1

Republic of the Philippines

Mindanao State University
COLLEGE OF HEALTH SCIENCES
Marawi City
RESOURCE UNIT
Topic: Eating Disorders
OBJECTIVES TOPICS/CONTENT METHODS/LEAR TIME FRAME REFERENCES
NING ACTIVITIES
At the end of this learning Eating is part of everyday life. It is necessary for https://www.singlecare.com/
experience, the learner will survival, but it is also a social activity and part of Brief lecture 30-45 minutes blog/news/eating-disorder- GROUP 6 Members:
be able to: many happy occasions. People go out for discussion using statistics/ (Eating Disorders MUSTAPHA, Sharifah L.
dinner, invite friends and family for meals in PowerPoint statistics 2022) PADO, Jamaleah Faiza E.
1. Different types of their homes, and celebrate special events such Presentation
PADO, Jamyllah Farra E.
Eating disorders as marriages, holidays, and birthdays with food.
2. Clinical Yet for some people, eating is a source of worry https://nurseslabs.com/eatin
manifestations of and anxiety. Are they eating too much? Do they g-disorders-anorexia-
eating disorders look fat? Is some new weight loss promotion bulimia-nervosa/ (Eating
3. Compare and going to be the answer? Obesity has been Disorders: Anorexia &
contrast Anorexia identified as a major health problem in the Bulimia Nervosa)
Nervosa and Bulimia United States; some call it an epidemic. The
Nervosa number of obesity-related illnesses among https://www.healthline.com/h
4. Discuss various children has increased dramatically. At the ealth/eating-disorders-
etiologic theories of same time, millions of women are either diagnosis#psychological-
eating disorders starving themselves or engaging in chaotic evaluations (Diagnosing an
5. Identify effective eating patterns that can lead to death. In this Eating Disorder)
treatment for clients presentation, we are going to tackle all about
with eating disorders eating disorders. Videbeck, S. L. (2011).
6. Evaluate feelings, Pyschiatric-Mental Health
beliefs, and attitudes Eating Disorders are illnesses that are Nursing (5th ed.).
about clients with characterized by irregular eating habits and Philadelphia: Wolters Kluwer
eating disorders extreme distress or concern about body weight Health | Lippincott Williams
or shape. Eating disturbances may involve & Wilkins.
inadequate or excessive food intake which can
basically cause harm to a person’s well-being.
The most common forms of eating disorders are
anorexia nervosa, bulimia nervosa, binge-eating
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disorder, pica, rumination disorder, avoidant or

restrictive food intake disorder (ARFID), and
other specified feeding or eating disorder
(OSFED).

Eating disorders can be viewed on a continuum,

with clients with anorexia nervosa eating too
little or starving themselves, client with bulimia
eating chaotically, and clients with obesity
eating too much.

• Although many believe that eating

disorders are relatively new,
documentation from the Middle Ages
indicates willful dieting leading to self-
starvation in female saints who fasted to
achieve purity.
• In the late 1800s, doctors in England
and France described young women
who apparently used self-starvation to
avoid obesity.
• It was not until the 1960s, however, that
anorexia nervosa was established as a
mental disorder.
• Bulimia nervosa was first described as a
distinct syndrome in 1979.

TYPES OF EATING DISORDERS

The most common eating disorders found in

the mental health setting are anorexia nervosa,
bulimia nervosa, binge-eating disorder, pica,
rumination disorder, avoidant or restrictive food
intake disorder (ARFID), and other specified
feeding or eating disorder (OSFED).
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1.Anorexia Nervosa is a life-threatening eating

disorder characterized by the client’s refusal or
inability to maintain a minimally normal body
weight, intense fear of gaining weight or
becoming fat, significantly disturbed perception
of the shape or size of the body, and steadfast
inability or refusal to acknowledge the
seriousness of the problem or even that one
exists.

