EATING DISORDERS

ANOREXIA NERVOSA(INTRODUCTION)

• Anorexia nervosa is an eating disorder defined by an inability

to maintain one’s body weight. other essential features of
this disorder include an intense fear of gaining weight, a
distorted image of one’s body, denial of seriousness of
illness.
INTRODUCTION(CONT)

• Anorexia nervosa is a complex eating disorder with three key features;

 Refuse to maintain a healthy body weight.

 An intense fear of gaining weight.

 A distorted body image.
CAUSES OR RISK FACTORS

 Stressful life events such as the onset of puberty, a breakup or

going away to school can also trigger anorexia.
 Research suggests that a genetic predisposition to anorexia may
run in families . If a girl has a sibling with anorexia she is 10 to
20 times more likely than the general population to develop
anorexia.
CAUSES OR RISK FACTORS (CONT)

 Body dissatisfaction
 Low self esteem
 Troubled family relationships
 Difficulty expressing feelings
 History of physical or sexual abuse
TYPES OF ANOREXIA NERVOSA

• There are two types of anorexia.

• In the restricting type of anorexia weight loss is achieved by
restricting calories(following drastic diets, fasting and
exercising to excess).
• In the purging type of anorexia weight loss is achieved by
vomiting or using laxatives and diuretics.
1. RESTRICTING SUBTYPE

• People with this subtype place severe restriction on the

amount and type of food they consume.
• Restricting certain food groups( e.g. carbohydrates, fats).
• Counting calories

• Skipping meals
 Cont…

• Obsessive rules and rigid thinking(e.g. only eating food

that is green colour and avoiding white food by assuming
that food have more calorie).
2. BINGE EATING OR PURGING SUBTYPE

• People with this subtype also place severe restriction on the amount
and type of food they consume . In addition to this the person will
display purging behaviour and may also engage it binge eating.

• Weight loss achieved by vomiting laxatives or diuretics.

SIGN AND SYMPTOMS

1. Physical signs and symptoms

• Rapid weight loss or frequent weight changes.

• Loss or disturbance of menstruation in girls and women and decreased

libido in men.

• Fainting or dizziness , lethargy and low energy.

 Physical signs and symptoms
(cont)
• Feelings bloated , constipated or then development of intolerances to

food , abdominal pain.

• Feeling tired and not sleeping well, anaemia.
• Facial changes (e.g. looking pale , sunken eyes) , fine hair appearing on
face and body.
• Compromized immune system.
2. PSYCHOLOGICAL SIGN AND SYMPTOMS

• Preoccupation with eating food, body shape and weight, intense

fear of gaining weight.
• Feeling anxious or irritable around meal times.
• Depression and anxiety
• Reduced capacity for thinking and difficulty in concentration.
PSYCHOLOGICAL SIGN AND SYMPTOMS(CONT)

• Low self esteem .

• Increased sensitivity to comments relating to food , weight, body shape,
exercise.
• Extreme body image dissatisfaction.
3. BEHAVIOURAL SIGNS AND SYMPTOMS

• Dieting behaviour (e.g. fasting, counting calories, avoiding food groups

such as fats and carbohydrates)
• Intentional misuse of laxatives ,appetite suppressants, enemas and
diuretics.
• Evidence of binge eating (e.g. disappearance or hoarding of food).
• Eating in private and avoiding meals with other people.
BEHAVIOURAL SIGNS AND SYMPTOMS(CONT)

• Anti-social behaviour
• Self harm, substance abuse or suicide attempts.
• Obsessive rituals around food preparation and eating (e.g. eating very
slowly , cutting food into small pieces).
EXAMINATION AND INVESTIGATION

• Physical examination.
• Laboratory tests
CBC
Electrolytes
Protein
LFT, RFT, TFT
Urinalysis
EXAMINATION AND INVESTIGATION (CONT)

• Psychological evaluation
 Thoughts, feeling and eating habits
THERAPEUTIC AND NURSING MANAGEMENT

• The long term aims of psychological treatment for anorexia nervosa are
to reduce risk and to encourage weight gain , normal eating and exercise
behaviours , with full psychological and physical recovery as ultimate
goal.
• Psychotherapy

• Behavioural therapy
• cognitive behavioural therapy
MANAGEMENT (CONT)

• Adolescent focused individual therapy ( for children and adolescents).

• Drugs therapy: Antidepressants (e.g. SSRI) or anti psychotics can also

used .
• Family support is needed.

