Eating disorder Anorexia Nervosa Bulimia Nervosa
Eating disorder is characteristic by abnormal eating habits that may involve either insufficient or
excessive food intake to the determent of an individual’s physical and emotional health.
Eating is a normal social activity but sometime may individual following eating habits and food
pattern by abnormal way which might be caused some complications in their future life.
The incidence and prevalence of eating disorders depends as always on the definition used and
the population being considered. The peak incidence of Anorexia Nervosa is around the age of
18. For the bulimia nervosa is slightly higher.
Eating disorder affects all the socioeconomic levels. (Anorexia nervosa has the highest mortality
rate of any psychiatric disorder. The mortality rate for anorexia nervosa is 4% and bulimia
nervosa is 3.9%.)
ANOREXIA NERVOSA
Anorexia Nervosa is an eating disorder occurs most often in adolescent girls. The problem is
found as refusal of food to maintain normal body weight by reducing food intake, especially fats
and carbohydrates.
• Anorexia is syndrome characterized by three essential criteria.
• The first is to self-induced starvation, to a significant degree.
• The second is relentless drive for thinner or morbid fear of fatness.
• The third is presence of medical signs and symptoms resulting from starvation.
• Anorexia Nervosa is often associated with disturbance of body images, the perception that one
is distressingly large despite being thin.
Types of Anorexia Nervosa
1. Binge / Purge Type • The individual suffering from anorexia nervosa binge / purge type will
purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a
sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives,
or excessively exercising.
2. Restrictive • In this form of anorexia nervosa, the individual will fiercely limit the quantity of
food consumed, characteristically ingesting a minimal amount that is well below their body’s
caloric needs, effectively slowly starving him or herself.
ETIOLOGY
• Biological
• Social
• Psychological factors are complicated in the cause of anorexia nervosa.
RISK FACTORS
• Accepting society’s attitudes about thinness.
• Being perfectionist.
• Experiencing childhood anxiety.
• Feeling increased concern or attention to weight and shape.
• Having family history of addictions or eating disorder.
• Having negative self-image.
SYMPTOMS and COMPLICATION
• CVS – Bradycardia, hypotension, ECG abnormalities, myocarditis. • SKIN - dry skin, hair lose,
etc.
ENDOCRINE – Amenorrhea, hypoglycemia, irregular menses, imbalance of LH. • FLUID AND
ELECTROLYTE – dehydration, vomiting, alkalosis.
• GI – constipation, esophagitis, hypertrophy. • HAMALOGICAL – anemia, leucopenia.
EXAMINATION AND TESTS
1. Complete physical examination including laboratory tests to rule out the endocrine, metabolic
and central nerves system abnormality or other disorders.
2. Complete blood testing, • - Hb level • - Platelet count • - Cholesterol level • - Calcium
3. ECG reading irregular. • Thyroid function Tests. • Urinalysis
Medical Management
• The goals of treatment are to first restore normal body Weight and eating habits and then to
address psychological issue. A Hospital stay may be needed if;
• The person has lost a lot of Weight (Below 30% of ideal body Wright).
• Weight loss continues despite treatment.
• Medical complications such as heart rate problems, changes mental status and low potassium
levels.
• The person has severe depression or thinks about committing suicide.
• Short term management aimed to ensure weight gain and correct nutritional deficiencies. •
Long term treatment aimed to maintaining a normal weight achieved through a short-term
management
Other treatments may include.
• Antidepressant drug therapy.
• Behavioral therapy.
• Psychotherapy.
• Supportive care.
• Cognitive behavioral therapy (CBT)
NURSING MANAGEMENT:
• Monitor the weight of client.
• Correction of nutritional deficiency by providing nutritious diet. Eating must be supervised by
the nurse and provide balanced
• In the early stage of Anorexia Nervosa, the treatment is for patient to remain in bed in single
room while the Nurse maintains close observation.
• Eating must be supervised by the nurse and provide balanced diet of at least 3000 calories
should be provided in 24 hrs.