Clients with anorexia become totally absorbed

in their quest for weight loss and thinness. The
term anorexia is actually a misnomer: These
clients do not lose their appetites. They still
experience hunger but ignore it and signs of
physical weakness and fatigue; they often
believe that if they eat anything, they will not be
able to stop eating and will become fat. Clients
with anorexia often are preoccupied with food-
related activities such as grocery shopping,
collecting recipes or cookbooks, counting
calories, creating fat-free meals, and cooking
family meals. They also may engage in unusual
or ritualistic food behaviors such as refusing to
eat around others, cutting food into minute
pieces, or not allowing the food they eat to
touch their lips. These behaviors increase their
sense of control. Excessive exercise is
common; it may occupy several hours a day.

2. Bulimia Nervosa is an eating disorder

characterized by recurrent episodes (at least
twice a week for 3 months) of binge eating
followed by inappropriate compensatory
behaviors to avoid weight gain such as purging,
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fasting, or excessively exercising.

The amount of food consumed during a binge

episode is much larger than a person would
normally eat. The client often engages in binge
eating secretly. Between binges, the client may
eat low-calorie foods or fast. Binging or purging
episodes are often precipitated by strong
emotions and followed by guilt, remorse,
shame, or self-contempt. The weight of clients
with bulimia usually is in the normal range,
although some clients are overweight or
underweight. Recurrent vomiting destroys tooth
enamel, and incidence of dental caries and
ragged or chipped teeth increases in these
clients. Dentists are often the first health care
professionals to identify clients with bulimia.

3. Binge-Eating Disorder (BED) is an eating

disorder characterized by recurrent episodes of
binge eating but it is not associated with the
recurrent use of inappropriate compensatory
behaviors as in bulimia nervosa, and does not
occur exclusively during the course of bulimia
nervosa, or anorexia nervosa methods to
compensate for overeating, such as self-
induced vomiting.

The essential features are recurrent episodes of

binge eating; no regular use of inappropriate
compensatory behaviors, such as purging or
excessive exercise or abuse of laxatives; guilt,
shame, and disgust about eating behaviors; and
marked psychologic distress. Binge eating
disorder frequently affects people over age 35,
and it occurs often in men. Individuals are more
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likely to be overweight or obese, overweight as

children, and teased about their weight at an
early age. Thirty-five percent reported that binge
eating preceded dieting; 65% reported dieting
before binge eating.

Even if not hungry, people with BED may

consume a large amount of food in a short
period of time.

4. Pica is an eating disorder that involves

persistent eating of non-nutritive substances
such as hair, dirt, and paint chips for a period of
at least one month.

5. Rumination disorder is characterized by

repeatedly and persistently regurgitating food
after eating, but it’s not due to a medical
condition or another eating disorder such as
anorexia nervosa, bulimia nervosa, binge-eating
disorder, or avoidant/restrictive food intake
disorder.

6. Avoidant/restrictive food Intake disorder

(ARFID) is an eating or feeding disturbance
characterized by persistent failure to meet
appropriate nutritional or energy needs due to
having no interest in eating regarding food with
certain sensory characteristics, such as color,
texture, smell or taste; or fear of choking.

7. Other Specified Feeding or Eating Disorder

(OSFED) are eating behaviors that cause
clinically compelling distress and impairment in
areas of functioning, but do not meet the full
criteria for any of the other feeding and eating
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disorders.

CAUSES OF EATING DISORDERS

A specific cause for eating disorders is

unknown; initially, dieting may be the stimulus
that leads to their development.

1. Biologic factors. Studies of anorexia nervosa

have shown that these disorders tend to run in
families; genetic vulnerability also might result
from a particular personality type or a general
susceptibility to psychiatric disorders. Or it may
directly involve a dysfunction of the
hypothalamus. A family history of mood or
anxiety disorders (e.g., obsessive–compulsive
disorder) places a person at risk for an eating
disorder.

