Anorexia Vs Bulimia

Eating
Disorders
Anorexia Vs. Bulimia
Prepared: Steven Matthew L
Dasig
• 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 DISORDERS
• RELATED TO WEIGHT LOSS
• 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.
Definition of Terms
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.

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What are some of the biological, psychological and social factors that can contribute to eating disorders?

What are some of the symptoms and manifestations of bulimia nervosa?

Eating

•Body image disturbance

• Olanzapine (Zyprexa) – antipsychotic associated weight gain

• Fluoxetine(Prozac) has shown some effectiveness in preventing

• Metabolic - Electrolyte abnormalities, particularly

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

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

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

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

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