Feeding & Eating

Disorders
Delasondra | Mantilla | Pastor
 INTRODUCTION
Feeding and eating disorders are
characterized by a persistent disturbance
of eating or eating-related behavior that
results in the altered consumption or
absorption of food and that significantly
impairs physical health or psychosocial
functioning.
PICA
 PICA
Pica is a compulsive eating
disorder in which people eat
non-food items. Dirt, clay,
and flaking paint are the most
common items eaten. Less
common items include glue,
hair, cigarette ashes, and
feces .
 DIAGNOSTIC CRITERIA
A. Persistent eating of nonnutritive, nonfood
substances over a period of at least 1 month.

B. The eating of nonnutritive, nonfood substances

is inappropriate to the development level of
the individual.
 DIAGNOSTIC CRITERIA
C. The eating behavior is not part of a culturally
supported or socially normative practice.

D. If the eating behavior occurs in the context of

another mental disorder, it is sufficiently
severe to warrant additional clinical attention.
 DIAGNOSTIC FEATURES
1. The essential feature of pica is the eating of one
or more non-nutritive, nonfood substances on a
persistent basis over a period of at least 1 month

2. Typical substances ingested tend to vary with age

and availability and might include paper, soap, cloth,
hair, string, wool, soil, chalk, talcum powder, paint,
gum, metal, pebbles, charcoal or coal, ash, clay,
starch, or ice
 DIAGNOSTIC FEATURES
3. The eating of nonnutritive, nonfood substances
can be an associated feature of other mental
disorders (e.g., intellectual disability
[intellectual developmental disorder], autism
spectrum disorder, schizophrenia).
 CLINICAL MANIFESTATIONS
• Belly pain
• Nausea
• Bloating
• Fatigue
• Behavior problems
• School problems
• Lead poisoning
 RISK AND PROGNOSTIC FACTORS

Environmental
• Neglect, lack of supervision, and
developmental delay can increase the risk
for this condition
 DIAGNOSTIC TESTS
1. Medical Evaluation
2. X-ray
3. Blood tests
4. Health History
 TREATMENT
Close medical monitoring is necessary throughout
treatment of the eating behavior. Additionally,
close collaboration with a mental health team
skilled in treating pica is ideal for optimal
treatment of these complex cases.
 NURSING DIAGNOSES
● Imbalanced Nutrition: Less than Body Requirements
related to ingestion of nonnutritive, nonfood
substances
● Risk for Injury related to ingestion of nonfood
substances
● Disturbed Thought Processes
 NURSING MANAGEMENT
● Supervise the patient during mealtimes and for a specified
period after meals (usually one hour).
● Establish a minimum weight goal and daily nutritional
requirements.
● Eliminate toxic substances such as lead, mercury, etc.
● Use a consistent approach. Sit with the patient while eating;
present and remove food without persuasion and comment.
Promote a pleasant environment and record intake.
● Provide nutritional therapy within a hospital treatment
program as indicated when the condition is life-threatening.
ANOREXIA
NERVOSA
 ANOREXIA NERVOSA
Anorexia nervosa — often simply called
anorexia — is an eating disorder
characterized by an abnormally low body
weight, an intense fear of gaining weight
and a distorted perception of weight. People
with anorexia place a high value on
controlling their weight and shape, using
extreme efforts that tend to significantly
interfere with their lives.
 DIAGNOSTIC CRITERIA
A. Restriction of energy intake relative to
requirements, leading to a significantly low
body weight in the context of age, sex,
developmental trajectory, and physical health.
Significantly low weight is defined as a
weight that is less than minimally normal or,
for children and adolescents, less than that
minimally expected.
 DIAGNOSTIC CRITERIA
B. Intense fear of gaining weight or of
becoming fat, or persistent behavior that
interferes with weight gain, even though at a
significantly low weight.
 DIAGNOSTIC CRITERIA
C. Disturbance in the way in which one’s body
weight or shape is experienced, undue influence
of body weight or shape on self-evaluation, or
persistent lack of recognition of the seriousness of
the current low body weight.
 DIAGNOSTIC FEATURES
There are three essential features of anorexia
nervosa:
● individual's weight be significantly low
● intense fear of gaining weight or of becoming
fat
● experience and significance of body weight and
shape are distorted
 RISK AND PROGNOSTIC FACTORS

