EATING DISORDERS
definition, etiology, types, nursing
process, treatment
EATING DISORDERS
• Eating Disorder is a disorder
characterized by alteration or
disturbance in eating pattern and body
image interfering relationship and
occupational functioning.
TYPES OF ANOREXIA
1. Anorexia Nervosa
2. Bulimia Nervosa
• More than 90% of cases of anorexia
nervosa and bulimia occurs in women.
However there is also an increasing # of
cases in men
ANOREXIA NERVOSA
ANOREXIA is a life-threatening eating disorder characterized by
body weight 85% or less than the expected for their age and
height.
SIGNS AND SYMPTOMS
A – Amenorrhea for at least 3 consecutive cycles
N – No organic factor accounts for weight loss
O – Obviously thin but feels fat
R – Refusal to maintain body weight
E – Emotional expression is restrained
X – Symptoms such as depression and social withdrawal
I – Intense fear of gaining weight and Insomnia
A – Always think of food and food related activities
PREOCCUPATION WITH FOOD AND
FOOD RELATED ACTIVITIES
• Grocery shopping
• Collecting recipe or cookbooks
• Counting calories
• Creating fat free meals
• Unusual ritualistic food behaviors
Refusing to eat around others
Cutting food into small pieces
Not allowing food to touch their lips
SUBTYPES OF ANOREXIA
NERVOSA
1. RESTRICTING SUBTYPE
- weight loss through fasting, dieting and
excessive exercise
2. BINGE-PURGING SUBTYPE
- weight loss through induce vomiting, use of
laxatives, diuretics and enema
MEDICAL COMPLICATION
RELATED TO WEIGHT LOSS
• CARDIAC • HEMATOLOGIC
- Hypotension - leukopenia
- Bradycardia - anemia
- Cardiac arrythmias - thrombocytopenia
• DERMATOLOGIC • METABOLIC
- dry, cracking skin - hypothyroidism
- lanugo > intolerance to
- acrocynaosis (blue cold, weakness
hands and feet -hypoglycemia
MEDICAL COMPLICATION
RELATED TO WEIGHT LOSS
• Musculoskeletal • Reproductive
- Loss of fat - Amenorrhea
• Neuropsychiatric
- Osteoporosis
- Depression
- Pathologic fractures - Insomnia
• Gastrointestinal • Others
- Constipation - Electrolyte imbalances
- Abdominal pain - Elevated BUN
- Gas and diarrhea - Hypertrophy of salivary
gland
BULIMIA NERVOSA
BULIMIA is an eating disorder characterized by recurrent
episodes of binge eating at least twice a week for 3
months.
SIGNS AND SYMPTOMS:
B – Binge eating
U – Under strict dieting or vigorous exercise
L – Lack control over eating
I – Induced vomiting
M – Moth-eaten appearance teeth
I – Increase and persistent concern of body
A – Abuse of diuretics and laxatives
MEDICAL COMPLICATION
RELATED TO PURGING
• DENTAL • METABOLIC
- Perimyolysis (erosion - Electrolyte
abnormalities
of dental enamel)
Hypokalemia
• GASTROINTESTINAL
Hypochloremic
- Salivary gland and alkalosis
pancreas inflammation Hypomagnesemia
- esophagitis Elevated BUN
- parotid gland • NEUROPSYCHIATRIC
enlargement - Seizures, fatigue,
weakness
DISTINGUISHING FEATURES
• ANOREXIA • BULIMIA
1. Early age at onset 1. Later age at onset
- 14 to 18 year old - usually 18 or 19 year
old
2. Below normal body 2. Near normal body
weight weight
3. Do not recognize the 3. Usually ashamed and
eating behavior as a embarrassed by the
problem eating behavior
ETIOLOGY
• BIOLOGIC FACTOR
– Genetic vulnerability result from a personality type
– Hypothalamus dysfunction
a. Lateral hypothalamus dysfunction
- decrease eating and decreased responses to
sensory stimuli that are important to eating
b. Ventromedial dysfunction
- leads to excessive eating, weight gain and
decreased responsiveness to the satiety
ETIOLOGY
– Neurochemical changes
a. decrease level of norepinephrine
- seen in clients during period of
restricted food intake as seen in
anorexia, pressure
b. increase level of serotonin
- increase satiety
c. low level of serotonin as well as low
platelet levels of monoamine oxidase have
been found in clients with bulimia and the
binged and purge subtype of anorexia
ETIOLOGY
• DEVELOPMENTAL FACTORS
- Failure to develop autonomy
- Failure to establish unique identity
- Advertisements, magazines, and movies that feature
thin models reinforce the cultural belief that slimness
is attractive N.