• The goal should to be achieving weight gain of 0.5 to 1 Kg. per week.
• Monitor the serum electrolysis levels.
• Control vomiting by making bathroom inaccessible for at least 2 hrs. After food.
Bulimia Nervosa
Bulimia nervosa is an eating disorder in which a person creates a destructive pattern of eating in
order to control their weight. People with bulimia tend to go on eating binges, consuming large
amounts of food in a short period of time.
Bulimia is an illness in which person binges on food or has regular episodes of significant over –
eating and feels a loss of control. The affected person then uses various methods such as
vomiting or Laxative abuse to prevent Weight gain.
People with bulimia tend to show signs of:







depression
anxiety
obsessive-compulsive disorders
may cause moodiness and irritability.
Feelings of embarrassment and shame.
They’re also at risk for substance abuse problems
suicidal behavior.
Types of Bulimia
• Bulimia Nervosa Purging type – This type of bulimia nervosa accounts for most cases of those
suffering from this eating disorder. In this form, individuals will regularly engage in self-induced
vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.
• Bulimia Nervosa Non-purging type – In this form of bulimia nervosa, the individual will use
other inappropriate methods of compensation for binge episodes, such as excessive exercising or
fasting.
CAUSES
There is no single cause of bulimia but there are some factors which are responsible for bulimia.
1. Culture
2. Families- If you are having mother or sister with bulimia you are more likely to have bulimia.
3. Life changing or stressful events - Traumatic events as well as stressful things can lead to
bulimia.
4. Personality traits - A person with bulimia may not like herself. She hates the way she looks or
feels hopeless. She may be very moody have problems expressing anger.
5. Biology- Genes, Hormones or chemicals in brain may be factors in developing bulimia.
SYMPTOMS
• Binges regularly. (Eats large amount of food over short period) and purges of time regularly.
• Diet and exercises often but maintain or regains Wright.
• Has swollen neck glands.
• Has scars on the back of hands from forced vomiting
• Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest,
• Chronic dehydration
• Inflammation of the esophagus
DIAGNOSIS
• Medical evaluation to rule out the upper gastro-intestinal disorder.
• MSE
• History.
• Lab test (Hb% level, blood glucose, and baseline ECG)
Medical Management
PSYCHOTHERAPY
1) Cognitive Behavioral Therapy - Cognitive Behavioral Therapy should be considered
benchmark. First line treatment of bulimia nervosa. Manual guided treatments that include about
18 – 20 sessions over 5 to 6 months.
2)PHARMACOTHERAPY- Antidepressant medications have been shown to be helpful
in treating bulimia. This includes the selective serotoxin reuptake inhibitors such as “fluoxetine”.
Nursing intervention
• Establish construct with patients that specifies amount and type of food she must eat at each
meal.
• Set a time limit for each meal.
• Assess and monitor patients suicide potential.
• Explain the risk of laxative, and diuretic abuse.