2. Developmental factors. Onset of anorexia

nervosa usually occurs during adolescence or
young adulthood; some researchers believe its
causes are related to developmental issues.
Two essential tasks of adolescence are the
struggle to develop autonomy and the
establishment of a unique identity. Autonomy, or
exerting control over oneself and the
environment, may be difficult in families that are
overprotective or in which enmeshment (lack of
clear role boundaries) exists. Such families do
not support members’ efforts to gain
independence, and teenagers may feel as
though they have little or no control over their
lives. They begin to control their eating through
severe dieting and thus gain control over their
weight. Losing weight becomes reinforcing: by
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continuing to lose, these clients exert control

over one aspect of their lives.

3. Family influences. Girls growing up amid

family problems and abuse are at higher risk for
both anorexia and bulimia; disorders eating is a
common response to family discord. Girls
growing up in families without emotional support
often try to escape their negative emotions.
They place an intense focus outward on
something concrete: physical appearance.
Disordered eating becomes a distraction from
emotions.

4. Sociocultural factors. In the United States

and other Western countries, the media fuels
the image of the “ideal woman” as thin. The
culture equates beauty, desirability, and,
ultimately, happiness with being very thin,
perfectly toned, and physically fit. Adolescents
often idealize actresses and models as having
the perfect “look” or body even though many of
these celebrities are underweight or use special
effects to appear thinner than they are. Books,
magazines, dietary supplements, exercise
equipment, plastic surgery advertisements, and
weight loss programs abound; the dieting
industry is a billion-dollar business. The culture
considers being overweight a sign of laziness,
lack of self-control, or indifference; it equates
pursuit of the “perfect” body with beauty,
desirability, success, and will power. Thus,
many women speak of being “good” when they
stick to their diet and “bad” when they eat
desserts or snacks. Pressure from others also
may contribute to eating disorders. Pressure
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from coaches, parents, and peers and the

emphasis placed on body form in sports such
as gymnastics, ballet, and wrestling can
promote eating disorders in athletes.

INCIDENCES AND STATISTICS

Eating disorder statistics worldwide

• Global eating disorder prevalence

increased from 3.4% to 7.8% between
2000 and 2018. (the american journal of
clinical nutrition, 2019).
• 70 million people internationally live with
eating disorders. (National eating
disorders association).
• Japan has the highest prevalence of
eating disorders in asia, followed by
hong kong, singapore, taiwan, and south
korea. (International journal of eating
disorders, 2015).
• Austria had the highest rate of
prevalence in Europe at 1.55% as of
2012. (Psychology today, 2013).
• almost half of all americans know
someone with an eating disorder. (South
carolina department of mental health)

Eating disorder statistics by sex

• Eating disorders were more prevalent

among young women (3.8%) than men
(1.5%) in the U.S. as of 2001-2004.
(Journal of the American Academy of
Child and Adolescent Psychiatry, 2010)
• A quarter of those with anorexia are
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male. Men have an increased risk of

dying because they are diagnosed much
later than women. This could be in part
due to the misconception that men do
not experience eating disorders. (Eating
Disorders Resource Catalogue, 2014)

Eating disorder statistics by age

• Globally, 13% of women older than 50

experience disordered eating behaviors.
(International Journal of Eating
Disorders, 2012)
• The median age of eating disorder onset
was 21 years old for binge eating
disorder and 18 years old for anorexia
and bulimia nervosa. (Journal of the
American Academy of Child and
Adolescent Psychiatry, 2010)
• The lifetime prevalence of eating
disorders in the U.S. was 2.7% among
adolescents as of 2001-2004. (Journal
of the American Academy of Child and
Adolescent Psychiatry, 2010)
• Of adolescents with eating disorders, the
17- to 18-year-old age group had the
highest prevalence (3%). (Journal of the
American Academy of Child and
Adolescent Psychiatry, 2010)
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Symptoms of anorexia nervosa include:

• Fear of gaining weight or becoming fat

even when severely underweight.
• Body image disturbance.
• Amenorrhea or absence of menstrual
period.
• Depressive symptoms such as
depressed mood, social withdrawal,
irritability, and insomnia.
• Preoccupation with thoughts of food.
• Feelings of ineffectiveness.
• Inflexible thinking.
• Strong need to control environment.
• Limited spontaneity and overly
restrained emotional expression.
• Complaints of constipation and
abdominal pain.
• Cold intolerance.
• Lethargy.
• Emaciation.
• Hypotension, hypothermia, bradycardia.
• Hypertrophy of salivary glands.
• Elevated BUN.
• Electrolyte imbalances.
• Leukopenia and mild anemia.
• Elevated liver function studies.
Symptoms of bulimia nervosa include:

• Recurrent episodes of binge eating.