• FAMILY INFLUENCE
- Response to family conflict and problems
- Childhood adversities such as child abuse
- Sexual abuse, parental maltreatment, rejection,
excessive paternal control, overprotectiveness,
unfriendliness
ETIOLOGY
SOCIOCULTURAL FACTORS
1. Cultural beliefs – “ideal woman”, perfect
look”
2. Advertisement
3. Pressure from peers
NURSING PROCESS
ASSESSMENT
HISTORY BULIMIA
ANOREXIA - Pleasing others and
- Perfectionist with above avoiding conflicts
average intelligence
- Achievement oriented - Has history of impulsive
- Dependable behavior such as
- Seeking approval substance abuse and
- Parents describe client as shoplifting
being “good” and - History of anxiety,
“causing us no trouble” depression and
personality disorders
GENERAL APPEARANCE and
BEHAVIOR
ANOREXIA BULIMIA
• Appears slow, lethargic and • With normal body
fatigued
weight or slightly
• Emaciated
decreased or increased
• Slow to respond to questions
and avoids to acknowledge • General appearance is
any eating problem not unusual
• Often wear loose fitting • Appears open and willing
clothes layers regardless of to talk
weather to hide weight loss
and to keep warm
MOOD AND AFFECT
ANOREXIA BULIMIA
- Often seen sad, anxious - Initially pleasant and
and worried cheerful as though
- Seldom smile, somber nothing is wrong
and serious most of the - May express intense
time guilt, shame and
embarrassment when
discussing binge eating
and purging
THOUGHT PROCESS AND CONTENT
ANOREXIA
ANOREXIA and
- Have paranoid ideas BULIMIA
about their family and
health care professionals - Cannot think about
believing they are their themselves without
enemies who are trying thinking about weight
to make them fat by - Preoccupied with dieting,
forcing them to eat food and food related
- Body image disturbance behavior
can be delusional even
clients are severely
underweight.
SENSORIUM, PROCESSES
and SELF CONCEPT
ANOREXIA BULIMIA
- Mild confusion, slowed - Alert and oriented
mental process, difficulty - Intact intellectual
with concentration and functioning
attention due to severe
malnourishment/
starvation
- Low self concept - Low self concept
ROLES AND RELATIONSHIPS
ANOREXIA BULIMIA
- Withdraw from peers - Feels great shame about
and pay little attention to their binge eating and
friendship purging behaviors
- Failure at school which is - Time spent buying and
in contrast to previously eating food and purging
successful academic interfere clients’ role
achievement performance
NURSING DIAGNOSIS AND
PLANNING
B. NURSING DIAGNOSIS
1. Imbalance nutrition: less than body requirement
2. Ineffective coping 3. Disturbed body image
C. PLANNING
1. Client will establish adequate nutritional eating pattern
2. Client will demonstrate non-food related coping
mechanism
3. Client will verbalize acceptance of body image with
stable body weight
NURSING INTERVENTION
1. Establish nutritional eating pattern
a. Sit with the client during meals and snacks
b. Observe client ff. meals and snacks (1- 2
hours)
c. Weight client daily in uniform clothing
d. Offer liquid protein supplement if unable
to complete required calories
e. Adhere to treatment program guidelines
regarding restrictions
- no diet beverages and food substitutions
- set specific time for meals
- Be alert for attempts to hide or discard
foods
NURSING INTERVENTION
2. Help client identify emotions and develop a non-food
related coping strategies
a. Help client identify feeling.
b. Self-monitoring using a journal to raise clients’
awareness about behavior and help them
regain a sense of control
c. Manage emotions through relaxation
techniques and distraction with music or
another activity
NURSING INTERVENTION
3. Help client deal with body image issues
a. Recognize benefits of a normal or near
normal body weight
b. Increased self esteem
c. Identify personal strength, interest and
talents to broadened clients’ perception of
themselves
NURSING INTERVENTION
4. Provide client and family education
CLIENT:
a. Basic nutritional needs
b. Harmful effects of restrictive dieting and
purging
c. Realistic goals of eating and body weight
d. Acceptance of healthy body image
NURSING INTERVENTION
FAMILY AND FRIENDS
a. Provide emotional support
b. Become informed about eating disorders
c. Encourage expression of concerns about
clients’ health
d. Avoid talking about weight, food
intake and calories
EVALUATION
1. Demonstrate alternative methods of dealing
with stress
2. Demonstrate more satisfying relationships
3. Develop a positive self - concept
TREATMENT
ANOREXIA
1. Medical management
- focuses on weight restoration, nutritional
rehabilitation, rehydration and correction of electrolyte
imbalances.
2. PSYCHOPHARMACOLOGY
- Cyproheptadine ( Periactin) – high doses/28 days
- Amitriptyline ( Elavil)
- Olanzapine (Zyprexa)
- Flouxetine (Prozac)
3. PSYCHOTHERAPY
- Family therapy - Individual therapy
TREATMENT
BULIMIA
1. COGNITIVE-BEHAVIORAL THERAPY
- strategies designed to change the client’s
thinking (cognition) and action (behavior)
2. PSYCHOPHARMACOLOGY
a. TCA
- Desipramine (Norpramin)
- Imipramine (Tofranil)
b. SSRI
•END
