Inter-American University, Metropolitan Campus

Nursing Department

Eating Disorders, DSMV Actualizations: Symposium

Heidi Reyes
Jennifer Gherman
Raymond Aviles
Alexander Rivera
Alexander Rivera

A. Problem Statement

In every persons life activity is always a big part of them. Sports have
always been present, and are even mentioned in the Greek or Roman history, by
Aesop, a slave and storyteller believed to have lived in ancient Greece between
620 and 560 BCE. Phrase mentioned by Aesop was later made as an example by
a German philosopher, Hegel, first mentioned it in his epigram of his preface in
his Philosophy of Rights a phrase, first in Greek, then in Latin (in the form Hic
Rhodus, hic saltus). He did not explain the meaning, due to lack of understanding
but brought it to the light. Later on was used again by the philosopher Karl Marx.
In the The Braggart an athlete boasts that he once performed a stupendous jump
in Rhodes, and can produce witnesses: the punchline is the comment of a
bystander, who means that there is no need of witnesses, since the athlete can
demonstrate the jump here and now. For me the saying embodies the pressure in
athletes competing to be great, fouled by the standards put on spectators or the
competition itself. The phrase is a general way means, come her and show what
you can do. It emphasizes the importance of performance, which is a practiced
that has continued till today. This kind of pressure is the base to other side line
problems, for example eating disorders.
Eating disorders is any of a range of psychological disorders characterized
by abnormal or disturbed eating habits, such as anorexia nervosa. Anorexia
nervosa dates back to the late 12 century; specifically with the description
wasting diseases. Among some of the wealthy in the Middle Ages, practices
involved people who would vomit during meals so they could consume more,
even though there were thousands of people dying of hunger (But that is another
political topic for another occasion)which is considered as bulimia . Knowledge
of eating disorders became public with the publications of books like the one
made by the author Hilde Bruch, making 1970s the timeframe where it actually
reached public awareness, including the exposure of cases. The lack of knowledge
made healthcare providers for that time to think that anorexia was an endocrine
disorder and treated with pituitary hormones. Eating disorders in adolescents are
strongly predicted by the earlier presence of depression, bipolar disorder, and
anxiety. The eating disorders are of genetic pre disposition, and are related to
inherited differences in serotonin receptors.

Many wonder if the eating disorders are yet one more disease of Western
civilization, most strongly predicated by our poor diets or in this case by lack of
education and strong pressure in competitions. This specific need is what made
way to form the PICO questions that will lead to the finding of our research
articles. For example our population is athletes, especially from a professional
level, which had as intervention questionnaires to determine their conception
about eating disorders, their image concept, how comfortable there are with their
body in a scale of 0-5, their knowledge of good eating habits, etc The
comparison was made with nonprofessional athletes, even if they are on the same
level of performance, payment for performance was used as a key descriptor in
professional athletes. The outcome was to stablish a correlation between eating
disorders and the athletes, especially in a professional level, making our question
Are professional athletes more prone to develop eating disorders? This is not
only the center for our research, but nowadays the industry of sports is growing
making the scenario for nurses more wide involving encounters for these patients.

The world of sports is now involving more hand to hand collaboration

especially with healthcare professionals. Their need for health assistance is greater
due to the high incidence of lesions, but if to this we add eating disorders, this will
put them in a greater risk based on the high demand that sports have on their
body. Knowing the population and how truly prone they are, helps the nurse to
make a more focused nursing care plan. Learning to identify based on the
actualization of the DSMV, and knowing the physical and nutritional impact in the
athletes will also help to create and accurate and complete treatment. The PICO
question also helps the nurses to think on the population that is actually suffering
from it, and to identify the factors that make it happen. Understanding is what
actually is going to provide that strategy, for example athletes that lack knowledge
of eating disorders may have a different rout of treatment compared to athletes
that know , but still continue to practice habits that will or have already develop
into eating disorders. Another factor that we looked into was the type of sport
practiced, making it knowledgeable that not all sports have the same demand,
pressure, standards and needs of performance. Based on this, we actually can
make a prediction on the sports that may generate more eating disorder cases;
making the clarification that in only this statement, genetic disposition is been
taken out of consideration for sake of the argument. Stress due to high demand of
performance can lead to a traumatic experience and generate the eating disorders.
Knowing these kinds of consequences can help educate sports industries in how to
manage it and create prevention programs that nurses working in rehabilitation
facilities can implement as primary care practice in routine checkups.

