FEEDING AND EATING DISORDERS

FEEDING AND EATING

DISORDERS are characterized by
a persistent disturbance of eating
and eating related behavior that
results in the altered consumption
or absorption of food and that
significantly impairs physical
health or psychosocial
functioning.

ETIOLOGY:

1.Biologic Factors
– serotonin levels

2.Sociocultural Factors
– physical attractiveness in obtaining approval

3.Family Factors
– genetic component and family environment

4.Cognitive and Behavioral Factors

– positive attention from others, low self-esteem, extreme
concerns about body shape and weight.

5.Psychodynamic Factors
– early history of sexual abuse, regression, obsession,
anxiety
(anorexia); ambivalence (bulimia)

FEEDING AND EATING

DISORDER

1. Pica

2. rumination disorder

3. avoidant/restrictive food intake disorder

4. anorexia nervosa

5. bulimia nervosa

6. binge-eating disorder
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 I. ANOREXIA NERVOSA
–“anorexia” means “loss of appetite”
–underweight
– DENY their condition is problematic

Objective Signs: Subjective Symptoms:

• Deliberate weight loss • Fear of losing control over the
• Hypotension, bradycardia,hypothermia amount of food eaten
• Amenorrhea • Helplessness
• Constipation • Depression
• Dry skin, cracking • Irritability
• Lanugo • Social withdrawal
• Preoccupied to food and eating which • Lessened sex drive
involves all aspects of life. • Obsessional symptoms
• Engage in bizarre behavior

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PSYCHOTHERAPEUTIC MANAGEMENT
Serious: Hospitalization
Outpatient Therapy: less than 6 months, are not binging and purging
TNPR
• Increase self-esteem
o Assist in identifying positive qualities about themselves
o Identify patient’s non weigh related interests.
• Increase weight
o Hospitalization
o Rehabilitation
• Reestablish eating pattern
o Set limits
o Teach patient about their disorder
o Initiate a behavior modification program that rewards weight gain with meaningful privileges
MILIEU
• Tour of the setting
• Provide a warm nurturing atmosphere
• Involve families in the treatment
• Involve the dietitian
• Psychotherapy group and individual therapy.

II.BULIMIA NERVOSA
- “bulimia” means “to have insatiable appetite”
- Weight is NORMAL
- AWARE that their eating is pathologic

Objective signs Subjective Symptoms

• Mechanical irritation and injuries to the GIT • Fear of becoming fat
• Fluid and Electrolytes abnormalities • Anxiety
• Esophagitis • Guilt
• Pancreatitis • Depression (common)
• Aspiration Pneumonia
• Reflex constipation
• Cardiomyopathy
• Menstrual irregularities
• Enlarged salivary glands (painless)
• Erosion of the dental enamel

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PSYCHOTHERAPEUTIC MANAGEMENT
Initial goal: Medical stabilization of the bulimic patient is the initial treatment, then PSYCHOTHERAPY
• Create an atmosphere of trust
• Help patient identify feelings associated with the binge purge behavior.
• Encourage client identify positive qualities about themselves in order to improve self esteem.
• Teach patient about bulimia nervosa
• Consistency/ limit setting
MILIEU
Goal: To establish normal eating pattern and to interrupt the binge and purge cycle.
• First participate in simple treatment, such as guided self help or
psychoeducational group
• Cognitive behavior therapy
o Self monitoring (Diary or Manual)
• Help manage emotions • Intensive treatment
o Relaxation techniques o Interpersonal psychotherapy
o Distraction techniques o Partial/full hospitalization
o Antidepressant medication

COMPARISON BETWEEN ANOREXIA AND BULIMIA

SIMILARITIES
• Restriction of intake at times, especially anorectics • Perfectionist traits
• Bingeing or overeating at times, especially bulimics • Belief that their worth is based solely on
• Purging through vomiting, laxatives, or diuretics appearance
• Overexercise • Discomfort in social settings, especially with the
• Extreme concern about appearance opposite gender
• Misperception of their size, shape, and level of fat
• Low self-esteem

DIFFERENCES

Anorexia Bulimia
• Early onset • Later onset
• Very low weight • More normal weight
• Amenorrhea for some patients • Menstrual irregularities
• Hormonal imbalance • Fluid and electrolyte imbalance
• Constipation if not using laxatives • Gastrointestinal problems related to bingeing and
purging
III. BINGE EATING DISORDER (BED)

Primary Goal: Establish a regular, healthy eating pattern.

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KEY NURSING INTERVENTIONS for EATING DISORDER
✓ Monitor daily caloric intake
✓ Regularly monitor electrolyte status
✓ Observe patients for signs of purging
✓ Monitor activity level
✓ Weigh daily
✓ Plan for dietitian
✓ Encourage use of therapies or support groups
✓ Promote decision making
✓ Promote positive self-concept

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