● Temperamental
● Environmental
● Genetic and physiological
 DIAGNOSTIC TESTS
1. Hematology
2. Serum chemistry
3. Endocrine
4. Electrocardiography
5. Bone mass
6. Electroencephalography
7. Resting energy expenditure
8. Physical signs and symptoms
 TREATMENT
1. Hospitalization
2. Restoring a healthy weight
3. Psychotherapy:
● Family-based therapy
● Individual therapy
4. Medication:
● Antidepressants or other psychiatric medications
 NURSING DIAGNOSES
● Imbalanced Nutrition: Less than Body Requirements
related to chronic/excessive use of laxatives or
inadequate food intake as evidenced by low BMI
● Disturbed body image related to continual negative
evaluation of self as evidenced by distorted body
image
● Disturbed thought processes related to psychological
conflicts as evidenced by failure to recognize hunger
 NURSING MANAGEMENT
● Assess and observe the client closely for
self-destructive behavior or suicidal intent.
● Maintain consistency of treatment. One staff member
per shift should be identified to have the final word
on all decisions (though other staff or the client
may have input).
● Remain aware of your own behavior with the client.
Be consistent, truthful, and nonjudgmental.
 NURSING MANAGEMENT
● Allow the client food only at specified snack and
mealtimes. Do not talk with the client about
emotional issues at these times. Encourage the
client to ventilate his or her feelings at other times
in ways not associated with food or eating.
● Observe and record the client’s responses to stress.
Encourage the client to approach the staff at
stressful times.
 NURSING MANAGEMENT
● As tolerated, encourage the client to express his or
her feelings regarding achievement, family issues,
independence, social skills, sexuality, and control.
● Refer the client and family to support groups in the
community or via the internet. However, caution the
client and family about internet groups that
encourage anorexia and provide guidance regarding
evaluation of online resources.
BULIMIA
NERVOSA
 BULIMIA NERVOSA
Bulimia nervosa, commonly called
bulimia, is a serious, potentially
life-threatening eating disorder. People
with bulimia may secretly binge —
eating large amounts of food with a loss
of control over the eating — and then
purge, trying to get rid of the extra
calories in an unhealthy way.
 DIAGNOSTIC CRITERIA
A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following:
● Eating, in a discrete period of time
(e.g., within any 2-hour period), an
amount of food that is definitely larger
than what most individuals would eat in
a similar period of time under similar
circumstances.
 DIAGNOSTIC CRITERIA
● A sense of lack of control over eating
during the episode (e.g., a feeling that one
cannot stop eating or control what or how
much one is eating).
B. Recurrent inappropriate compensatory behaviors
in order to prevent weight gain, such as
self-induced vomiting; misuse of laxatives,
diuretics, or other medications; fasting; or
excessive exercise.
 DIAGNOSTIC CRITERIA
C. The binge eating and inappropriate
compensatory behaviors both occur, on average, at
least once a week for 3 months.
D. Self-evaluation is unduly influenced by body
shape and weight.
E. The disturbance does not occur exclusively
during episodes of anorexia nervosa.
 DIAGNOSTIC FEATURES
There are three essential features of bulimia
nervosa:
● recurrent episodes of binge eating
● recurrent inappropriate compensatory behaviors
to prevent weight gain
● self-evaluation that is unduly influenced by
body shape and weight
 RISK AND PROGNOSTIC FACTORS

