EATING

DISORDERS
are characterized by
“a persistent disturbance of
eating or eating-related Eating disorders can be viewed on a
behavior that results in the continuum, with clients with anorexia
altered consumption or eating too little or starving
absorption of food and that themselves, clients with bulimia
significantly impairs physical eating chaotically, and clients with
health or psychosocial obesity eating too much.
functioning”

BRIEF HISTORY ETIOLOGY

Documentation from the Middle Ages A specific cause for eating disorders is unknown.
indicates willful dieting leading to self- Initially, dieting may be the stimulus that leads to their
starvation in female saints who fasted to development.
achieve purity. Biologic Factors:
In late 1800s, doctors in England and Studies of anorexia nervosa and bulimia nervosa have shown
France described young women who that these disorders tend to run in families.
used self-starvation to avoid obesity. Disruptions of the nuclei of the hypothalamus may produce
Anorexia nervosa was established as a many of the symptoms of eating disorders.
mental disorder on 1960s. Developmental Factors:
Bulimia nervosa was first described as a Two essential tasks of adolescence are the struggle to
distinct syndrome in 1979. develop autonomy and the establishment of a unique
identity.
Body image Autonomy may be difficult in families that are overprotective
disturbance occurs or in which enmeshment (lack of clear role boundaries)
when there is an exists.
extreme discrepancy Self-doubt and confusion can result if the adolescent does
between one’s body not measure up to the person she or he wants to be.
image and the Advertisements, magazines, television, and movies that
perceptions of others feature thin models reinforce the cultural belief that slimness
and extreme is attractive.
dissatisfaction with Family Influences:
one’s body image. Girls growing up amid family problems and abuse are at
higher risk for both anorexia and bulimia.
Childhood adversity has been identified as a significant risk
factor in the development of problems with eating or weight
in adolescence or early adulthood.
Sociocultural Factors:
Adolescents often idealize actresses and models as having
the perfect “look” or body.
The dieting industry is a billion-dollar business.
Pressure from others may also contribute to eating disorders.
Studies indicate that bullying and peer harassment are also
related to an increase in disordered eating habits for both
bullies and victims.
 a life-
threatening
ANOREXIA eating disorder
in which the
NERVOSA person has a
morbid fear of
obesity.

characterized by the client’s:

The disorder occurs
restriction of nutritional intake necessary to maintain a minimally
normal body weight,
predominantly in females 12
intense fear of gaining weight or becoming fat, to 30 years of age.
significantly disturbed perception of the shape or size of the
body, and Without intervention, death
steadfast inability or refusal to acknowledge the seriousness of from starvation can occur.
the problem or even that one exists.

RISK FACTORS
Biologic Factors: Obesity; dieting at an early age
Developmental Factors: Issues of developing autonomy and having control over self and
environment; developing a unique identity; dissatisfaction with body image.
Family Factors: Family lacks emotional support; parental maltreatment; cannot deal with conflict.
Sociocultural Factors: Cultural ideal of being thin; media focus on beauty, thinness, fitness;
preoccupation with achieving the ideal body.
Clients with anorexia nervosa can be classified into two subgroups depending on how they
control their weight.
1. Restricting Subtype
a. lose weight primarily through dieting,
fasting, or excessive exercising.
2. Binge eating and Purging Subtype
a. engage regularly in binge eating
followed by purging.

Binge eating means consuming a large Purging involves compensatory behaviors

amount of food (far greater than most designed to eliminate food by means of self-
people eat at one time) in a discrete period of induced vomiting or misuse of laxatives,
usually 2 hours or less. enemas, and diuretics.
 Bulimia nervosa is an eating disorder (commonly called
the binge-and-purge syndrome) characterized by
extreme overeating, followed by self-induced vomiting
and abuse of laxatives and diuretics.
The disorder occurs predominantly in females and begins
in adolescence or early adult life.
Photos show the common symptoms of Bulimia and how
the cycle of Binge and Purge happens.
RISK FACTORS
Biologic Factors: Obesity; early dieting;
possible serotonin and norepinephrine
disturbances; chromosome 1 susceptibility
Developmental Factors: Self-perceptions of
being overweight, fat, unattractive, and
undesirable; dissatisfaction with body image
Family Factors: Chaotic family with loose
boundaries; parental maltreatment including
possible physical or sexual abuse
Sociocultural Factors: Cultural ideal of being
thin; media focus on beauty, thinness, fitness;
preoccupation with achieving the ideal body.
weight-related teasing
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.
Reference Videbeck, 2020; Psychiatric-Mental Health Nursing;
Psychiatric Nursing Pocket Guide; photos were grabbed forom
verywellmind.com ang google
BULIMIA
NERVOSA
OTHER 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.
Night eating syndrome is characterized by morning
anorexia, evening hyperphagia 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,
Eating or feeding disorders in childhood include
pica, which is persistent ingestion of nonfood
substances, and rumination, or repeated
regurgitation of food that is then rechewed, re-
swallowed, or spit out.
Both of these disorders are more common in
persons with intellectual disability.
Orthorexia nervosa, sometimes called orthorexia, is
an obsession with proper or healthful eating.
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.
 MANAGEMENT
ANOREXIA BULIMIA
Clients with anorexia nervosa can be difficult to Cognitive-Behavioral Therapy
treat because they are often resistant, appear CBT has been found to be the most effective
uninterested, and deny their problems. treatment for bulimia.
Medical management focuses on weight Strategies designed to change the client’s
restoration, nutritional rehabilitation, thinking (cognition) and actions (behavior)
rehydration, and correction of electrolyte about food focus on interrupting the cycle of
imbalances. dieting, binging, and purging and altering
Nutritionally balanced meals and snacks dysfunctional thoughts and beliefs about food,
that gradually increase caloric intake to a weight, body image, and overall self-concept.
normal level for size, age, and activity are Self-monitoring techniques raise client
given. awareness about behavior and help them
For severely malnourished clients: regain a sense of control.
Web-based CBT has been effective as well.
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.
Access to a bathroom is supervised to prevent Drugs, such as desipramine (Norpramin),
purging as clients begin to eat more food. imipramine (Tofranil), amitriptyline (Elavil),
Weight gain and adequate food intake are most nortriptyline (Pamelor), phenelzine (Nardil), and
often the criteria for determining the effectiveness fluoxetine (Prozac), were prescribed in the same
of treatment. dosages used to treat depression
Psychopharmacology
Amitriptyline (Elavil) and the antihistamine
C L I E N T A N D F A M I L Y
cyproheptadine (Periactin) in high doses (up to 28
mg/day) can promote weight gain in inpatients
E D U C A T I O N
with anorexia nervosa.
Psychotherapy
Family therapy may be beneficial for families of
clients younger than 18 years and also useful to
help members be effective participants in the
client’s treatment.
Therapy that focuses on the client’s particular
issues and circumstances, such as coping skills,
self- esteem, self-acceptance, interpersonal
relationships, and assertiveness, can improve
overall functioning and life satisfaction.
Enhanced cognitive–behavioral therapy (CBT-E)
has also been adapted for management of
Anorexia Nervosa, addressing not only the body
image disturbance and dissatisfaction, but also
perfectionism, mood intolerance, low self- esteem,
and interpersonal difficulties.
Client Family and Friends
Basic nutritional needs Provide emotional support
Harmful effects of restrictive Express concern about the client’s health.
eating, dieting, and purging Encourage the client to seek professional help.
Realistic goals for eating Avoid talking only about weight, food intake, and calories.
Acceptance of healthy body Become informed about eating disorders.
image It is not possible for family and friends to force the client to eat.
The client needs professional help from a therapist or
psychiatrist.