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EATING DISORDERSPyschiatric Nursing

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EATING

Eating is the ingestion of food to provide for all organismtheir nutritional needs, particularly for energy and growth.

Animals and other heterotrophs must eat in order to

survive: carnivores eat other animals, herbivores eatplants, omnivores consume a mixture of both plant andanimal matter, and detritivores eat detritus. Fungi digest

organic matter outside of their bodies as opposed to

animals that digest their food inside their bodies. Eatingis an activity of daily living.

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Physiologically, eating is generally triggered byhunger, but there are numerous physical and

psychological conditions that can affect appetiteand disrupt normal eating patterns. These includedepression, food allergies, ingestion of certainchemicals, bulimia, anorexia nervosa, pituitary

gland malfunction and other endocrine problems,and numerous other illnesses and eatingdisorders.

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Eating Disorder

Can be viewed on a continuum with the clientswith anorexia eating too little or straving

themselves, clients with bulimia eating chaotically,

and clients with obesity eating too much. There ismuch overlap among the eating disorders: 30% to50% of normal-weight people with bulimia have ahistory of anorexia nervosa and low body weight

and about 50% of people with anorexia nervosaexhibit bulimic behavior .

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Clients with bulimia have later age of onset and

near-normal body weight. They usually areashamed and embarrased by the eating behavior.More than 90% of cases of anorexia nervosa andbulimia occur in females. Although fewer men than

women suffer from eating disoders, the number ofmen with anorexia or bulimia may be much higher

than previously believed .Men, however, are less likely to seek treatment .

The prevalence of both 3% of the generalpopulation in the united states.

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ANOREXIA NERVOSA-- also known as simply Anorexia, is an eating disorder

characterized by refusal to maintain a healthy bodyweight and an obsessive fear of gaining weight.

-- It is often coupled with a distorted self image whichmay be maintained by various cognitive biases that alter

how the affected individual evaluates and thinks about

her or his body, food and eating.--Persons with anorexia nervosa continue to feel hunger,but deny themselves all but very small quantities of food.

--The average caloric intake of a person with anorexia

nervosa is 600800 calories per day, but extreme casesof complete self-starvation are known.

http://en.wikipedia.org/wiki/Body_imagehttp://en.wikipedia.org/wiki/Cognitive_biashttp://en.wikipedia.org/wiki/Cognitive_biashttp://en.wikipedia.org/wiki/Body_image

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--It is a serious mental illness with a highincidence of comorbidity and the highest mortality

rate of any psychiatric disorder.--Anorexia most often has its onset in

adolescence and is most prevalent amongadolescent girls.However, more recent studies

show that the onset age of anorexia decreasedfrom an average of 13 to 17 years of age to 9 to

12.--While it can affect men and women of any

age,race , and socioeconomic andculturalbackground,Anorexia nervosa occurs in females

10 times more than in males.

http://en.wikipedia.org/wiki/Comorbidityhttp://en.wikipedia.org/wiki/Race_(classification_of_human_beings)http://en.wikipedia.org/wiki/Socioeconomicshttp://en.wikipedia.org/wiki/Culturehttp://en.wikipedia.org/wiki/Culturehttp://en.wikipedia.org/wiki/Socioeconomicshttp://en.wikipedia.org/wiki/Race_(classification_of_human_beings)http://en.wikipedia.org/wiki/Comorbidity

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It is a life threatening eating disorder

characterized by the clients's refusal or inability tomaintain a minimally normal body weight, intense

fear of gaining weight or becoming fat,significantly disturbed perception of the shape or

size of the body, and steadfast inability or refusalto acknowledge the seriousness of the problem or

even that one exsists.Clients with anorexia nervosa can be classified

into two subgroups depending on how they controltheir weight.

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Clients with the restricting subtype lose weightprimarily through dieting, fasting, or excessively

excercising.Binge eating- means consuming a large amountof food( far greater than most people eat at onetime) in a discrete period of usually 2 hours or

less.

