E A T I N G DISORDERS

ETIOLOGY:

1. Biologic Factors
serotonin levels

2. Sociocultural Factors
physical attractiveness in obtaining approval

3. Family Factors
genetic component and family environment
TYPES:
I. Anorexia Nervosa 4. Cognitive and Behavioral Factors
1. Restricting Type positive attention from others, low self-esteem, extreme
2. Binge-eating / concerns about body shape and weight.
Purging Type
II. Bulimia Nervosa 5. Psychodynamic Factors
1. Purging Type early history of sexual abuse, regression, obsession, anxiety
2. Nonpurging Type (anorexia); ambivalence (bulimia)

I. ANOREXIA NERVOSA
anorexia means loss of appetite
underweight
DENY their condition is problematic
Types:
1. Restricting Type
during an episode of anorexia nervosa, individuals do not engage in recurrent episodes of binge eating
or purging.
2. Binge-eating / Purging Type
during an episode of anorexia nervosa, individuals engage in recurrent episodes of binge eating or
purging.
Onset: preadolescence to early adulthood; average (12 to 13 years of age)
Course: insidous
Pre-morbid: Perfectionist, introvert with problems with self esteem and peer relationship.

DSM CRITERIA
Objective Signs: Refusal to maintain body weight at or above Subjective Symptoms:
Deliberate weight loss
a minimum normal weight for age and Fear of losing control over the
Hypotension, bradycardia,hypothermia
height amount of food eaten
Amenorrhea Intense fear of gaining weight or becoming Helplessness
Constipation fat even though UNDERWEIGHT Depression
Dry skin, cracking
Disturbance in the way in which ones body Irritability
Lanugo weight or shape is experienced, overvaluing Social withdrawal
Preoccupied to food and or
of shape eating which
weight or DENIAL of Lessened sex drive
involves all aspects of life. of low weight.
seriousness Obsessional symptoms
Engage in bizarre
In behavior
females, absence of at least three
consecutive menstrual cycle.
1
PSYCHOTHERAPEUTIC MANAGEMENT
Serious: Hospitalization
Outpatient Therapy: less than 6 months, are not binging and purging
TNPR
Increase self-esteem
o Assist in identifying positive qualities about themselves
o Identify patients non weigh related interests.
Increase weight
o Hospitalization
o Rehabilitation
Reestablish eating pattern
o Set limits
o Teach patient about their disorder
o Initiate a behavior modification program that rewards weight gain with meaningful privileges
MILIEU
Tour of the setting
Provide a warm nurturing atmosphere
Involve families in the treatment
Involve the dietitian
Psychotherapy group and individual therapy.

II. BULIMIA NERVOSA

- bulimia means to have insatiable appetite
- Weight is NORMAL
- AWARE that their eating is pathologic

Types:
1. Purging Type
regularly engages in self-induced vomiting or the use of laxatives, diuretics, or enemas
2. Nonpurging Type
regularly uses strict diet, fasting, or vigorous exercise, but does not regularly engage in purging.

Onset: 15 to 24 years old; typical 18 19, college

Course: CHRONIC and Intermittent

DSM-IV-TR CRITERIA
Recurrent episodes of binge eating in a short time
period, with intake much greater than average
A feeling of lack of control over eating behaviors
during eating binges
Recurrent inappropriate compensatory behavior in
order to prevent weight gain, such as self induced
vomiting, use of laxatives or diuretics, strict
dieting or fasting, vigorous exercise, or taking diet
pills

2
 Binge eating and inappropriate compensatory
behaviors both occur on average at least twice a
week for 3 months.
Self evaluation is unduly influenced by body shape
and weight

Objective signs Subjective Symptoms

Mechanical irritation and injuries to the GIT Fear of becoming fat
Fluid and Electrolytes abnormalities Anxiety
Esophagitis Guilt
Pancreatitis Depression (common)
Aspiration Pneumonia Marker Food
Addiction
Reflex constipation
Cardiomyopathy
Menstrual irregularities
Enlarged salivary glands (painless)
Erosion of the dental enamel
Russells sign

PSYCHOTHERAPEUTIC MANAGEMENT
Initial goal: Medical stabilization of the bulimic patient is the initial treatment, then PSYCHOTHERAPY
TNPR
Create an atmosphere of trust
Help patient identify feelings associated with the binge purge behavior.
Encourage client identify positive qualities about themselves in order to improve self esteem.
Teach patient about bulimia nervosa
Consistency/ limit setting
MILIEU
Goal: To establish normal eating pattern and to interrupt the binge and purge cycle.
First participate in simple treatment, such as guided self help or
psychoeducational group
Cognitive behavior therapy
o Self monitoring (Diary or Manual)
Help manage emotions Intensive treatment
o Relaxation techniques o Interpersonal
o Distraction techniques psychotherapy
o Partial/full hospitalization
o Antidepressant medication
III. BINGE EATING DISORDER (BED)
- eating disorder not otherwise specified
- shares many criteria of bulimia nervosa but without the regular
compensation for excess intake.
Onset: late adolescence to early adulthood
DSM-IV-TR CRITERIA
Recurrent binge eating at least 2 days per week for 6
months and at least 3 of the following:
o Eating rapidly
o Eating until becoming uncomfortably full
3
 o Eating large amounts when not hungry
o Eating alone because of embarrassment
o Disgust, depression, guilt because of eating
episodes
Primary Goal: Establish a regular, healthy eating pattern.

IV. EATING DISORDERS IN MALES

10% - 15% of eating-disordered population
Homosexual
with history of obesity
feel less guilt than females about episodes of bingeing and purging
dieting or bingeing is more often related to a desire to build a lean body for participation in sports

COMPARISON BETWEEN ANOREXIA AND BULIMIA

SIMILARITIES
Restriction of intake at times, especially anorectics Perfectionist traits
Bingeing or overeating at times, especially bulimics Belief that their worth is based solely on appearance
Purging through vomiting, laxatives, or diuretics Discomfort in social settings, especially with the
Overexercise opposite gender
Extreme concern about appearance Misperception of their size, shape, and level of fat
Low self-esteem
DIFFERENCES
Anorexia Bulimia
Early onset Later onset
Very low weight More normal weight
Amenorrhea for some patients Menstrual irregularities
Hormonal imbalance Fluid and electrolyte imbalance
Constipation if not using laxatives Gastrointestinal problems related to bingeing and
purging

KEY NURSING INTERVENTIONS for EATING DISORDER

Monitor daily caloric intake
Regularly monitor electrolyte status
Observe patients for signs of purging
Monitor activity level
Weigh daily
Plan for dietitian
Encourage use of therapies or support groups
Promote decision making
Promote positive self-concept