Nursing Diagnosis
Nursing
diagnoses
Related to
Evidenced by
Desired outcome
Anxiety
Perceived threat to
physical body,
body image, and
self-concept
Expressed concern,
apprehension, fear, anguish,
distress; preoccupation with
body shape and weight;
compulsive and ritualistic
behavior; difficulty
concentrating; decreased
ability to problem solve;
nonverbal cues (eg, facial
tension, psychomotor
agitation)
Reduce anxiety as
evidenced by
appearance and selfreport; acknowledge
and discuss fears;
recognize healthy
and unhealthy fears;
identify signs and
symptoms of
anxiety; identify
and show
techniques to
decrease anxiety
Body image,
disturbed
Cognitive
distortions
Negative feelings about body
shape and weight; expression
of shame and guilt;
concealment of body with
oversized clothing;
dependent on others'
opinions; fear of rejection by
others
Verbalize
acceptance of body
appearance; express
congruence between
body reality and
perception; identify
positive aspects
about body
Cardiac output,
decreased
Cardiomyopathy,
arrhythmia
Bradycardia; hypotension;
palpitations;
electrocardiogram changes;
fatigue
Exhibit adequate
cardiac output as
evidenced by
normal blood
pressure and pulse
rate
Constipation
Decreased gastric
emptying, poor
eating habits, and
dehydration
Decreased frequency; dry,
hard, formed stools; straining
with defecation; decreased
bowel sounds; abdominal or
back pain; palpable
abdominal mass
Establish normal
bowel elimination
pattern (soft formed
stool every 1–3
days); identify
contributing factors
and appropriate
preventive
strategies; exhibit
adequate fluid and
food intake; express
relief from
associated
discomfort
Coping, family
disabled
Ambivalent family
relationships,
resistance to
treatment, issues
of control,
unexpressed
feelings
Denial of existence or
severity of patient's
condition; intolerance,
neglect, rejection, hostility,
abandonment, enmeshment
Appropriately and
openly express
feelings; verbalize
realistic
understanding and
expectations of
patient; visit or
contact patient
regularly;
participate
positively in the
care of the patient
within limits of
family's ability,
patient needs, and
treatment plan
Coping,
ineffective
Anxiety,
depression,
maladaptive
response patterns,
inadequate social
support,
maturational crisis
Verbalized inability to cope
or request help; impaired
cognition and perceptions;
diminished problem-solving
capacity; use of maladaptive
and self-destructive
behaviors (eg, verbal
manipulation, binge
episodes, laxative abuse)
Identify ineffective
coping behaviors
and consequences;
identify alternative
coping strategies;
show adaptive
problem-solving
skills; identify crisis
prevention
resources; remain
free of selfdestructive
behaviors
Fluid volume
deficit
Loss of fluid
through
inadequate intake,
gastric losses
(vomiting),
diarrhea
Decreased urine output;
concentrated urine; output
exceeds intake; sudden
weight loss; increased serum
sodium and hematocrit;
increased pulse; orthostatic
hypotension; decreased
Maintain fluid
volume at a
functional level as
evidenced by
adequate urinary
output (>1300
mL/d), normal
blood pressure; thirst,
weakness; poor skin turgor
specific gravity,
normal vital signs,
moist mucous
membranes, and
good skin turgor;
verbalize
understanding of
causative factors
and preventive
strategies; show
behaviors
promoting adequate
hydration
Fluid volume,
excess, risk for
Excess fluid
related to
refeeding
Severe malnutrition requiring
the need for refeeding
Stabilized fluid
volume as
evidenced by
balanced intake and
output (within 500
mL), normal vital
signs, normal
specific gravity,
stable weight, and
absence of edema;
describe
understanding of
dietary/fluid
restrictions; list
signs that require
further evaluation
and notification of
care provider
Deficient
knowledge
regarding
condition,
prognosis, and
treatment needs
Inadequate
understanding,
lack of knowledge,
cognitive
distortions
Verbalized deficit;
inadequate food and fluid
intake and development of
preventable complications;
inadequate follow-through of
instructions; misconception
of weight loss through use of
inappropriate compensatory
behaviors
Participate in
learning process;
explain nutritional,
psychological,
medical, and social
consequences of
disorder; exhibit
understanding of
treatment regimen;
list available
resources after
discharge
Noncompliance
Value system,
health beliefs,
cultural factors,
motivation and
readiness for
change, care
provider–patient
relationships
Resistant behavior;
nonadherence to treatment
regimen; lack of progress;
minimization of severity of
