Eating disorders

EATING
DISORDERS
JAYESH PATIDAR
www.drjayeshpatidar.blogspot.com

Topics
 Covered:
 Anorexia Nervosa
 Bulimia Nervosa
 Not Covered:
 Overeating and Binge
Eating Disorder (DSM)
 Obesity
 Bariatric Surgery
www.drjayeshpatidar.blogspot.in

Anorexia Nervosa

Anorexia Nervosa:
Incidence and Characteristics
 Affects 3.7% of women
 Less common than bulimia
 6 to 20% die as a result of the illness
 Higher death rate than any other
psychiatric disorder

Anorexia Nervosa Characteristics,
cont’d
 Females, 90% (Male numbers are growing)
 Onset:
 Adolescence to early adulthood
 Age of onset is decreasing
 Often insidious
Occurs during important life transitions
 No loss of appetite
 Deliberate Weight loss

Cultural Influences
 Weight and Shape are
very important
 Computer Graphics:
make thin models
even thinner
 Preoccupation with
food, eating, fitness
 Unrealistic Ideals

DSM IV-TR Criteria
 Refusal to maintain normal weight
 Intense fear of gaining weight, even if
underweight
 Body image disturbances
 In female adults or adolescents, absence
of at least 3 consecutive menstrual cycles
 Types are: Restricting and Binge/Purging

Psychosocial Factors
 May be avoidant or have
social problems
 Rigid, competitive, perfectionistic
 Compulsive and obsessive
 Hyperactive
 Anxious
 Compliant “people pleasers”

Food-Related Behaviors in
Anorexia Nervosa
 Restricting intake, fasting
 Hoarding food
 Highly avoidant of certain foods
 Preoccupation with calories, meals, recipes, etc.
 Preparing/serving elaborate meals for others
 Rituals before and during eating
 become compulsions

Purging Behavior in Anorexia
 Purgers and vomiters
 Eat normally in a social situations
 Amount of food eaten is not excessive
 Purge if no success with severe restricting
(Not on the test)

Metabolic Consequences

Anorexia: More Consequences
 Decreased peristalsis is exacerbated by
overuse of laxatives or enemas
 Delayed gastric emptying
 Feel full much longer
 Dehydration

Anorexia: Consequences
 Amenorrhea, decreased development of
secondary sex characteristics
 Osteopenia or Osteoporosis
 Bone mass loss may be irreversible
 Weakness and fatigue
 But will persist in excessive exercising to burn calories

Anorexia: Complications
 Heart failure, life threatening
arrhythmias
 Cardiac ventricular dilation
 Decreased thickness of the
ventricular wall
 Decrease oxygenation of the cardiac
muscle
 Renal failure

Complications, cont’d
 Electrolyte imbalance
 Hypokalemia
 Hypocalcemia
 Metabolic imbalance
 Metabolic Acidosis
 Metabolic Alkalosis

Complication of Treatment:
Re-feeding Syndrome
 Severe Fluid Shifts from too rapid
re-introduction of food
 Extracellular to intracellular
 Cardiovascular, neurological and
hematologic complications
 Refeed slowly
 Close supervision

Nursing Diagnosis: Critical thinking
Write a nursing diagnosis for each of these
consequences of Anorexia Nervosa:
 1) Severe weight loss to 60% of average body
weight
 2) Bradycardia
 3) Overuse of laxatives to achieve wt. loss
 4) Refeeding Syndrome

Nursing Diagnosis: Critical thinking
Some possible choices
1) Nutrition less than body requirements r/t
refusal to eat; r/t excessive exercise
2) R/F falls r/t hypotension
3a) Fluid volume deficit r/t laxative overuse
3b) Constipation r/t altered gastric motility
4a) Imbalanced fluid volume r/t fluid shifts
4b) Impaired cardiac or peripheral tissue
perfusion r/t decreased cardiac output

Mental Health Problems
Associated with Anorexia
 Fear of losing control (Anxiety)
 Low sex drive
 Feelings of helplessness
 Feel abandoned or inadequate
 Combat by controlling what they eat
 Obsessive-compulsive disorder
 Major Depression
 (Dx and tx only after weight gain is established)
 Substance abuse
 Personality disorders

Etiology of Anorexia
 High levels of serotonin
 SSRIs are not effective
 If used should not be
started until weight
restoration is established

