EATING DISORDERS
 OVERVIEW
 Gross disturbance in eating behaviors
 Very common in adolescent females
 Age of Onset:
 Anorexia Nervosa - typically begins between 14 to 18 years old
 Bulimia Nervosa – typically begins between 18 to 19 years old
 Etiology:
Disorder
Anorexia
Nervosa
Biologic
Obesity; Dieting at
an early age
Bulimia
Nervosa
Obesity; Dieting;
Possible serotonin
& norepinephrine
disturbances;
Chromosome 1
susceptibility
Developmental
Issues of developing
autonomy & having
control over self &
environment; develop a
unique identity; dissatisfaction with body
image
Self-perceptions of
being overweight, fat,
unattractive, & desirable; Dissatisfaction
with body image
Family
Family lacks emotion
nal support; parental
maltreatment; can’t
deal with conflict
Chaotic family with
loose boundaries;
parental maltreatment
including possible
physical or sexual
abuse
Socio-Cultural
Cultural ideal of
being thin; Media
focus on beauty,
thinness, fitness;
Preoccupation
with achieving the
ideal body
Same as above;
weight-related
teasing
 TYPES OF EATING DISORDERS
 Anorexia Nervosa
 A life-threatening eating disorder characterized by the client’s
 Refusal or inability to maintain a minimally normal body weight
 Intense fear of gaining weight or becoming fat
 Significantly disturbed perception of the shape or size of the body
 Steadfast inability or refusal to acknowledge the seriousness of the problem or even
that one exists
 Symptoms:
 Body image disturbance – occurs when there is an extreme discrepancy between
one’s body image & the perceptions of others & extreme dissatisfaction with one’s
body image
 Amenorrhea
 Alexithymia – difficulty in identifying & expressing feelings
 Depressive symptoms such as depressed mood, social withdrawal, irritability &
insomnia
 Preoccupation with thoughts of food (grocery shopping, collecting recipes or
cookbooks, counting calories, creating fat-free meals, cooking family meals)
 Feelings of ineffectiveness
 Inflexible thinking
 Strong need to control environment
 Limited spontaneity & overly restrained emotional expression
 Engage in unusual or ritualistic food behaviors (refusing to eat around others, cutting
food in minute pieces, not allowing food to touch their lips)
 Complaints of constipation & abdominal pain
 Cold intolerance
 Lethargy
 Emaciation
 Hypotension, hypothermia & bradycardia
 Electrolyte imbalances
 Leukopenia & mild anemia
 Treatment:
 Medical Management
 Focuses on weight restoration, nutritional rehabilitation, rehydration, correction of
electrolyte imbalances
 Access to bathroom is supervised to prevent purging
 Psychopharmacology
 Amitriptyline (Elavil) in high doses (up to 28mg/day) can promote weight gain
 Olanzapine (Zyprexa) for antipsychotic effect (for bizarre body image distortions)
& associated weight gain
 Fluoxetine (Prozac) shows some effectiveness in preventing relapse
 Psychotherapy
 Family Therapy
 Individual Therapy
 Bulimia Nervosa
 Characterized by recurrent episodes (at least twice a week for 3 months) of binge eating
followed by inappropriate compensatory behaviors to avoid weight gain such as
purging
 Binge Eating – consuming large amount of food (far greater than most people eat at
one time) in a discrete period usually 2 hours or less
 Purging – the compensatory behaviors designed to eliminate food by means of selfinduced vomiting or misuse of laxatives, enemas & diuretics
 Binging or purging episodes are often precipitated by strong emotions & followed by
guilt, remorse, shame or self-contempt
 Clients are aware that their eating behavior is pathologic & go to great lengths to hide it
from others
 Symptoms:
 Self-evaluation overly influenced by body shape & weight
 Usually within normal weight range, possible underweight or overweight
 Restrict of total calorie consumption between binges, selecting low-calorie foods
while avoiding foods perceived to be fattening or likely to trigger a binge
 Depressive & anxiety symptoms
 Possible substance use involving alcohol or stimulants
 Loss of dental enamel
 Chipped, ragged appearance of teeth
 Increased dental caries
 Menstrual irregularities
 Dependence on laxatives
 Esophageal tears
 F&E abnormalities
 Metabolic alkalosis (vomiting) or metabolic acidosis (diarrhea)
 Treatment:
 Cognitive-Behavioral Therapy
 Found to be the most effective treatment for bulimia
 Strategies are designed to change the client’s thinking (cognition) & actions
(behavior) about food & focus on interrupting the cycle of dieting, binging &
purging & altering dysfunctional thoughts & beliefs about food, weight, body
image & overall self-concept
 Psychopharmacology
 Antidepressants such as Tofranil, Elavil, Parnate, Nardil, Prozac effective in
reducing binge eating; also improves moods & reduces preoccupation with shape
& weight; however, most of the positive results are short-term in nature
 NURSING INTERVENTIONS
 Establishing nutritional eating patterns
 Sit with the client during meals & snacks
 Offer liquid protein supplement if unable to complete a meal
 Adhere to treatment program guidelines regarding restrictions
 Observe client following meals & 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 & develop non-food coping strategies
 Ask the client to identify feelings
 Self-monitoring using a journal
 Relaxation techniques
 Distractions
 Helping 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 & family education
 Client:
 Basic nutritional needs
 Harmful effects of restrictive eating, dieting, purging
 Realistic goals for eating
 Acceptance of healthy body image
 Family & 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 & friends to force the client to eat; the client needs
professional help from a therapist or a psychiatrist