Purguring- means the compensatory behaviors

designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas,and diuretics.

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Clients with anorexia do not binge but still engagein purguring behaviors after ingesting small

amounts of food.Clients with anorexia become totally absorbed in

their quest for weight loss and thinnes.They may also engage in unusual or ritualistic

food behaviors such as refusing to eat aroundothers, cutting foods into minute pieces, or notallowing the food they eat to touch their lips.

These behavior incresed their sense of control.

Excessive excersice is common; it may occupyseveral hours a day.

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AN, typically begins between 14 to 18 years ofage. Clients often deny that they have anxietyregarding their appearance or a negative body

image.They are very pleased with their ability to control

their weight and may express this.They also unable to identify their emotions aboutlife events such as school or relationships with

family or friends. A profound sense of emptiness is

common.As the illness progress, depression and lability in

mood become more apparent.

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Clients believe that their jealous of their weight

loss and may think that family and health careprofessionals are trying to make them FAT and

UGLY.Study of clients with AN, found that after 21

years, 50% had recoverd fully, 25% hadintermediate outcomes, 10% still met all theclients of AN, and 15% had died of anorexia-

related causes.Clients who abuse laxatives are at a greater risk

for medical complications.

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Signs and symptoms

A person with anorexia nervosa may exhibit anumber of signs and symptoms, some of which

are listed below. The type and severity vary ineach case and may be present but not readily

apparent. Anorexia nervosa and the associatedmalnutrition that results from self-imposed

starvation , can cause severe complicationsinevery major organ system in the body.

http://en.wikipedia.org/wiki/Malnutritionhttp://en.wikipedia.org/wiki/Starvationhttp://en.wikipedia.org/wiki/Complicationshttp://en.wikipedia.org/wiki/Organ_systemhttp://en.wikipedia.org/wiki/Organ_systemhttp://en.wikipedia.org/wiki/Complicationshttp://en.wikipedia.org/wiki/Starvationhttp://en.wikipedia.org/wiki/Malnutrition

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obvious, rapid, dramatic weight loss

lanugo : soft, fine hair grows on face and body

obsessionwithcaloriesand facontent

preoccupation with food , recipes , or cooking ; may cook elaboratedinners for others but not eat themselves

dietingdespite being thin or dangerously underweightfearof gaining weight or becoming overweight

rituals: cuts food into tiny pieces; refuses to eat around others;hides or discards food

purging: uses laxatives , diet pills , ipecac syrup , or water pills ;may engage in self-induced vomiting ; may run to the bathroomafter eating in order to vomit and quickly get rid of the calories .

http://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Lanugohttp://en.wikipedia.org/wiki/Fixation_(psychology)http://en.wikipedia.org/wiki/Food_energyhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Foodhttp://en.wikipedia.org/wiki/Recipeshttp://en.wikipedia.org/wiki/Cookinghttp://en.wikipedia.org/wiki/Dietinghttp://en.wikipedia.org/wiki/Underweighthttp://en.wikipedia.org/wiki/Fearhttp://en.wikipedia.org/wiki/Laxativeshttp://en.wikipedia.org/wiki/Diet_pillshttp://en.wikipedia.org/wiki/Ipecac_syruphttp://en.wikipedia.org/wiki/Water_pillshttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Caloriehttp://en.wikipedia.org/wiki/Caloriehttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Water_pillshttp://en.wikipedia.org/wiki/Ipecac_syruphttp://en.wikipedia.org/wiki/Diet_pillshttp://en.wikipedia.org/wiki/Laxativeshttp://en.wikipedia.org/wiki/Fearhttp://en.wikipedia.org/wiki/Underweighthttp://en.wikipedia.org/wiki/Underweighthttp://en.wikipedia.org/wiki/Dietinghttp://en.wikipedia.org/wiki/Cookinghttp://en.wikipedia.org/wiki/Recipeshttp://en.wikipedia.org/wiki/Foodhttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Food_energyhttp://en.wikipedia.org/wiki/Fixation_(psychology)http://en.wikipedia.org/wiki/Lanugohttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Weight_loss

