EATING

Prepared by: Genevieve D. Chavez, RN

DISORDER

Because you are more than a body

Prepared by: Genevieve D. Chavez, RN
 Learning
Objectives

1. Compare and contrast the symptoms of anorexia nervosa and

bulimia
nervosa.
2. Discuss various etiologic theories of eating disorders.
3. Identify effective treatment for clients with eating disorders.
4. Apply the nursing process to the care of clients with eating
disorders.
5. Provide teaching to clients, families, and community members
to increase
knowledge and understanding of eating disorders.
6. Evaluate your feelings, beliefs, and attitudes about clients
with eating
disorders.
 Are they eating too much?
 Do they look fat?
 Is some new weight loss
promotion going to be the
answer?
 CATEGORIES OF EATING DISORDERS

 Anorexia nervosa is a life-threatening eating disorder characterized by the client’s restriction of nutritional intake
necessary 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, and steadfast inability or refusal to acknowledge the seriousness of
the problem or even that one exists

 Binge eating means consuming a large amount of food (far greater than most people eat at one time) in a discrete period of
usually 2 hours or less.
 Purging involves compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of
laxatives, enemas, and diuretics.
 CATEGORIES OF EATING DISORDERS

 Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating
followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively
exercising.
 The amount of food consumed during a binge episode is much larger than a person would normally eat. The client often
engages in binge eating secretly. Between binges, the client may eat low-calorie foods or fast. Binging or purging episodes
are often precipitated by strong emotions and followed by guilt, remorse, shame, or self-contempt.
 The weight of clients with bulimia is usually in the normal range, though some clients are overweight or underweight.
 Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these
clients. Dentists are often the first health care professionals to identify clients with bulimia.
 Related Disorders

 Binge eating disorder is characterized by recurrent episodes of binge eating; no regular use of inappropriate
compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating
behaviors; and marked psychological distress. Binge eating disorder frequently affects people over age 35, and it occurs
more often in men than does any other eating disorder. Individuals are more likely to be overweight or obese, overweight
as children, and teased about their weight at an early age.
 Night eating syndrome is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after
the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress,
low self-esteem, anxiety, depression, and adverse reactions to weight loss. Most people with night eating syndrome are
obese. Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants has shown limited, yet positive effects.
 Related Disorders

 Pica, which is persistent ingestion of nonfood substances.

 Rumination, or repeated regurgitation of food that is then rechewed, re-swallowed, or spit out.

 Orthorexia nervosa, sometimes called orthorexia, is an obsession with proper or healthful eating. Others believe it is a
type of anorexia or a form of obsessive–compulsive disorder. Behaviors include compulsive checking of ingredients;
cutting out increasing number of food groups; inability to eat only “healthy” or “pure” foods; unusual interest in what
others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs.
 ANOREXIA NERVOSA

 Anorexia nervosa typically begins between the ages of 14 and 18 years. In the early stages, clients often deny having a
negative body image or anxiety regarding their appearance. They are pleased with their ability to control their weight and may
express this.

 For clients with anorexia, about 30% to 50% achieve full recovery, while 10% to 20% remain chronically ill. Compared to the
general population, clients with anorexia are six times more likely to die from medical complications or suicide.

 Clients with the lowest body weights and longest durations of illness tended to relapse most often and have the poorest
outcomes.

 Clients who abuse laxatives are at a higher risk for medical complications.
Treatment and Prognosis

 Major life-threatening complications that indicate the need for hospital admission include severe fluid, electrolyte, and
metabolic imbalances; cardiovascular complications; severe weight loss and its consequences; and risk for suicide.

 Short hospital stays are most effective for clients who are amenable to weight gain and who gain weight rapidly while
hospitalized. Longer inpatient stays are required for those who gain weight more slowly and are more resistant to gaining
additional weight.

 Outpatient therapy has the best success with clients who have been ill for fewer than 6 months, are not binging and
purging, and have parents likely to participate effectively in family therapy.

 Cognitive–behavioral therapy (CBT) can also be effective in preventing relapse and improving overall outcomes.
Medical Management

 Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte
imbalances.

 Amitriptyline (Elavil) and the antihistamine in high doses (up to 28 mg/day) can promote weight gain in inpatients with
anorexia nervosa.
 Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions)
and associated weight gain.
 Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or
completely restored (Davis & Attia, 2017); however, close monitoring is needed because weight loss can be a side effect.
 BULIMIA NERVOSA

 Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or 19 years is the typical age of onset. Binge eating
frequently begins during or after dieting.
 Between binging and purging episodes, clients may eat restrictively, choosing salads and other low-calorie foods. This
restrictive eating effectively sets them up for the next episode of binging and purging, and the cycle continues.
 Clients with bulimia are aware that their eating behavior is pathologic, and they go to great lengths to hide it from others.
They may store food in their cars, desks, or secret locations around the house. They may drive from one fast-food restaurant to
another, ordering a normal amount of food at each but stopping at six places in 1 or 2 hours.
 Such patterns may exist for years until family or friends discover the client’s behavior or until medical complications develop
for which the client seeks treatment.
 Most clients with bulimia have near-normal weight, which reduces the concern about severe malnutrition, a factor in clients
with anorexia nervosa.
Treatment and Prognosis

 Cognitive–Behavioral Therapy
 CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual
to guide treatment. Strategies designed to change the client’s thinking (cognition) and actions (behavior) about food focus on
interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight,
body image, and overall self-concept.
 Web-based CBT, including face time with a therapist, has been effective as well as traditionally delivered CBT. Smartphone
applications (apps) for eating disorder self-management are also promising and highly acceptable to user groups.

Psychopharmacology
 Since the 1980s, many studies have been conducted to evaluate the effectiveness of medications, primarily antidepressants,
to treat bulimia.
 Drugs, such as desipramine (Norpramin), imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), phenelzine
(Nardil), and fluoxetine (Prozac), were prescribed in the same dosages used to treat depression.
Points to Consider When Working with Clients with Eating Disorders

 Be empathetic and nonjudgmental, though this is not easy. Remember the client’s perspective and fears about
weight and eating.

 Avoid sounding parental when teaching about nutrition or why laxative use is harmful. Presenting information
factually without chiding the client will obtain more positive results.

 Do not label clients as “good” when they avoid purging or eat an entire meal. Otherwise, clients will believe
they are “bad” on days when they purge or fail to eat enough food.
 Remember:
You are more than
a body
 Thank You!

Do you have any

questions?