EATING DISORDERS
RNSG 2213
Topics
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Covered:
 Anorexia Nervosa
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Bulimia Nervosa
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Not Covered:
 Overeating and Binge
Eating Disorder (DSM)
 Obesity
 Bariatric Surgery
Anorexia Nervosa
Anorexia Nervosa:
Incidence and Characteristics
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Affects 3.7% of women
Less common than bulimia
6 to 20% die as a result of the illness
Higher death rate than any other
psychiatric disorder
Anorexia Nervosa Characteristics,
cont’d
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Females, 90% (Male numbers are growing)
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Onset:
Adolescence to early adulthood
 Age of onset is decreasing
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Often insidious
 Occurs during important life transitions
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 No loss of appetite
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Deliberate Weight loss
Cultural Influences
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Weight and Shape are
very important
Computer Graphics:
make thin models
even thinner
Preoccupation with
food, eating, fitness
Unrealistic Ideals
DSM IV-TR Criteria
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Refusal to maintain normal weight
Intense fear of gaining weight, even if
underweight
Body image disturbances
In female adults or adolescents, absence
of at least 3 consecutive menstrual cycles
Types are: Restricting and Binge/Purging
Psychosocial Factors
May be avoidant or have
social problems
 Rigid, competitive, perfectionistic
 Compulsive and obsessive
 Hyperactive
 Anxious
 Compliant “people pleasers”
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Food-Related Behaviors in
Anorexia Nervosa
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Restricting intake, fasting
Hoarding food
Highly avoidant of certain foods
Preoccupation with calories, meals, recipes, etc.
Preparing/serving elaborate meals for others
Rituals before and during eating
 become compulsions
Purging Behavior in Anorexia
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Purgers and vomiters
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Eat normally in a social situations
Amount of food eaten is not excessive
Purge if no success with severe restricting
(Not on the test)
Metabolic Consequences
Anorexia: More Consequences
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Decreased peristalsis is exacerbated by
overuse of laxatives or enemas
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Delayed gastric emptying
Feel full much longer
Dehydration
Anorexia: Consequences
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Amenorrhea, decreased development of
secondary sex characteristics
Osteopenia or Osteoporosis
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Bone mass loss may be irreversible
Weakness and fatigue
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But will persist in excessive exercising to burn calories
Anorexia: Complications
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Heart failure, life threatening
arrhythmias
Cardiac ventricular dilation
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Decreased thickness of the
ventricular wall
Decrease oxygenation of the cardiac
muscle
Renal failure
Complications, cont’d
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Electrolyte imbalance
 Hypokalemia
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Metabolic imbalance
 Metabolic Acidosis
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Hypocalcemia
Metabolic Alkalosis
Complication of Treatment:
Re-feeding Syndrome
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Severe Fluid Shifts from too rapid
re-introduction of food
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Extracellular to intracellular
Cardiovascular, neurological and
hematologic complications
Refeed slowly
Close supervision
Nursing Diagnosis: Critical thinking
Write a nursing diagnosis for each of these
consequences of Anorexia Nervosa:
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1) Severe weight loss to 60% of average body
weight
2) Bradycardia
3) Overuse of laxatives to achieve wt. loss
4) Refeeding Syndrome
Nursing Diagnosis:
Critical thinking
Some possible choices
Nutrition less than body requirements r/t
refusal to eat; r/t excessive exercise
2) R/F falls r/t hypotension
3a) Fluid volume deficit r/t laxative overuse
3b) Constipation r/t altered gastric motility
4a) Imbalanced fluid volume r/t fluid shifts
4b) Impaired cardiac or peripheral tissue
perfusion r/t decreased cardiac output
1)
Mental Health Problems
Associated with Anorexia
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Fear of losing control (Anxiety)
Low sex drive
Feelings of helplessness
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Obsessive-compulsive disorder
Major Depression
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Feel abandoned or inadequate
Combat by controlling what they eat
(Dx and tx only after weight gain is established)
Substance abuse
Personality disorders
Etiology of Anorexia
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High levels of serotonin
SSRIs are not effective
 If used should not be
started until weight
restoration is established
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Etiology: Anorexia and the
Family
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Emotional restraint
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Enmeshed relationships
Rigid organization