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may engage in frequent, strenuousperception : perceives self to be overweight

despite being told by others they are too thinbecomes intolerant to cold:frequently complains of being cold due to loss ofinsulating body fat or poor circulation due to

extremely low blood pressure;body temperature lowers (hypothermia ) in effortto conserve energydepression :

may frequently be in a sad, lethargicstatesolitude : may avoid friends and family; becomeswithdrawn and secretive

http://en.wikipedia.org/wiki/Perceptionhttp://en.wikipedia.org/wiki/Hypothermiahttp://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Solitudehttp://en.wikipedia.org/wiki/Solitudehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Hypothermiahttp://en.wikipedia.org/wiki/Perception

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clothing: some may wear baggy, loose-fittingclothes to cover weight loss if they have been

confronted about their health and wish to hide it,while others will wear baggy clothing to hide whatthey see as an unattractive and overweight body.Cheeksmay become swollen due to enlargementof the salivary glandscaused by excessivevomitingswollen joints [citation needed]abdominal distension[citation needed]bad breath[citation needed]Missing three of the menstruation cycle

http://en.wikipedia.org/wiki/Cheekshttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Jointshttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Menstruation_cyclehttp://en.wikipedia.org/wiki/Menstruation_cyclehttp://en.wikipedia.org/wiki/Menstruation_cyclehttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Jointshttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Cheeks

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Binge eating-is a pattern of disordered eating whichconsists of episodes of uncontrollable eating. It issometimes as a symptom of binge eating disorder .During such binges, a person rapidly consumes anexcessive amount of food. Most people who have eatingbinges try to hide this behaviour from others, and often

feel ashamed about being overweight or depressedabout their overeating. Although people who do not haveany eating disorder may occasionally experienceepisodes of overeating, frequent binge eating is often asymptom of an eating disorder . A 2009 study of femalerats concluded that binge eating of sweet-fat food altersopioid receptors in the nucleus of the solitary tract .

http://en.wikipedia.org/wiki/Menstruation_cyclehttp://en.wikipedia.org/wiki/Menstruation_cyclehttp://en.wikipedia.org/wiki/Disordered_eatinghttp://en.wikipedia.org/wiki/Binge_eating_disorderhttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Solitary_tracthttp://en.wikipedia.org/wiki/Solitary_tracthttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Binge_eating_disorderhttp://en.wikipedia.org/wiki/Disordered_eating

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Purging

means the compensatory behaviors designed toeliminate food by means of self induced vomitingor misuse of laxatives.

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BULIMIA NERVOSA- often simply called bulimia,is an eating disorder characterized by recurrentepisodes og binge eating followed byinappropriate compensatory behaviors to avoidweight gain such as purging, fasting, orexcessively excercising.Binging or Purguring episodes are oftenprecipitatedby strong emotions and followed byguilt,remorse, shame, or self-contempt.

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BN usually begins in late adolescence or earlyadulthood: 18-19 years in the typical age of onset.Binge eating frequently begins during or after

dieting, clienta may eat restrictively, choosingsalads and other low-calorie foods.Clients w/ bulimia are aware that their eatingbehavior is pathologic and go to great lengths to

hide it from others.

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Related disorder

Eating disorder usually first diagnosed in infancy

and childhood include rumination disorder, pica,and feeding disorder.Binge eating disorder is listed as a researchcategory in DM-IV-TR,2000; it is beinginvestigated to determine its classification as amental disorder.Night eating syndrome(NES)- is characterized bymorning anorexia, evening hyperphagia(consuming 50% of daily calories after the lastevening meal), and night time awakening toconsume snacks.

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Etiology

A specific cause for eating disorder is unknown.Initially dieting may be the stimulus that leads totheir development. Biologic vulnerabitlity,developmental problems, and family and socialinfluences can turn dieting into an eating disorder.Psychological and psychologic reinforcement ofmaladaptive eating behavior sustains the cycle.

