Eating Disorders

Anorexia Vs. Bulimia

• Eating disorders can be viewed on a
continuum with clients with anorexia
eating too little or starving themselves,
clients with bulimia eating chaotically,
and clients with obesity eating too much.
• Biological factors - obsessive-compulsive disorder
• Psychological factors -perfectionist
• Family factors – strict parents
• Social factors – sorority, dance companies
• Cultural pressures – westernized countries
• Media factors - models
• Lifestyle and eating disorder -cheerleaders
• Physical or sexual abuse – bad/ do not deserve to eat
• Body image is how a person perceives his or
her body, i.e., a mental self-image.
– For most people, body image is consistent with
how others view them. For people with anorexia
nervosa, however, their body image differs greatly
from the perception of others. They perceive
themselves as fat, unattractive, and undesirable
even when they are severely underweight and
malnourished.
• Body image disturbance occurs when there is
an extreme discrepancy between one’s body
image and the perceptions of others and
extreme dissatisfaction with one’s body image.
 BULIMIA NERVOSA
“The Diet-Binge-Purge Disorder”

Definition of Terms:
• Diet - A regulated selection of foods, as for
medical reasons or cosmetic weight loss.
• Binge - A period of excessive or uncontrolled
indulgence in food or drink. Eating a large amount
of food over a short period of time.
• Purge – A self-induced vomiting in order to rid
self of stomach contents; to cleanse; eject the
contents of the stomach through the mouth.
• Alternating dieting, binging, and purging through
vomiting, enema, and laxatives.
• Person engages in episodes of starvation and other
methods of controlling weight.
• Engages in rapid eating for about 2 hours then terminates
binging by purging.
• Chronic disorder that manifest first during late adolescence
and early adulthood (15-24 years old).
• These people are known to be perfectionist, achievers
scholastically and professionally and highly dependent on
the approval of others to maintain self-esteem and hide
their disorder for fear of rejection.
• After binging, he/she becomes guilty and depressed for
lose of self control then self-criticizes himself/herself then
he/she purges as a form of cleansing and punishment.
 Symptoms/Manifestations

• B – binge eating
• U – under strict diet
• L – lacks control over binging
• I – Induced Vomiting (Purging)
• M – Minimum of 2 binge eating per
week
• I – Increase Concern of body
size/shape
• A – Abuse of diuretics and Laxatives
 Anorexia Nervosa
“The relentless pursuit of thinness”

• characterized by extreme low body weight

and body image distortion, with an
obsessive fear of gaining weight
• eat normally in social situations but retreat
to the nearest bathroom to purge
themselves after eating
 Symptoms
A –Amenorrhea
N – No Organic Factor
Accounts for weight loss
O – Obviously thin but feels
fat
R – Refusal to maintain
Normal Body Weight
E – Epigastric discomfort is
common
X – peculiar symptom –
hiding foods
I – Intense Fear of gaining
weight
A – always thinking of foods
• Complaints of constipation
and abdominal pain
• Cold intolerance
• Lethargy
• Emaciation
• Hypotension, hypothermia,
and bradycardia
• Hypertrophy of salivary
glands
• Elevated BUN (blood urea
nitrogen)
• Electrolyte imbalances
• Leukopenia and mild anemia
• Elevated liver function
studies
 Types of Anorexia
1. Restricting
– Severely restricts food intake but does not engage
in the behaviors seen in the binge eating type.
Weight loss by dieting, fasting and excessive
exercise.
2. Binge eating/Purging type
– Engages in binge eating or purging behavior which
involves self-induced vomiting or the misuse of
laxatives, diuretics, or enemas.
 Nursing Diagnoses
( Eating Disorders)

• Body image disturbance

• Self- esteem disturbance
• Ineffective individual coping
 Drugs
• Amitriptyline (Elavil) and the antihistamine cyproheptadine
(Periactin) in high doses (up to 28 mg/day) – promote weight gain

• Olanzapine (Zyprexa) – antipsychotic associated weight gain

• Fluoxetine(Prozac) has shown some effectiveness in preventing

relapse in clients whose weight has been partially or completely
restored.
• ANTI-DEPRESSANTS such as desipramine (Norpramin),
imipramine (Tofranil), amitriptyline (Elavil), nortriptyline
(Pamelor), phenelzine (Nardil) – reducing binge eating (studies)

