NCM 117 (LEC)

MALADAPTIVE PATTERNS OF BEHAVIOR

HANDOUT

EATING & FEEDING DISORDER

I. ADAPTIVE EATING RESPONSE

EATING IS PART OF EVERYDAY life. No individual lives without eating. It is necessary for
survival. Eating is also a social activity wherein people gather together and chat over a dinner
date, a family get-together or a barbeque party or a picnic in a friend’s home. Eating is part of
many happy occasions like weddings, birthdays, holidays, thanks giving.

But for some people, eating is a source of worry and anxiety. If not, eating is a way to
relieve tension and frustrations.

Adaptive eating responses can be viewed on a continuum, where a person eats without the
influence of anxiety or frustrations. People eat appropriately in terms of amount and caloric intake
and if ever they go beyond and below the amount and caloric intake, by over eating or skipping
meals, it is due to an acceptable occasion and situations.

Overeating or fasting under the influence of stress or anxiety or depression is a borderline to

maladaptive eating response

II. BEHAVIORS RELATED TO EATING DISORDERS

A. Binge eating - Consumption of large amount of food over a short period of time

B. Fasting or restricting - Limiting amount or type of food consumption over long period of
time

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 C. Purging - A compulsion to eliminate or evacuate food after consuming it either in large or
normal or small amount, usually due to extreme guilt. Purging could either be thru
vomiting, excessive exercising, use of laxatives, diuretics, enema.

D. Rumination (Merycism) - is characterized by ingesting food, chewing it, swallowing and

regurgitate back to the mouth, rechewed again and re-swallowed. (Some spit but most of
the time swallowed)

E. Pica - is the persistent eating of non-edible substances that has no nutritional value such
as dirt or paint, ballpen, hair, chair

III. MALADAPTIVE EATING RESPONSE – EATING & FEEDING DISORDERS

A. ANOREXIA NERVOSA

A psychophysiologic condition common in girls and young women, characterized

by prolonged inability or refusal to eat,

Sometimes accompanied by vomiting, weight loss, extreme emaciation,

amenorrhea and other biological changes.

Some people with anorexia nervosa restrict their intake of food while others
engage in binge eating and purging.

Individuals with anorexia nervosa refuse to maintain a minimally normal weight for
height and express intense fear of gaining weight

People with anorexia nervosa view themselves as flawed or chubby or fat, even if
their weight and physical appearance manifest the opposite. Some of Anorexic
may be diagnosed also with Body Dysmorphic Disorder – when one cannot stop
thinking about one or more perceived defects or flaws in his/her appearance
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 B. BULIMIA NERVOSA

Individuals with bulimia nervosa engage in repeated episodes of binge eating

followed by inappropriate compensatory behaviors such as purging through self-
induced vomiting, misuse of laxatives, diuretics, or other medications; fasting; or
excessive exercise.

This disorder is characterized by a significant disturbance in the perception of body

shape and weight

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 C. BINGE EATING DISORDER

Individuals with binge-eating disorder engage in repeated episodes of binge

eating, after which they experience significant distress.

They do not use the compensatory behaviors (e.g., purging: vomiting and
laxatives) that are seen in patients with bulimia nervosa.

Repeated binge eating inevitably causes obesity

D. NIGHT EATING SYNDROME

Individuals with Night Eating Syndrome have symptoms of morning anorexia and
difficulty staying asleep at night and experience depression mostly in the evening.

Night eaters usually have two awakenings per night and these awakenings are
associated with eating

Currently included in the other specified eating disorder category at DSM-5:

• Evening Hyperphagia - consumption of 25% or more of the total daily
calories after the evening meal + Nocturnal awakening = 2 or more x per
week
• The person must have awareness of the NE to differentiate it from
parasomnia sleep-related eating disorder

E. AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)

• Over food restricting may lead to Feeding disorder called : Avoidant Restrictive
Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was
previously referred to as “Selective Eating Disorder.” ARFID is similar to
anorexia in that both disorders involve limitations in the amount and/or types of

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 food consumed, but unlike anorexia, ARFID does not involve any distress about
body shape or size, or fears of fatness.

• They just lack interest in eating or food; avoid food based on the sensory
characteristics of food; concern about aversive consequences of eating. These
results to failure to meet appropriate nutritional demands of the body

*Associated Disorders with Eating Disorders:

a. Depression
b. Anxiety
c. Substance abuse
d. Somatoform (Body Dysmorphic)
e. Psychosis

COMPLICATIONS OF EATING DISORDERS:

PREDISPOSING / RISKS FACTORS

Biological
• Hypothalamus (Appetite Regulation Center)
- Decrease Tryptophan may lead to
- Decrease Serotonin (Bulimia)
- Decrease Norepinephrine
- Decrease Dopamine (Binge)
- Controls SATIETY
• Obesity – may lead to early dieting
- Serotonin and Norepinephrine disturbances
Psychological
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 •
Self-perceptions of being overweight, fat, unattractive, and undesirable; dissatisfaction
with body image
• Issues of developing autonomy and having control over self and environment;
developing a unique identity; dissatisfaction with body image
Environmental / Sociocultural
• Family lacks emotional support; parental maltreatment; cannot deal with conflict
• Chaotic family with loose boundaries; parental maltreatment including possible
physical or sexual abuse
• Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation
with achieving the ideal body

