *why* the initial intake isn't leading to weight gain. - Doing so without addressing potential compensatory behaviors might only increase patient distress or lead to more intense purging/exercise. *Increase fluid intake* - While adequate **hydration** is important, it does not directly address the issue of **lack of weight gain** in anorexia nervosa, which is fundamentally a caloric deficit problem. - Increased fluid intake would not provide the necessary calories for weight restoration. *Increase the dose of anxiolytics* - Anxiolytics may help manage **anxiety** related to eating, but they do not directly promote **weight gain** or prevent compensatory behaviors. - This step does not address the core issue of why the recommended diet is not leading to weight gain.

Q: Pagophagia involves eating

Ice. ***Ice*** - **Pagophagia** is a specific form of **pica**, characterized by a compulsive desire to consume **ice**, ice chips, or iced drinks. - It is often associated with **iron-deficiency anemia**, though the exact mechanism for this craving is unclear. *Sand* - The compulsive consumption of **sand** is known as **geophagy**, which is another form of pica. - This behavior is distinct from pagophagia and is not specifically linked to ice consumption. *Salt* - An excessive craving for **salt**, while sometimes indicative of an underlying condition (e.g., adrenal insufficiency), is not referred to as pagophagia. - **Pagophagia** specifically refers to the consumption of ice. *Clay* - The ingestion of **clay** is a specific type of **geophagy**, similar to eating sand. - It is a different form of pica and does not describe the selective craving for and consumption of ice.

Q: Diagnostic criteria for Bulimia nervosa are all EXCEPT

Presence of other psychiatric disorders. ***Presence of other psychiatric disorders*** - While psychiatric comorbidities like depression, anxiety, and substance abuse are **extremely common** in individuals with bulimia nervosa, they are **not a diagnostic criterion** for the disorder. - The DSM-5 diagnosis of bulimia nervosa focuses specifically on **eating behaviors** (binge eating), **compensatory mechanisms** (purging/non-purging), and the impact on self-evaluation, not on the presence of co-occurring mental health conditions. - This is the correct answer as it is **NOT** a diagnostic criterion. *Lack of control over eating behaviour* - This is a **core diagnostic criterion** of bulimia nervosa. - Individuals must experience a sense of **lack of control** over eating during binge episodes (feeling unable to stop eating or control what or how much they are eating). - This feeling of loss of control during binges is essential for diagnosis. *Self induced vomiting* - This is a **diagnostic criterion** as one of the inappropriate compensatory behaviors used to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - At least one type of compensatory behavior must occur regularly (average of once weekly for 3 months). *Binge eating* - This is a **fundamental diagnostic criterion** involving eating an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances. - Must occur in a discrete time period (e.g., within any 2-hour period) with a sense of lack of control. - Binge episodes must occur, on average, at least once a week for 3 months for diagnosis.

Q: The following symptoms are common in Anorexia nervosa EXCEPT

Menorrhagia. ***Menorrhagia*** - Anorexia nervosa typically leads to **amenorrhea** (absence of menstruation) or **oligomenorrhea** (infrequent menstruation) due to hormonal imbalances, not **menorrhagia** (abnormally heavy or prolonged menstrual bleeding). - The severe nutritional deficiencies and low body fat percentage disrupt the hypothalamic-pituitary-gonadal axis, leading to **estrogen deficiency**, which prevents regular ovulation and uterine lining development. *Weight loss* - **Significant weight loss** is a defining characteristic of anorexia nervosa, resulting from self-imposed starvation and excessive exercise. - This symptom is central to the diagnostic criteria for the disorder. *Mood changes* - Individuals with anorexia nervosa frequently experience various **mood changes**, including **depression**, **anxiety**, **irritability**, and **social withdrawal**. - These emotional disturbances can be both a cause and a consequence of the eating disorder, often driven by constant food preoccupation and body image concerns. *Dehydration* - **Dehydration** is a common physical complication of anorexia nervosa, often resulting from inadequate fluid intake, persistent vomiting (if purging is involved), and potential misuse of laxatives or diuretics. - This can lead to **electrolyte imbalances** and other serious health problems.

Question 1

Which of the following eating disorders is most common?

Accepted Answer

Binge eating disorder

Answer

Bulimia Nervosa

Answer

Anorexia nervosa

Answer

All have same prevalence

Question 2

Avoidance of food is seen in

Accepted Answer

Anorexia nervosa

Answer

Binge eating disorder

Answer

Pica

Answer

Bulimia nervosa

Question 3

Bulimia nervosa is associated with

Accepted Answer

alkalosis

Answer

acidosis

Answer

obesity

Answer

decreased sexual drive

Question 4

Which of the following is not seen in anorexia nervosa?

Accepted Answer

Decreased appetite

Answer

Avoidance of food

Answer

Purging episodes

Answer

Significantly reduced weight

Question 5

False regarding anorexia nervosa:

Accepted Answer

Decreased appetite is a feature

Answer

Weight loss is a feature

Answer

Excessive exercising can be a feature

Answer

Psychiatric symptoms such as depression may be associated

Question 6

A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

Accepted Answer

Observe patient for 2 hours after meal

Answer

Increase the caloric intake from 1500 kcal to 2000 kcal per day

Answer

Increase fluid intake

Answer

Increase the dose of anxiolytics

Question 7

Pagophagia involves eating

Accepted Answer

Ice

Answer

Sand

Answer

Salt

Answer

Clay

Question 8

Diagnostic criteria for Bulimia nervosa are all EXCEPT

Accepted Answer

Presence of other psychiatric disorders

Answer

Lack of control over eating behaviour

Answer

Self induced vomiting

Answer

Binge eating

Question 9

The most appropriate management approach for anorexia nervosa includes:

Accepted Answer

Multidisciplinary approach with psychological therapy and nutritional rehabilitation

Answer

Immediate high-calorie diet with rapid weight gain

Answer

Strict bed rest with minimal physical activity

Answer

Antipsychotic medications as first-line treatment

Question 10

The following symptoms are common in Anorexia nervosa EXCEPT

Accepted Answer

Menorrhagia

Answer

Weight loss

Answer

Mood changes

Answer

Dehydration

Eating Disorders — MCQs

Eating Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?