• Compensatory behavior such as self-
induced vomiting, misuse of
laxatives, diuretics, enema or other
medications, or excessive exercise.
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• Self-evaluation overly influenced by

body shape and weight.
• Usually within normal weight range,
possible underweight or overweight.
• Restriction of total calorie consumption
between binges, selecting low-calorie
foods while avoiding foods perceived to
be fattening or likely to trigger a binge.
• Depressive and anxiety symptoms.
• Possible substance use involving
alcohol and stimulants.
• Loss of dental enamel.
• Chipped, ragged, or moth-eaten
appearance of teeth.
• Increased dental caries.
• Menstrual irregularities.
• Dependence on laxatives.
• Esophageal tears.
• Fluid and electrolyte abnormalities.
• Metabolic alkalosis (from vomiting) or
metabolic acidosis (from diarrhea).
• Mildly elevated serum amylase levels.

Assessment and Diagnostic Findings

The following diagnostic tests and assessment

cues are commonly used for patients suspected
with eating disorders:

• Physical and mental status

evaluation.
• Complete blood count (CBC). The
hemoglobin levels are typically normal,
although elevations are observed in
states of dehydration; the white blood
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cell count (WBC) is typically low due to

increased margination, and
thrombocytopenia is also observed.
• Blood chemistries. Hyponatremia
(reflects excess water intake or the
inappropriate secretion of antidiuretic
hormone), hypokalemia (results from
diuretic
or laxative use), hypoglycemia (results
from the lack of glucose precursors in
the diet or low glycogen stores;
low blood glucose may also be due to
impaired insulin clearance), elevated
blood urea nitrogen (renal function is
generally normal except in patients
with dehydration, in whom the BUN level
may be elevated), Hypokalemic
hypochloremic metabolic alkalosis
(observed with vomiting), acidosis
(observed in cases of laxative abuse).
• Liver function tests. Liver function test
results are minimally elevated, but levels
encountered in patients with
active hepatitis are not observed;
albumin and protein levels are usually
normal, because although the amount of
food intake is restricted, it usually
contains high-quality proteins.

Medical Management

• Nutritional rehabilitation and weight

restoration. Clients receive nutritionally
balanced meals and snacks that
gradually increase caloric intake to a
normal level for size, age, and activity.
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• Family-based therapy. Individuals with

anorexia nervosa may respond best to
family-based treatment, also known as
the Maudsley method, an established
therapeutic modality for achieving and
maintaining remission from anorexia
nervosa.
• Cognitive behavioral therapy
(CBT). CBT is an evidence-based,
effective treatment for bulimia nervosa
(BN); behavioral approaches to avoiding
undesirable eating habits are used,
including diary keeping; behavioral
analyses of the antecedents, behaviors,
and consequences (so-called ABCs)
associated with binge eating and
purging episodes; and exposure to food
paired with progressive response
prevention regarding binge eating and
purging.
• Interpersonal
psychotherapy. Interpersonal
psychotherapy (IPT) addresses specific
issues in the interpersonal arena that
create the context for and stimulate
dynamic tensions that spur the patient’s
symptoms; these generally encompass
such processes as grief, role transitions,
role conflicts or disputes, and
interpersonal deficits.
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Pharmacologic Management

Several classes of drugs have been studied, but

few have shown clinical success.