illness; devaluation of
treatment team plan and
usefulness of therapy;
development of
complications related to
symptom exacerbation
Identify
consequences of
noncompliance;
participate in the
development of
treatment goals and
plan; show
understanding of
disorder and
treatment regimen
Nutrition,
imbalanced: less
than body
requirements
Insufficient dietary
intake, decreased
ingestion of food
or nutrient
absorption
secondary to selfinduced vomiting
and laxative abuse
Body weight >15% below
ideal (may be normal or
overweight in bulimia
nervosa); weight loss;
impaired hunger and satiety;
electrolyte imbalance;
decreased metabolism;
bradycardia; hypotension;
weakness; amenorrhea; hair
loss; lanugo; brittle nails;
poor skin turgor; reduced
muscle tone and
subcutaneous fat; cold
intolerance/hypothermia;
laboratory findings of protein
and vitamin deficiencies
Establish regular
meal pattern and
normal caloric
intake to support
and maintain
normal body
weight; show
progressive gain
toward goal weight;
display
normalization of
laboratory values;
free of signs of
malnutrition;
express
understanding of
causative factors
and nutritional
needs; show
adequate food
intake and
abstinence from
binge eating and use
of inappropriate
compensatory
behaviors
Nutrition:
imbalanced,
more than body
requirements
Food intake
excessive relative
to metabolic need
Report of binge-eating
episodes; observed
dysfunctional eating patterns
Verbalize
understanding of
nutritional needs
and risk for weight
gain; show
appropriate
behavioral change
in eating patterns;
identify alternative
coping strategies
rather than binge
eating; exhibit
abstinence from
binge eating
Pain, acute
Abdominal
cramping,
irritation of
epigastric and
gastric mucosa,
gastric distention
Verbal reports; facial
grimacing; autonomic
response (sudden or severe
pain)
Verbalize pain
relief; follow
prescribed
pharmacologic
regimen; verbalize
methods that
provide relief;
identify and exhibit
strategies to prevent
recurrence
Powerlessness
Hospitalization,
helplessness
Expressed apathy, passivity,
uncertainty, or lack of
control over therapy or selfcare; verbalized
dissatisfaction or frustration
with limits placed on
maladaptive behaviors (eg,
self-induced vomiting);
inability to stop binge
episodes; nonparticipation in
care, dependence on others
State sense of
control over the
present situation
and future
outcomes;
participate in
decision making
with regard to plan
of care; identify
areas within
patient's control and
those that are not
Self esteem,
chronic low
Negative
evaluation of self
Negative self-worth;
expressed shame or guilt;
rejection of positive
feedback, dwells on negative
feedback; indecisive; seeks
Show behaviors
aimed at promoting
positive self-esteem;
verbalize increased
sense of self-esteem
reassurance repeatedly;
dependent; self-value solely
determined by body shape
and weight
and self-acceptance;
identify personal
strengths; set
realistic and
achievable goals;
participate in
decision making
Self mutilation,
risk for
Borderline
personality
disorder, use of
suicidal gestures to
manipulate others,
inappropriate
means to release
tension
Risk factors: history of selfinjury (eg, cutting, burning,
head banging, and/or
punching/pinching); history
of suicide attempts,
impulsivity, or abuse;
psychomotor agitation;
inability to control anger;
inability to verbalize feelings
Appropriately
express feelings;
identify
precipitating events;
express increased
self-esteem; exhibit
self-control as
evidenced by
absence of selfmutilation; engage
in use of adaptive
coping to manage
negative feelings
Suicide, risk for
Impulsivity, major
depression
Risk factors: history of
previous suicide attempts;
major depressive episodes;
clinically significant
depressed mood; suicidal
ideation, plan, gesture, or
recent attempt; verbalization
of feeling sad, blue, hopeless,
life is not worth living
Remain safe and
harm-free; verbally
express feelings;
remain free from
access to harmful
objects
Thought,
processes,
disturbed
Cognitive
distortions related
to eating disorder
Obsessional preoccupations,
magical thinking,
magnification, dichotomous
thinking, personalization,
and self-reference related to
food intake, body image,
self-concept
Exhibit
improvement in
cognitive
distortions; identify
triggers and cues;
independently
engage in activity of
daily living
Trauma, risk for
Loss of bone
integrity
Risk factors: long-term
malnutrition, history of bone
fractures or bone loss
Remain traumafree; show
appropriate
behaviors aimed at
reducing risk of
injury