COLLEGE OF NURSING - NCM 117 1

COLLEGE OF NURSING - NCM 117

EATING DISORDERS
ANOREXIA NERVOSA
Sir William Gull
ANOREXIA “loss of Appetite”

BW:
85% less than expected for their age and height

Age of onset:
10 – 40 years of age, 16 (average) , adolescence
Pre-morbid:
Perfectionist, introvert with problems with self esteem and peer relationship.
DSM CRITERIA
Refusal to maintain body weight at or above a minimum
normal weight for age and height
Intense fear of gaining weight or becoming fat even though
underweight
Disturbance in the way in which one’s body weight or shape is
experienced, overvaluing of shape or weight or denial of
seriousness of low weight.
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, fat
levels below this amount will lead to amenorrhea.
2 types
Restricting type
Young women, who are in normal weight range for height and build
before the disorder begins.
They usually participate in rigid exercise programs to reduce
weight.
Binge eating/Purging type
Are more often overweight before eating disorder begins
Dangerous methods like: induction of vomiting, or excessive use of
laxatives.
Objective signs
Insomnia and
Deliberate weight
early loss
morning walks
Amenorrhea,
Osteopenia or low
osteophorosis,
levels of LHkyphosis
and FSH,
Anemia
Ventricular dilatation
Constipation
Decrease thickness of the L ventricular wall, size of the chambers,
myocardial oxygen uptake.
Hypotension
Preoccupied
Bradycardia to food and eating which involves all aspects of life.
Engage in bizarre behavior
Hypothermia
Dehydration
Dry skin, cracking
Lanugo
Delayed gastric emptying
Pitting edema
ETIOLOGY
Biological
Psychodynamic
Two basic drives:
Physiological sexual and aggressive
disturbances
Eating and
Increase sexual drive
SEROTONIN are appetite
levels
Early CSF
Increase history of sexual
level abuse
of 5HIAA
Regression to pre-pubertal stage
Obesity
Obsession
Socio-cultural
Thin beauty ideal for women
Relational Orientation of women
Family
Genetics
Family environment
BULIMIA NERVOSA
“bulimia” literally means to have insatiable appetite.
Massive overeating and is used interchangeably with binge
eating or binging “bulimarexia”
Weight is normal
Aware that their eating is pathologic and go to great lengths to
hide it from others.
Onset:
15 to 24 years old.
Typical 18 – 19, College
Course:
CHRONIC and Intermittent
DSM CRITERIA
Recurrent episodes of binge eating
A feeling of 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 in
order to prevent weight gain, such as self induced
vomiting, use of laxatives or diuretics, strict dieting
or fasting, vigorous exercise, or taking dieter pills.
Self evaluation is unduly influenced by body shape and
weight
2 types
Purging Type
Non purging Type
OBJECTIVE SIGNS
Addiction irritation and injuries to the GIT
Mechanical
Reflex constipation
Fluid and Electrolytes abnormalities
dehydration
Rebound edema
hyponatremia
Cardiomyopathy
hypokalemia
Menstrual irregularities
Hypochloremia
Enlarged salivary glands (painless)
Esophagitis
Erosion of the
Esophageal dental enamel
stricture
Pancreatitis
Aspiration Pneumonia
 Biological Cognitive and Behavioral
Hypothalamic dysfunction Cycles of low self esteem,
ETIOLOGY (hunger area) extreme concerns about
Satiety center disturbance body shape and weight,
Low serotonin strict dieting, binge eating
and compensatory
Socio-cultural behavior.
Same with AN Psychodynamic
Family Personality Structure
Genetics Ambivalent feeling
Chaotic family with loose
boundaries
Parental maltreatment
including possible physical
or sexual abuse.
PSYCHOTHERAPEUTIC MANAGEMENT

Initial goal: Medical stabilization of the bulimic patient is the

initial treatment, then your PSYCHOTHERAPY
A multidisciplinary approach involving the Physician, Nurses,
Dietitian and psychotherapist
TNPR
Create an atmosphere of trust
Help patient identify feelings associated with the binge purge
behavior.
Accept patient as worthwhile human beings
Encourage client identify positive qualities about themselves
in order to improve self esteem.
Teach patient about bulimia nervosa
MILIEU
 GOAL:
 To establish normal eating pattern and to interrupt the binge and
purge cycle.
Reasons for hospitalize a bulimic
To treat psychiatric or medical crisis, such as suicidal feelings,
or a serious fluid electrolyte imbalance
To provide order to an otherwise chaotic life
To allow patients to examine their living situations
To provide treatments to patients who live in area far away
from other services.
Stepped care (Fairburn)
First participate in simple treatment, such as guided self help
or psychoeducational group
Cognitive behavior therapy
Self monitoring (Diary or Manual)
All food eaten including binges and mood, emotions and thought
Help manage emotions
Relaxation techniques
Distraction techniques
Intensive treatment
Interpersonal psychotherapy
Partial/full hospitalization
Antidepressant medication
Some Principles for management
For inpatients, encourage patient to adhere to the meal and
snack schedules of the hospital. Regularization of eating
prevents the precipitation of binge eating by dieting or restrictive
eating practice. Follow the dietitian
Encourage patient to approach a staff member when they have the
urge to binge and purge
Encourage patient to attend group therapy meetings
For young patient living at home, encourage participation of the
family
For in patients, encourage participation in art, recreation,
occupational therapy,
Encourage patient to participate in individual psychotherapy
Determine patient ability to view weighing.
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.
CBQ
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X symptoms
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