Mental Health Nursing II
NURS 2310
Unit 9
Eating Disorders
Anorexia Nervosa
Definition
Prolonged loss of appetite; self-starvation
with a disruption in metabolism due to
inadequate calorie intake.
Incidence & Population Affected
Increased in the past 30 years
 Affects approximately 1% of young women

– Occurs predominantly in females aged twelve
to thirty
– Less than 10 percent of cases are males
Etiology & Characteristics
Morbid fear of obesity
 Gross distortion of body image; sees self as “fat”
when obviously underweight
 Preoccupation/obsession with food

– hoarding or concealing food
– preparing elaborate meals for others while severely
restricting self
Refusal to eat; marked weight loss
 May include extensive exercising
 Physiological symptoms include amenorrhea,
hypothermia, bradycardia, hypotension, edema,
lanugo, and metabolic changes

Diagnostic Criteria
Refusal to maintain body weight at or
above a minimally normal weight for age
and height
 Intense fear of gaining weight or becoming
fat, even though underweight
 Disturbance in the way in which one’s body
weight or shape is experienced, undue
influence of body weight or shape on selfevaluation, or denial of the seriousness of
the current low body weight
 Amenorrhea

Bulimia Nervosa
Definition
Excessive, insatiable appetite; episodic,
uncontrolled, compulsive, rapid ingestion
of large quantities of food over a short
period of time, followed by inappropriate
compensatory behaviors to rid the body
of the excess calories.
Incidence & Population Affected
More prevalent than anorexia nervosa
 Affects approximately 4% of young women

– Onset occurs in late adolescence or early
adulthood
– Occurs mainly in populations with an abundant
availability of food, and in which the ideal of
beauty is thinness
Etiology & Characteristics
Persistent overconcern with personal
appearance
 Weight fluctuations common due to
alternating binges and fasts
 Excessive vomiting and laxative/diuretic
abuse may lead to problems with
dehydration and electrolyte imbalances
 Gastric acid in vomitus contributes to the
erosion of tooth enamel
 Individual may experience tears in the
gastric or esophageal mucosa

Diagnostic Criteria
Recurrent episodes of binge eating
 Recurrent inappropriate compensatory
behavior in order to prevent weight gain,
such as self-induced vomiting; misuse of
laxatives, diuretics, enemas, or other
medications; fasting; or excessive exercise
 The binge eating and inappropriate
compensatory behaviors both occur, on
average, at least twice a week for 3 months
 Self-evaluation is unduly influenced by body
shape and weight

Obesity
Definition
Chronic disease defined by having a Body Mass
Index (BMI) of more than 30.
Incidence & Population Affected
61% of the U.S. population age 20 or older
are overweight; 27% are obese; 4.7% are
morbidly obese
 Affects black women more than white
women, and white men more than black men
 6 times more prevalent among lower
socioeconomic classes

Etiology & Characteristics
May have a genetic component
 Lifestyle factors; lack of physical activity
 Leads to problems with hyperlipidemia,
hyperglycemia, diabetes mellitus,
osteoarthritis due to trauma to weightbearing joints, angina and respiratory
insufficiency due to increased workload of
the heart and lungs
 Food is considered a social outlet
 Depression/low self-esteem
 May involve binge-eating disorder

Diagnostic Criteria
(Binge-Eating Disorder)
Recurrent episodes of binge eating in which one
does not feel in control of what/how much is
being consumed
 Binge-eating episodes are associated with
– eating much more rapidly than normal
– eating until feeling uncomfortably full
– eating alone because of being embarrassed by
how much one is eating
– feeling depressed or guilty after overeating
 Marked distress regarding binge eating
 The binge eating occurs, on average, at least 2
days a week for 6 months

Nutritional Deficits

Electrolyte imbalances

Nutrient deficits

Malnutrition

Poor glucose control

Deficiency in vital fats

Vitamin deficiencies
Treatment Modalities

Education
– Learning healthy eating patterns

Weight management
– Nutrition education
– Exercise program
– Surgery

Individual therapy
– Cognitive-behavioral therapy (CBT)
– Coping with thoughts and feelings
Family therapy
 Psychopharmacology

– Antidepressants
– Anxiolytics
Milieu Therapy
*Focuses on behavior modification





Changing maladaptive eating behaviors
Empowering client to take control of treatment
Contract for privileges based on weight gain or
weight maintenance
Goals of therapy agreed upon by client and staff
System of rewards and privileges can be earned
by client, who is given ultimate control
– Client chooses whether or not to abide by the
contract
– Client is made accountable for choices and
behaviors