• PLACEBO
 MEDICAL COMPLICATIONS OF
•
EATING
RELATED TO WEIGHT LOSS
DISORDERS
– Musculoskeletal - Loss of muscle mass, loss of fat, osteoporosis, and
pathologic fractures
– Metabolic - Hypothyroidism (symptoms include lack of energy, weakness,
intolerance to cold, and bradycardia), hypoglycemia, and decreased insulin
sensitivity
– Cardiac - Bradycardia, hypotension, loss of cardiac muscle, small heart,
cardiac arrhythmias (including atrial and ventricular premature contractions,
prolonged QT interval, ventricular tachycardia), and sudden death
– Gastrointestinal - Delayed gastric emptying, bloating, constipation,
abdominal pain, gas, and diarrhea
– Reproductive - Amenorrhea and low levels of luteinizing and follicle-
stimulating hormones
– Dermatologic - Dry, cracking skin due to dehydration, lanugo (i.e., fine,
baby-like hair over body), edema, and acrocyanosis (i.e., blue hands and feet)
– Hematologic - Leukopenia, anemia, thrombocytopenia, hypercholesterolemia,
and hypercarotenemia
– Neuropsychiatric - Abnormal taste sensation, apathetic depression, mild
organic mental symptoms, and sleep disturbances
RELATED TO PURGING (VOMITING AND
LAXATIVE ABUSE)

– Metabolic - Electrolyte abnormalities, particularly

hypokalemia, hypochloremic alkalosis,
hypomagnesemia, and elevated blood urea nitrogen
(BUN)
– Gastrointestinal - Salivary gland and pancreas
inflammation and enlargement with an increase in
serum amylase, esophageal and gastric erosion or
rupture, dysfunctional bowel, and superior mesenteric
artery syndrome
– Dental - Erosion of dental enamel (perimyolysis),
particularly front teeth
– Neuropsychiatric - Seizures (related to large fluid
shifts and electrolyte disturbances), mild neuropathies,
fatigue, weakness, and mild organic mental symptoms
INTERVENTIONS FOR CLIENTSWITH
EATING DISORDERS
Establishing nutritional eating patterns
– Sit with the client during meals and snacks.
– Offer liquid protein supplement if unable to complete meal.
– Adhere to treatment program guidelines regarding restrictions.
– Observe client following meals and snacks for 1 to 2 hours.
– Weigh client daily in uniform clothing.
– Be alert for attempts to hide or discard food or inflate weight.
Helping the client identify emotions and develop non–food-related coping
strategies
– Ask the client to identify feelings.
– Self-monitoring using a journal
– Relaxation techniques
– Distraction
– Assist client to change stereotypical beliefs.
Helping the client deal with body image issues
– Recognize benefits of a more near-normal weight.
– Assist to view self in ways not related to body image.
– Identify personal strengths, interests, talents.
Providing client and family education
CLIENT AND FAMILY TEACHING:
EATING DISORDERS

• CLIENT
– Basic nutritional needs
– Harmful effects of restrictive eating, dieting, purging
– Realistic goals for eating
– Acceptance of healthy body image
• FAMILY AND FRIENDS
– Provide emotional support.
– Express concern about client’s health.
– Encourage client to seek professional help.
– Avoid talking only about weight, food intake, calories.
– Become informed about eating disorders.
– It is not possible for family and friends to force the client to eat.
The client needs professional help from a therapist or psychiatrist.
1. PICA = Characterized by persistent eating of nonnutritive food
substances such as clay, paint, plaster ice or starch or the compulsive
eating of one specific food only.

2. ANOREXIA ATHLETICA = Behaviors are usually a part of anorexia

nervosa, bulimia or OCD. The person is excessively obsessed with
exercise and engaged in it beyond the requirements of good health.

3. MUSCLE DYSMORPHIA = aka bigorexia. It is the opposite of

anorexia nervosa.

4. ORTHOREXIA NERVOSA = coined by Steven Bratman, M.D. to

describe “a pathological fixation on eating a proper or pure or superior
food. They obsess over what to eat, how to prepare food, how much
to eat, and where to obtain “pure” and “proper” foods.

5. NIGHT-EATING DISORDER = Lack of appetite for breakfast

because of preoccupation on the amount of food eaten the night
before. Eating occurs late in the day or night.
6. NOCTURNAL SLEEP-RELATED EATING DISORDER =
Characterized by the person who eats while asleep. He/she has no
recollection that he/she has eaten the night during the night.

7. RUMINATION SYNDROME =Bizarre eating pattern where the

person eats, swallows, and then regurgitates food back into the mouth
where it is chewed and swallowed again. It may be voluntary or
involuntary.

8. GOURMAND SYNDROME = Rare disorder characterized by

obsession with fine food, including its purchase, preparation, presentation
and consumption.

9. PRADER-WILLI SYNDROME = Congenital problem usually

associated with mental retardation and behavior problems that includes
incessant eating.

10. CHEWING AND SPITTING = Disorder commonly seen in

anorexia and sometimes bulimia, characterized by putting food in the
mouth, tasting, chewing then spitting.