B. PICO Questions
Population: athletes from professional level
Intervention: questionnaires to determine their conception about eating disorders,
their image concept, how comfortable there are with their body in a scale of 0-5, their
knowledge of good eating habits.
Comparison: nonprofessional athletes
Outcome: stablish a correlation between eating disorders and the athletes, especially
in a professional level
Question: Are professional athletes more prone to develop eating disorders?
Main topics and terms for search:
Athletes/Professional/Eating disorders/Questionnaires
Limits for search:
Age: 18-30 yrs./Language: English /Year of publication: 2011-2015
Type of study or publication:
Systematic review
Clinical practice guidelines
Individual research studies
Data bases:
Pubmed Clinical Inquiries
Evidence-based Journals
Ebsco Host
Information to answer question:
Professional athletes are an investment to teams, this makes the company to invest
in a good training as wells as education regarding eating disorders. Still, cases will develop with
a greater possibility in sports where weigh has a positive correlation with performance like
gymnastics or swimming. When dealing with athletes that have a high physical activity,
nutritional deficiencies on fatty acids can develop other conditions like depression, converting
them into dual diagnosis patients. For nonprofessional athletes, the risk for eating disorders
becomes greater due to lack of education, supervision and high situations of stress regarding
coalification info professional teams.

C. Search Strategies
Once we started doing the research, we only had the general topic in mind. As we started
narrowing down the specific factor for our search we decided to specify on eating disorders. The
decision was made based on our culture. On the media there is always a stereotype that leads to
conducts that may develop into eating disorders. Once the topic was assigned, the population was
obtained by stating certain search limits. The first one is that it was going to be athletes,
specifically professionals or elite, which are the ones that do not only compete in mayor
competitions, but that, are paid to do so. The second search limit is the age, making it a range of
18 years- to 30 years old. This range was selected because is the normal age for athletes to
compete in a professional level. We have to take into consideration that not all sports have the
same age limit, but since we are not narrowing the investigation for only one sport, the range was
made as broader as possible. Even thou the population did not had a sex limit, many of the
studies found involved only women. One of the studies mentioned the statistics for male athletes
but decided to develop the data on women. This may give the perception that woman are more
susceptible to acquire eating disorders, which such information has not been proved by any
investigation, other that there is a genetic predisposition for such mental health disorders.
For our mode of investigation we decided to analyze researches that involved
questionnaires. This was decided in order to not only study the factor, characteristics, or
diagnosis that many athletes consider or know about eating disorders, but to compare them to the
real diagnosis of eating disorders based on the DSMV. For example binge eating disorder will
now have its own category as an eating disorder. In the DSM-IV, binge-eating disorder was not
recognized as its own disorder but rather was diagnosable under the category Eating Disorder
Not Otherwise Specified (EDNOS). Binge eating disorder is defined as recurring episodes of
eating significantly more food in a short period of time than most people would eat under similar
circumstances, with episodes accompanied by feelings of lack of control. A second type of
eating disorder, Anorexia nervosa, is characterized by emaciation, a relentless pursuit of thinness
and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense
fear of gaining weight. The new criteria have several minor but important changes. From the
DSM-V:Criterion A focuses on behaviors, like restricting calorie intake, and no longer includes
the wordrefusal in terms of weight maintenance since that implies intention on the part of the
patient andcan be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the
absence of at leastthree menstrual cycles, will be deleted. This criterion cannot be applied to
males, pre-menarchalfemales, females taking oral contraceptives and post-menopausal females.
In some cases, individuals exhibit all other symptoms and signs of anorexia nervosa but still
report some menstrual activity.

Third but no last Bulimia nervosa is characterized by recurrent and frequent episodes of
eating unusually large amounts of food (e.g., binge-eating), and feeling a lack of control over the
eating. This binge-eating is followed by a type of behavior that compensates for the binge, such
as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive
exercise. The newly revised DSM-5 criteria reduce the frequency of binge eating and
compensatory behaviors that people with bulimia nervosa must exhibit, to once a week from
twice weekly as specified in DSM-IV.
All the information was retrieved by five peer reviewed journal articles. They were found
on the data based Ebsco Host. These articles had a time frame of five year or earlier.
D. Synthesis of Evidence
Athletes population is a group of patients that are growing every day because of the
new wave of accessibility to academies or sports programs. When we as individual
decided to participate in a competition it becomes an experience, but when one as
individual starts to get paid for competing it becomes a full time job with all the perks
that brings with it. The athletes have to comply with standards and this may lead the to
develop eating disorders especially if these athletes do not have the education or
knowledge on this. Our research was based on the perception these athletes had of
themselves, of eating disorders, and what habits are considered part of an eating disorder.
In statistics 61% were satisfied with their self-esteem, 1.8& was susceptible to bulimia,
and 6.8% was susceptible to anorexia. Many stated that there coaches gave them
education on eating disorder and other psychological disorders. Only 18 to 45% in sports
that had a direct correlation with weight showed actions that may develop eating
disorders, if coaches do not make necessary interventions this can reach 70%. On nutrient
deficiency, research showed that athletes suffering eating disorders show low absorption
of fatty acids like omega 3 and omega 6 that are precursor for neurotransmitters
regulators like serotonin. This may also cause mayor depressive symptoms making
patients with dual diagnosis.