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BIOLOGIC FACTORS

Studies of anorexia and bulimia have shown thatthese disorder tend to run in families. Found a

genetic susceptibility for anorexia and bulimia onchromosoneTwo setsof nuclei are particularly important inmany aspects of hunger and satiety(satisfaction of

the appetite)

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Developmantal factors

BULIMIA NERVOSA

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly youngwomen. People with bulimia, known as bulimics,consume large amounts of food (binge) and then

try to rid themselves of the food and calories(purge) by fasting, excessive exercise, vomiting,or using laxatives. The behavior often serves to

reduce stress and relieve anxiety. Because

bulimia results from an excessive concern withweight control and self-image, and is often

accompanied by depression, it is also considereda psychiatric illness.

http://medical-dictionary.thefreedictionary.com/Fastinghttp://medical-dictionary.thefreedictionary.com/Exercisehttp://medical-dictionary.thefreedictionary.com/Laxativeshttp://medical-dictionary.thefreedictionary.com/Stresshttp://medical-dictionary.thefreedictionary.com/Anxietyhttp://medical-dictionary.thefreedictionary.com/Anxietyhttp://medical-dictionary.thefreedictionary.com/Stresshttp://medical-dictionary.thefreedictionary.com/Laxativeshttp://medical-dictionary.thefreedictionary.com/Exercisehttp://medical-dictionary.thefreedictionary.com/Fasting

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Bulimia nervosa is a serious health problem forover two million adolescent girls and young

women in the United States. The bingeing andpurging activity associated with this disorder can

cause severe damage, even death, although therisk of death is not as high as for anorexianervosa, an eating disorder that leads to

excessive weight loss.

http://medical-dictionary.thefreedictionary.com/Deathhttp://medical-dictionary.thefreedictionary.com/Anorexia+Nervosahttp://medical-dictionary.thefreedictionary.com/Anorexia+Nervosahttp://medical-dictionary.thefreedictionary.com/Anorexia+Nervosahttp://medical-dictionary.thefreedictionary.com/Anorexia+Nervosahttp://medical-dictionary.thefreedictionary.com/Death

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FAMILY INFLUENCES

Girls growing up amid family problems and abuseare at higher risk for both anorexia and bulimia.Mazzeo and espelage found that response to

family conflict and problems was strongly

associated with disordered eating.childhoodadversity has been identified as a significant risk

factoor in the development of problems with eatingor weight in adolescene or early adulthood.

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Sociocultural factors

the cultures equates beauty, desirability , andultimately happiness with being very thin, perfectlytoned, and physically fit. Adoloscene often idealize

actressess and models as having the perfect

LOOK or body even though many of thesecelebrities are underweight or use special effectsto appear thinner than they are. Books,

magazines,dietary supplements, exercise

equipment, plastic surgery advertisements, weightloss program abound.

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The culture considers being overweight a signlaziness, lack of self-control, or indifference; itequates pursuit of the perfect body with thebeauty, desirability, success, and will power.

Being good when they stick to their diet andbad when they eat desserts or snacks.

Pressure from others also may contribute eatingdisorder.

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CULTURAL CONSIDERATIONS

Both anorexia nervosa and bulimia nervosa arefar more prevalent in industrialized societies,where food is abundant and beauty is linked with

thinness.

Eating disordered are most common in thedifferent countries, like USA, canada, europe,australia, japan, new zealand, and south africa.

Immigrants from cultures in which eating

disordered are rare may develop eating disordersas they assimilate the thin-body ideal.

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Eating disorders appear equally common amonghispanic and white women and less common

among african american and asian women.Minority women who are younger, bettreeducated, and more closely identified risk for

developing an eating disorder.

Have shown a straggering increase among allU.S social classes and ethic groups. With today'stechnology, the entire world is exposed to the

western ideal, which equates thinness with beauty

and desirability. As this ideal becomes widespreadto non-Western cultures, anorexia and bulimia will

likely increase there as well.