● Temperamental
● Environmental
● Genetic and physiological
● Course modifiers
 DIAGNOSTIC TESTS
No specific diagnostic test for bulimia nervosa
currently exists. However, several laboratory
abnormalities may occur as a consequence of
purging and may increase diagnostic certainty.
These include fluid and electrolyte abnormalities,
such as hypokalemia, hypochloremia, and
hyponatremia.
 DIAGNOSTIC TESTS
Others:
● Metabolic alkalosis & acidosis
● Mildly elevated levels of serum amylase
● Significant and permanent loss of dental enamel
● Enlarged parotid glands
● Development of calluses or scars on the dorsal surface of
the hand from repeated contact with the teeth.
● Serious cardiac and skeletal myopathies
 TREATMENT
1. Psychotherapy:
● Cognitive behavioral therapy
● Family-based treatment
● Interpersonal psychotherapy
2. Medication:
● Fluoxetine (Prozac)
3. Nutrition Education
4. Hospitalization
 NURSING DIAGNOSES
● Imbalanced nutrition: less than body requirements
r/t purging or excessive use of laxatives.
● Ineffective coping r/t inability to meet basic needs.
● Disturbed body image r/t being excessively
underweight.
 NURSING MANAGEMENT
● Ask the client directly about thoughts of suicide
or self-harm.
● Set limits with the client about eating habits
(e.g., food will be eaten in a dining room
setting, at a table, only at conventional
mealtimes).
● Encourage the client to eat with other clients
when tolerated.
 NURSING MANAGEMENT
● Encourage the client to express feelings, such as
anxiety and guilt about having eaten.
● Maintain a nonjudgmental approach when
discussing the client’s feelings.
● Discuss the types of foods that are soothing to
the client and that relieve anxiety.
● Give positive feedback for the client’s efforts to
discuss feelings.
Binge-Eating
Disorder
BINGE-EATING DISORDER
Binge eating disorder (BED) is a severe,
life-threatening, and treatable eating disorder
characterized by recurrent episodes of eating
large quantities of food (often very quickly and
to the point of discomfort); a feeling of a loss
of control during the binge; experiencing shame,
distress or guilt afterwards; and not regularly
using unhealthy compensatory measures (e.g.,
purging) to counter the binge eating. It is the
most common eating disorder in the United
States.
 BINGE-EATING DISORDER
BED is one of the newest eating disorders formally
recognized in the DSM-5. Before the most recent revision in
2013, BED was listed as a subtype of EDNOS (now referred
to as OSFED). The change is important because some
insurance companies will not cover eating disorder treatment
without a DSM diagnosis.
DIAGNOSTIC CRITERIA
 DIAGNOSTIC CRITERIA
● Recurrent episodes of binge eating. An episode of binge eating
is characterized by both of the following:
a. Eating, in a discrete period of time (e.g., within any
2-hour period), an amount of food that is definitely
larger than what most people would eat in a similar
period of time under similar circumstances.
b. A sense of lack of control over eating during the episode
 DIAGNOSTIC CRITERIA
● The binge-eating episodes are associated with three (or more)
of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically
hungry.
4. Eating alone because of feeling embarrassed by how much
one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty
afterward.
 DIAGNOSTIC CRITERIA
● Marked distress regarding binge eating is present.
○ The binge eating occurs, on average, at least once a
week for 3 months
○ The binge eating is not associated with the recurrent
use of inappropriate compensatory behavior as in
bulimia nen/osa and does not occur exclusively during
the course of bulimia nervosa or anorexia nervosa.
 DIAGNOSTIC FEATURES
● The essential feature of binge-eating disorder is recurrent
episodes binge eating that must occur, on average, at least once
per week for 3 months.
● An occurrence of excessive food consumption must be accompanied
by a sense of lack of control to be considered an episode of binge
eating. An indicator of loss of control is the inability to refrain
from eating or to stop eating once started.
● Binge eating must be characterized by marked distress.
 DIAGNOSTIC TESTS
● Complete Medical History
● Physical Examination
● Blood and Urine Tests
● Psychological Evaluation
 ASSESSMENT
● Eating Disorder Examination (EDE)
● Eating Disorder Inventory (EDI-3)
● Binge Eating Scale (BES)
● Structures interview for Anorexic and Bulimic
Syndromes (SIAB-EX)
● Three Factor Eating Questionnaire (TFEQ)
 TREATMENT
● Psychotherapy
○ Cognitive behavioral therapy (CBT)
○ Interpersonal psychotherapy
○ Dialectical behavior therapy
● Medications
○ Topiramate (Topamax), an anticonvulsant
○ Antidepressants
○ Lisdexamfetamine dimesylate
● Behavioral weight-loss programs
 NURSING DIAGNOSES
● Imbalanced Nutrition more than body requirements
r/t ingestion of large quantities of food
● Chronic low self-esteem r/t continual negative
valuation of self
● Disturbed thought process r/t psychological conflicts:
perceived lack of control
 NURSING MANAGEMENT
● Maintain a nonjudgmental approach when discussing the client’s
feelings.
● Encourage the client to describe and discuss feelings verbally.
However, avoid discussing food-related feelings during
mealtimes, and begin to separate dealing with feelings from
eating or purging behaviors.
● Help the client explore ways to relieve anxiety, express feelings,
and experience pleasure that are not related to food or eating.
 NURSING MANAGEMENT
● Teach the client about the use of the problem-solving process:
identify the problem, examine alternatives, weigh the pros and
cons of each alternative, select and implement an approach, and
evaluate its success.
● Ongoing therapy may need to include significant others to sustain
the client’s non– food-related coping skills.
● Refer the client, family, and significant others to support groups
in the community or via the internet
THANK YOU FOR
LISTENING!
In your own words, describe the
feeding and eating disorders
mentioned:
Anorexia Nervosa
Bulimia Nervosa
BED
PICA
What is the difference
between anorexia and
bulimia?
 What are the common
treatments of feeding and
eating disorders?
Give at least (1) nursing
diagnosis for:
PICA
BED
Anorexia Nervosa
Bulimia Nervosa