Etiology: Anorexia and the
Family
 Emotional restraint
 Enmeshed relationships
 Rigid organization
 Tight control
 Drive for thinness is a way to seek control
 Avoidance of conflict
 Odd eating habits
 Emphasis on appearance

Bulimia Nervosa

Bulimia
 Means to have an insatiable appetitive
 Begins in adolescents
 Primarily in women
 4% of young adults
 Symptom overlap with Anorexia, making
diagnosis difficult

Bulimia Characteristics
 Hide their eating-disordered behaviors
 Lack of weight loss
 Coexisting mental disorders:
 Major Depression
 Personality disorders
 Post traumatic Stress Disorder
 Purging develops as a way to compensate for
massive amounts of food eaten
 Restrictive eating….then purging….cycle

Binge Episode
Massive Amounts of Food

Binge Eating
 Feelings of lack of control
 Often done in secret
 High calorie-High carbohydrate
 Consumed in less than 2 hours
 Addicted to the high experienced when eating

Purging = Compensatory Behavior
for Binge Eating
 May use manual stimulation, laxatives,
and/or emetics
 Over time, self-induced vomiting occurs
with minimal stimulation
 Post-purging: sense of relief, calm

Consequences and Complications of
Purging
 Electrolyte imbalances
 Metabolic Acidosis
 Metabolic Alkalosis
 Cardiomyopathy
 Enlarged salivary
glands
 Erosion of dental
enamel
 Russell’s sign
 Pancreatitis

Differences in Bulimia from
Anorexia
 Lowered serotonin activity
 Binge eating raises levels of serotonin
 Treatment with SSRI, particularly
fluoxetine (Prozac)
 Depression; shame; hide their eating

Bulima: Associated Family
Characteristics
 Mood disorders
 Substance abuse
 Conflict
 Disorganized
 Lacking nurturance
 Food is a symbolic form of nurturing
 Evidence Bulimia is a response to chaos

Management of Eating Disorders
 Anorexia
 Increase weight to
90% of average body
weight
 Increase self-esteem
 Decrease need for
perfection (provided
by thinness)
 Bulimia
 Stabilize weight
without purging

Management of Eating Disorders
 Both Anorexia and Bulimia:
 Inpatient treatment for medical stabilization
and dietary management
 Long-term outpatient tx. addresses
psychosocial issues

Management: Starvation Phase
of Anorexia
 Assess labs:
 Monitor intake/output
 Assess for cardiovascular, neurological and
complications
 Refeed slowly; careful dietary supervision
 Intravenous lines and feeding tubes if
client refuses food

Nurse Patient Relationship
 Anorexia Nervosa
 Usually forced into tx.
 Tx means loss of
control over eating
 Nurse is the enemy
 Bulimia Nervosa
 More likely to want
help: break the cycle
 More likely to enter
treatment of their on
volition
 Tendency to
manipulate
 Hide the degree of the
problem

Critical Thinking: Nursing
Interventions
 Give rationales for each of the following
interventions listed on next slide 

Nurse Patient Relationship:
Some Interventions for Eating
Disorders
 Do not confront denial,
but encourage feelings
identification
 Honesty
 Collaborate
 TEACH patient about
their disorder
 Assist to identify positive
qualities
 Eat with the client
 Set appropriate limits
 Encourage decision
making concerning issues
other than food
 Behavior modification:
 Patient input
 Reward for weight
gain

Psychopharmacology
 Anxiolytics when re-feeding is occurring
 SSRI for Bulimia
 Equally effective for depressed and non-
depressed patients
 Psychotherapy for Anorexia
 Use antidepressant for co-morbid severe
depression

Milieu Management
 Orientation
 Warm nurturing environment
 Convey an understanding of their fears
 Close observation
Do we let these patient go to the rest room alone?
Should we let them go to their room right after a meal?
 Nonjudgmental confrontation
 CONSISTENCY
 Encourage the patient to talk to staff when they
feel the need to purgewww.drjayeshpatidar.blogspot.in

Milieu Management, cont’d
 Weighing
 Family Therapy
 Group Therapy
Which groups would be best for clients with
eating disorders?
 Dietitian
 Follow-up Therapy (outpatient)

Scenarios: Communication
1) Two clients on the eating disorders unit are
overheard discussing recipes and meal plans in
the day room. How should the nurse respond?
2) An inpatient with Anorexia Nervosa complains
of feeling very full after eating and says she is
being given too much to eat. How should the
nurse respond?

Eating disorders

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