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Treatment

Treatment settings include inpatient especiallyeating disorder units. Partial hospitalization or day

treatment programs, and outpatient therapy.The choice of setting depends on the severity of

the illness, such as weight loss, physicalsymptoms, duration of binging and purging, drive

for thinness, body dissatisfaction, and comorbidpsychiatric conditons.

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Medical management

Focuses on weight restoration, nutritional

rehabilitation, rehydration, and correction ofelectrolyte imbalances. Clients receive nutritionallybalanced meals and snacks that graduallyincrease caloric intake to a normal level for

size,age,and activity.

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Bulimia nervosa

Most clients with bulimia are treated on anoutpatient basis. Hospital admission is indicated if

binging and purging behaviors are out of controland the client's medical status is compromised.Most clients with bulimia have near-normal weight,

which reduces the concern about severe

malnutrition-a factor in clients nervosa.

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Application of the nursing process

Although anorexia and bulimia have severaldifferences, many similarities are found in

assessing, planning, implementing, and evaluatingnursing care for clients with these disorders. Thusthis section adresses both eating disorders andhighlights differnces where they exists.

Assessment

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Assessment

Several specialized tests have been developedfor eating disorders. An assessment tool suchas the eating attitudes test often is used instudies of anorexia and bulimia. This test alsocan be used at the end of treatment toevaluateoutcomes because it is sensitive toclinical changes.

History

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History

Family members often desscribe clients withanorexia nervosa as perfectionist with above-average intelligence, achievement-oriented,dependable, eager to please , and seekingapproval before their condition began.

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Mood and affect

Clients with eating disorders have labile moodsthat usually corresponds to their eating ordieting behaviors. Avoiding 'bad or fatteningfoods gives them a sense of power and controlover their bodies, whereas eating, binging,purging leads to anxiety, depression, sndfeeling out of control

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Thought processes and content

Clients with eating disorder spend most of thetime thinking about dieting food, and food-related behavior.

Clients with anorexia who are severelyunderweight may have paranoid ideas abouttheir family and health care professionals,believing that they are 'enemies who are trying

to make them fat by forcing them to eat.

Sensorium and intellectual

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Sensorium and intellectualprocess

Generally clients with eating disorders are alertand oriented; their intellectual fuctions areintact. The exception is clients with anorexiawho are severly malnourished and showingsigns of starvation such as mild confusion,slowed mental processes, and difficulty withconcentration and attention.

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Judgement and insight

Client with anorexia have very limited insightand poor judgement about their health statu.

They do not believe that they have problem;

rather they think that others are trying tointerfere with their ability to lose weight and toachieve the desired body image.

S lf

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Self concept

Low self-esteem is prominent in clients witheating disorder.

They see themselves only in terms of their

ability to control their foood intake and weight. They tend to judge themselve harshly and see

themselves as bad if they eat certain foods orfail to lose weight.

R l d h t i ti

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Roles and characteristics

Eating disorders interfere with the ability to fulfillroles and to havesatisfying relationships.

Clients with anorexia may begin to fail at

school, which is in sharp contrast topreviouslysuccessful academic performance.

E l ti

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Evalution

The nurse can use assessment tools such asthe eating attitudes test to detect improvementfor clients with eating disorders. Both anorexiaand bulimia are chronic for many clients.

Residual symptoms such as dieting, compulsiveexcercising, and discomfort eating in a socialsetting are common.

Treatment is considered successful if the clientmaintains a body weight within 5% to 10% ofnormal with no medical complications fromstarvation or purging.

M t l h lth ti

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Mental health promotion

Nurse can educate parents, children, and youngpeople about strategies to prevent eatingdisorders.

Important aspects include realizing that theideal figures portrayed in advertisement andmagazines are unrealistics, developingrealistics ideas about body size, and shape,

resisting peer pressure to diet, improving selfesteem, and learning coping strategies fordealing with emotions and lifr issues.

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T.H.A.N.K .Y.O.U

=)))))))XOXO