IV. NURSING PROCESS

A. ASSESSMENT:
a. General Assessment
• Medical History
• Physical Exams:
1. VS, Height, Weight
2. Skin Color (yellow), Lanugo
3. Dental carries
4. Cold extremities, Muscle weakening, low bone density
5. Constipation
6. Hypotension, bradycardia
7. Impaired renal function
• Laboratory Exams (EEG, CT scan, T3, thyroxine level, Electrolytes, CBC)

b. Psychiatric Nursing Assessment

• Perception of the problem
• Eating habits
• History of dieting
• Methods used to achieve weight control (restricting, purging, exercising,
laxatives, diuretics)
• Value attached to a specific shape and weight
• Interpersonal and social functioning
• Mental status and physiological parameters

B. NURSING DIAGNOSIS

a. Imbalanced Nutrition
b. Decreased cardiac output
c. Risk for imbalance fluid and electrolytes
d. Risk for self-mutilation
e. Risk for injury
f. Anxiety
g. Disturbed Body Image
h. Powerlessness
i. Low Self-esteem
j. Ineffective coping

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 C. PLAN / IMPLEMENTATION OF CARE

a. Establish Nurse - Patient Relationship

b. Nutritional Stabilization - Acute Care

Typically, a patient with an eating disorder is admitted to the inpatient psychiatric

facility in a crisis state. The initial focus depends on the results of a comprehensive
assessment. Address any acute psychiatric symptoms, such as suicidal ideation,
immediately. The challenge is to do both: establish trust while monitoring the eating
pattern.

• Sit with the client during meals and snacks.

• Offer liquid protein supplement if client is unable to complete meal.
• Adhere to treatment program guidelines regarding restrictions.
• Observe client following meals and snacks for 1 to 2 hours.
• Weigh client daily in uniform clothing.
• Be alert for attempts to hide or discard food or inflate weight

c. Psychotherapy

Cognitive-behavioral therapy, - the most effective psychotherapy for eating

disorder. Restructuring faulty perceptions and helping individuals develop
accepting attitudes toward themselves and their bodies are the primary focus of
therapy. (e.g. self-monitoring by journaling)

When patients do not indulge in bulimic behaviors, issues of self-worth and

interpersonal functioning become more prominent

d. Family therapy – inclusion of family members or significant others is an essential

approach to promote support system. Family and friends should be taught never
to force the client to eat, instead refer to professional help.

e. Health Teachings: Coping skills other than food

• Help client identify emotions and develop non–food-related coping

strategies

• Ask the client to identify feelings. Self-monitoring using a journal

• Relaxation techniques
• Distraction
• Assist client to change stereotypical beliefs
• Help 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

f. Pharmacotherapy: SSRI – Fluoxetine (Prozac)

To reduce OC behavior after the patient has reached a maintenance weight

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN
 Tricyclic antidepressants help reduce binge eating and vomiting

The most important gauge of care / outcome is the attainment of a safe weight

D. EVALUATION OF CARE

The process of evaluation is built based in the outcomes identified and specified

Evaluation is ongoing, and the nurse can revise short-term indicators as necessary to achieve
the treatment outcomes established.

The indicators provide a daily guide for evaluating success and the nurse must continually
reevaluate them for their appropriateness.

Signs and Symptoms Nursing Diagnosis Outcomes

Emaciation, weight less than ideal / height, Imbalanced Nutrients are ingested and
dehydration, arrhythmias, nutrition: less than absorbed to meet metabolic
inadequate food intake, dry skin, decreased body requirements needs
blood pressure, decreased urine output,
increased urine concentration, weakness Decreased cardiac cardiac pump supports systemic
output perfusion pressure

Risk for fluid and electrolytes are in balance; fluids

electrolyte are in balance
imbalance

Excessive self-monitoring, describes self as Disturbed body Congruence between body

fat despite emaciation image reality, body ideal, and body
presentation; satisfaction with
body appearance

Destructive behavior toward self, poor Ineffective coping Demonstrates effective coping,
concentration, inability to meet role reports decrease in stress, uses
expectations, inadequate problem solving personal support system, uses
effective coping strategies,
reports increase in psychological
comfort

Indecisive behavior, lack of eye contact, Chronic low self- Verbalizes a positive level of
passive, reports feelings of shame, rejects esteem confidence; makes informed life
positive feedback about self decisions, expresses
independence with decision-
making processes

References:
• Margaret Jordan Halter, Varcaroli’s Foundations of Psychiatric-Mental Health Nursing,
8th edition, 2018
• Shiela L. Videbeck, Psychiatric Mental Health Nursing 6 th edition 2011.

Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU-CN