Tight control
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Drive for thinness is a way to seek control
Avoidance of conflict
Odd eating habits
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Emphasis on appearance
Bulimia Nervosa
Bulimia
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Means to have an insatiable appetitive
Begins in adolescents
Primarily in women
4% of young adults
Symptom overlap with Anorexia, making
diagnosis difficult
Bulimia Characteristics
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Hide their eating-disordered behaviors
Lack of weight loss
Coexisting mental disorders:
 Major Depression
 Personality disorders
 Post traumatic Stress Disorder
Purging develops as a way to compensate for
massive amounts of food eaten
Restrictive eating….then purging….cycle
Binge Episode
Massive Amounts of Food
Binge Eating
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Feelings of lack of control
Often done in secret
High calorie-High carbohydrate
Consumed in less than 2 hours
Addicted to the high experienced when eating
Purging = Compensatory Behavior
for Binge Eating
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May use manual stimulation, laxatives,
and/or emetics
Over time, self-induced vomiting occurs
with minimal stimulation
Post-purging: sense of relief, calm
Consequences and Complications of
Purging
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Electrolyte imbalances
Metabolic Acidosis
Metabolic Alkalosis
Cardiomyopathy
Enlarged salivary
glands
Erosion of dental
enamel
Russell’s sign
Pancreatitis
Differences in Bulimia from
Anorexia
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Lowered serotonin activity
Binge eating raises levels of serotonin
Treatment with SSRI, particularly
fluoxetine (Prozac)
Depression; shame; hide their eating
Bulima: Associated Family
Characteristics
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Mood disorders
Substance abuse
Conflict
Disorganized
Lacking nurturance
 Food is a symbolic form of nurturing
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Evidence Bulimia is a response to chaos
Management of Eating Disorders
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Anorexia
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Increase weight to
90% of average body
weight
Increase self-esteem
Decrease need for
perfection (provided
by thinness)
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Bulimia
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Stabilize weight
without purging
Management of Eating Disorders
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Both Anorexia and Bulimia:
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Inpatient treatment for medical stabilization
and dietary management
Long-term outpatient tx. addresses
psychosocial issues
Management: Starvation Phase
of Anorexia
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Assess labs:
Monitor intake/output
Assess for cardiovascular, neurological and
complications
Refeed slowly; careful dietary supervision
Intravenous lines and feeding tubes if
client refuses food
Nurse Patient Relationship
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Anorexia Nervosa
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Usually forced into tx.
Tx means loss of
control over eating
Nurse is the enemy
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Bulimia Nervosa
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More likely to want
help: break the cycle
More likely to enter
treatment of their on
volition
Tendency to
manipulate
Hide the degree of the
problem
Critical Thinking: Nursing
Interventions

Give rationales for each of the following
interventions listed on next slide 
Nurse Patient Relationship:
Some Interventions for Eating
Disorders
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Do not confront denial,
but encourage feelings
identification
Honesty
Collaborate
TEACH patient about
their disorder
Assist to identify positive
qualities
Eat with the client
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Set appropriate limits
Encourage decision
making concerning issues
other than food
Behavior modification:
 Patient input
 Reward for weight
gain
Psychopharmacology
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Anxiolytics when re-feeding is occurring
SSRI for Bulimia
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Equally effective for depressed and nondepressed patients
Psychotherapy for Anorexia
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Use antidepressant for co-morbid severe
depression
Milieu Management
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Orientation
Warm nurturing environment
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Convey an understanding of their fears
Close observation
Do we let these patient go to the rest room alone?
Should we let them go to their room right after a meal?
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Nonjudgmental confrontation
CONSISTENCY
Encourage the patient to talk to staff when they
feel the need to purge
Milieu Management, cont’d
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Weighing
Family Therapy
Group Therapy
Which groups would be best for clients with
eating disorders?
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Dietitian
Follow-up Therapy (outpatient)
Scenarios: Communication
1) Two clients on the eating disorders unit are
overheard discussing recipes and meal plans in
the day room. How should the nurse respond?
2) An inpatient with Anorexia Nervosa complains
of feeling very full after eating and says she is
being given too much to eat. How should the
nurse respond?