• Electrolyte supplements. Electrolyte

repletion is necessary in patients with
profound malnutrition, dehydration, and
purging behaviors; repletion may be
done orally or parenterally, depending
on the patient’s clinical state.
• Fat-soluble vitamins. Vitamins are
used to meet necessary dietary
requirements. They are utilized in
metabolic pathways, as well as in
deoxyribonucleic acid (DNA) and protein
synthesis.
• Antidepressants, SSRIs. These agents
have been reported to reduce binge
eating, vomiting, and depression and to
improve eating habits, although their
impact on body dissatisfaction remains
unclear.

Nursing Management

Nursing care for a client with eating disorder

include the following:

Nursing Assessment

• History. Family members often describe

clients with anorexia nervosa as
perfectionists with above-average
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intelligence, achievement oriented,

dependable, eager to please, and
seeking approval before their condition
began; clients with bulimia, however,
often have a history of impulsive
behavior such as substance abuse,
shoplifting, as well as anxiety,
depression, and personality disorders.
• General appearance and motor
behavior. Clients with anorexia appear
slow, lethargic, and fatigued; they may
be emaciated depending on the amount
of weight loss; clients with bulimia may
be underweight or overweight but are
generally close to expected body weight
for age and size.
• Mood and affect. Clients with eating
disorders have labile moods that usually
correspond to their eating or dieting
behaviors.
• Though processes and
content. Clients with eating disorders
spend most of the time thinking about
dieting, food, and food-related behavior.
• Self-concept. Low self-esteem is
prominent in clients with eating
disorders.

Nursing Diagnosis

Nursing diagnoses for clients with eating

disorders include the following:

• Imbalanced nutrition: less than body

requirements related to purging or
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excessive use of laxatives.

• Ineffective coping related to inability to
meet basic needs.
• Disturbed body image related to being
excessively underweight.

Nursing Care Planning and Goals

Nursing care plans and goals for clients with

eating disorders:

• The client will establish adequate

nutritional eating patterns.
• The client will eliminate use of
compensatory behaviors such as
excessive exercise and use of laxatives
and diuretics.
• The client will demonstrate coping
mechanisms not related to food.
• The client will verbalize feelings of guilt,
anger, anxiety, or an excessive need for
control.
• The client will verbalize acceptance of
body image with stable body weight.

Nursing Interventions

Nursing interventions for clients with eating

disorders are:

• Establishing nutritional eating

patterns. When clients can eat, a diet of
1200 to 1500 calories per day is
ordered, with gradual increases in
calories until clients are ingesting
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adequate amounts for height, activity

level, and growth needs; the nurse is
responsible for monitoring meals and
snacks and often initially will sit with a
client during eating at a table away from
other clients; after each meal or snack,
clients may be required to remain in
view of staff for 1 to 2 hours to ensure
that they do not empty the stomach by
vomiting.
• Identifying emotions and developing
coping strategies. The nurse can help
clients begin to recognize emotions such
as anxiety or guilt by asking them to
describe how they are feeling and
allowing adequate time for response.
• Dealing with body image issues. The
nurse can help clients to accept a more
normal body image; this may involve
clients agreeing to weigh more than they
would like, to be healthy, and to stay out
of the hospital; helping clients to identify
areas of personal strength that are not
food related broadens client’s
perceptions of themselves.

Evaluation

Goals are met as evidenced by:

• The client was able to establish

adequate nutritional eating patterns.
• The client was able to eliminate use of
compensatory behaviors such as
excessive exercise and use of laxatives
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and diuretics.
• The client was able to demonstrate
coping mechanisms not related to food.
• The client was able to verbalize feelings
of guilt, anger, anxiety, or an excessive
need for control.
• The client was able to verbalize
acceptance of body image with stable
body weight.

Documentation Guidelines

Documentation in a client with eating disorder

include:

• Individual findings, including factors

affecting, interactions, nature of social
exchanges, specifics of individual
behavior.
• Cultural and religious beliefs, and
expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching,
and actions performed.
• Attainment or progress toward the
desired outcome.