EATING

DISORDERS
 ANOREXIA NERVOSA

• Sir William Gull

• ANOREXIA “loss of Appetite”
• Course:
– INSIDOUS
• Age of onset:
– 10 – 40 years of age, 16 (average) ,
adolescence
 DSM CRITERIA
• Refusal to maintain body
weight
• Intense fear of gaining
weight or UNDERWEIGHT
• DENIAL
• In females, absence of at
least three consecutive
menstrual cycle.
 Amenorrhea Theories
• Lack of Nutrition will slow the functioning of
the Pituitary gland
• A woman must maintain 17% of body fat to
menstruate
 Objective signs
• Deliberate weight loss
• Amenorrhea
• Dry skin, cracking
• Lanugo
norexia
dolescent
menorrhea
nderweyt
   
 PSYCHOTHERAPEUTIC
MANAGEMENT
• Difficult to treat DENIAL
• Choice of setting depends on the severity of
the illness.
– Serious: Hospitalization
– Outpatient Therapy: less than 6 months, are not
binging and purging
 3 MAJOR OBJECTIVES
• Increasing self esteem
• Increasing weight
• Reestablish eating behavior.
 TNPR

• INCREASE SELF ESTEEM

– Assist in identifying positive qualities about
themselves
– Identify patient’s non weigh related interests.
• INCREASE WEIGHT
– Hospitalization
– Rehabilitation
• REESTABLISH
– Set limits
 MILIEU
• Tour of the setting
• Provide a warm nurturing atmosphere
• Involve families in the treatment
• Involve the dietitian
• Psychotherapy group and individual therapy.
 BULIMIA NERVOSA
• “bulimia” literally means to have insatiable
appetite.
• Weight is NORMAL
• AWARE that their eating is pathologic
• Onset:
– 15 to 24 years old.
– Typical 18 – 19, College
• Course:
– CHRONIC and Intermittent
 DSM CRITERIA
• Recurrent episodes of binge eating
• Lack of control over eating behaviors during
the eating binges.
• Binge eating and inappropriate compensatory
behaviors both occur on average at least twice
a week for 3 months.
• Recurrent inappropriate compensatory
behavior
 2 types
• Purging Type
• Non purging Type
 OBJECTIVE SIGNS
• Mechanical irritation
and injuries to the GIT
• Fluid and
Electrolytes • Menstrual
irregularities
abnormalities
• Enlarged salivary
glands (painless)
• Erosion of the dental
enamel
 PSYCHOTHERAPEUTIC
MANAGEMENT

• Initial goal: Medical stabilization of the

bulimic patient is the initial treatment, then
your PSYCHOTHERAPY
• A multidisciplinary approach
 TNPR
• 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.
 Stepped care (Fairburn)
• First participate in simple treatment, such
as guided self help or psychoeducational
group
• Cognitive behavior therapy

• Help manage emotions

• Intensive treatment
 BINGE EATING DISORDER (BED)
• Eating disorder that do not fit clearly into the
diagnostic criteria for Anorexia or Bulimia.
 DSM
• Recurrent binge eating at least 2 days per
week for 6 months at least 3 of the following:
– Eating rapidly
– Eating until becoming uncomfortably full
– Eating large amounts when not hungry
– Eating alone because of embarrassment
– Disgust, depression, guilt because of eating
episodes
 Primary Goal Therapy
• Establish a regular, healthful pattern.
Eating Related Problems
 PICA
• Persistent eating of non nutritious food
 Anorexia Athletica
• Obsessed exercised
 Muscle Dysmorphia
(bigorexia)

• Worry excessively that they are small even if

they have good muscle mass.
 Orthorexia Nervosa

• Pathologic fixation of eating proper, “pure” or

“superior” foods
 Night Eating Disorder
• Lack of appetite for breakfast because of
preoccupation on the amount of food eaten
the night before.
 Nocturnal Sleep related Eating
Disorder

• Persons who eats while asleep.

 Rumination Syndrome
• Bizarre eating pattern wherein the person
eats, swallows and then regurgitate food
back into the mouth again and then
swallowed again.
 Gourmand’s Syndrome
• Obsession with fine foods
 Prader Nilli Syndrome
• Incessant eating (congenital problem)
 Chewing and Spitting
• Putting foods in the mouth, tasting, chewing
then spitting.
KEY NURSING INTERVENTIONS
for EATING DISORDER

• Monitor daily caloric intake

• Observe patients for signs
of purging
• Monitor activity level
• Weigh daily
• Plan for dietitian
• Regular monitor electrolyte
status
 CBQ
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