• Nutrition counselling.
COMPLICATION
• Iron deficiency anaemia.
• Intestinal problems (e.g. abdominal pain ,constipation, diarrhoea)
• Osteoporosis
• Heart problems
• Loss or disturbance of menstruation in girls and women.
• Compromised immune system.
• Death could occur due to cardiac arrest.
BULIMIA NERVOSA
 BULIMIA NERVOSA

• Bulimia nervosa is a serious eating disorder. Characterized by a destructive

pattern of binging (eating too much unhealthy food) and inappropriate ,
reactionary behaviours to control weight.
• It is an eating disorder marked by binge eating i.e. out of control eating ,
followed by purging such as vomiting, taking laxative and excessive activity to
prevent the individual from gaining weight.
CAUSES AND RISK FACTORS

• Exact cause is unknown. It is assumed to be caused by a combination of

genetic and environmental factors.
• People binge and purge when feeling angry, depressed, stressed or
anxious.
• The typical age of onset for bulimia nervosa is late adolescence or early
adulthood, but onset can and does occur at any time throughout the
lifespan.
CAUSES AND RISK FACTORS (CONT)

• It mainly affect females , although at least one in 10 individuals with this

condition is male.
• It is found in all racial , religious, ethnic and socioeconomic group.
• It often occurs with psychiatric disorders such as mood disorders ,
depression, anxiety disorders , disorders of self injurious behaviour and
with family history of eating disorders.
CAUSES AND RISK FACTORS ( CONT)

• Poor body image

• Low self esteem
• History of trauma or abuse
• Major life changes(such as physical changes of puberty)
 SIGN AND SYMPTOMS

1. Binge eating sings and symptoms

 lack of control over eating.

 Secrecy surrounding eating

 Eating unusually large amount of food with no obvious change in
weight.
 Alternating between overeating and fasting: Rarely eats normal meals
SIGN AND SYMPTOMS (CONT)

2. Purging signs and symptoms

 Going to the bathroom after meals
 Using laxatives, diuretics or enemas after eating. May also take diet pills
to curb appetite or use the sauna to ‘’sweat out’’ water weight.
 They may try to cover up the smell with mouthwash, perfume, air
freshener , gum or mints.
 Excessive exercising
SIGN AND SYMPTOMS (CONT)

3. Physical signs and symptoms

 Calluses or scars on the knuckles or hand from sticking fingers down the
throat to induce vomiting.
 Puffy ‘’chipmunk’’ cheeks caused by repeated vomiting.
 Discoloured teeth from exposure to stomach acid when throwing up.
May look yellow, ragged or clear.
SIGN AND SYMPTOMS (CONT)

• Frequent fluctuations in weight; weight may fluctuate by 10 pounds or

more due to alternating episodes of bingeing ang purging.

SEVEN CORE SYMPTOMS OF BULIMIA NERVOSA

• Preoccupation with food

• Binge eating , usually in secret
• Vomiting after bingeing
• Abuse of laxatives , diuretics , diet pills
• Denial of hunger or drugs to induce vomiting
• Compulsive exercise
• Swollen salivary glands
• Broken blood vessels in the eyes
THERAPEUTIC AND NURSING MANAGEMENT

• The most important thing to do in the treatment of bulimia nervosa to

ensure good medical treatment.
• Individual therapy can include a wide-variety of techniques : cognitive
behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have
been shown in scientific studies to decrease the symptoms of bulimia
nervosa.
THERAPEUTIC AND NURSING MANAGEMENT(CONT)

• Group psychotherapy can be useful in helping individuals with a

supportive , therapeutic environment to discuss the challenges they face
throughout treatment.

• Family psychotherapy can be useful in helping to support both the

individuals with bulimia nervosa and their family members.

• Nutritional counselling is useful in guiding individuals towards a healthy

diet and regular eating habits.
THERAPEUTIC AND NURSING MANAGEMENT(CONT)

• Antidepressants : fluoxetine is effective medicine for bulimia nervosa.

This medication helps by decreasing the symptoms of bulimia nervosa ,
but it does not cure the illness.
• Support from family members and friends are very essential.
 COMPLICATIONS

• People with bulimia nervosa even if their weight remains ‘’normal’’ can
severely damage their bodies by binging and purging.
• Self-induced vomiting can injure the various parts of the gastrointestinal
tract : tooth decay , esophageal and stomach injury , and acid reflux are
all common in people.
 COMPLICATIONS

• Excessive purging behaviors can cause dehydration and changes in the

body’s electrolytes (e.g. low potassium).This can lead to multiple
problems including cardiac arrhythmias , heart failure and even death.