Eating related

disorders

PREPARED BY:
MARY RUTH V. ENRIQUEZ, RN MAN

RELATED EATING DISORDERS

Pica
Rumination
Feeding disorder

Pica
Characterized by an appetite for
substances largely non-nutritive, such as
ice, clay, chalk, soil or sand.
According to DSM-IV Criteria, For these
actions to be Pica:
They must persist for more than one
month when eating such object is
considered.
The most common, the consumption of ice
High risk of tooth cracking
Enamel deterioration
Jaw joint strain

 It can lead to intoxication in children

It can also lead to surgical emergencies
due to an intestinal obstruction as well as
subtle symptoms such as nutritional and
parasitosis.
Pica has been linked to mental disorders
and they often have psychotic comorbidity.
Stressors such as maternal deprivation,
family issues, parenteral neglect,
pregnancy, poverty, and disorganized
family structure are strongly linked to pica.

 Pica is more common in women

and children
Pregnant women, small children,
and those w/ developmental
disabilities such as autism.
Children eating painted plaster
containing lead may suffer brain
damage from lead poison
Eating soil is the ingestion of
animal feces and accompanying
parasites.

Signs and Symptoms

Pica is the consumption of substances w/no
significant nutritive value such as earth or
ice.
Subtypes are characterized by the substance
eaten for example:
Amylophagia : consumption of starch
Coprophagia : consumption of feces
Geophagy : soil, clay , chalk
Hyaphagia: consumption of glass
Consumption of dust or sand has been
reported among iron deficient patients.

 Lithophagia : consumption of pebbles and

rocks
Mucophagia : consumption of mucus
Odowa: soft stones eaten by pregnant
women in Kenya
Pagophagia: pathological consumption of
ice
Self- cannibalism: rare condition, where
body parts may be consumed
Trichophagia : consumption of hair or wool
Urophagia: consumption of urine
Xylophagia :consumption of wood or paper

Complications
Intestinal obstruction may cause as a
result of ingestion of paint, hairballs
Toxoplasma (parasitic organic) or
Toxocara infections may follow
ingestion of feces or dirt

Diagnosis
The health care provider should test
blood levels of iron and zinc.
Hemoglobin can also checked to test
for anemia.
Lead levels: should always be checked
in children who may have eaten objects
covered in lead-paint dust.
Test for infection, if the person has
been eating contaminated soil or animal
waste.

Diagnosis: DSM
Pica is currently recognized as a
mental disorder by the widely
used DSM-IV.
It has been proposed that mentalhealth conditions, such as
Obsessive compulsive disorder
and schizophrenia, can
sometimes cause pica.

Treatment
SSRIs: have been used successfully.
However, previous reports have
cautioned against the use of
medication until all non-psychotic
etiologies have been ruled out.

Rumination Disorder
Is a condition in which a person keeps
bringing up food from the stomach into the
mouth (regurgitation) and rechewing the food.
Causes is unknown, usually starts after 3
months, following a period of normal digestion
It occurs in infants and is rare in children and
teenagers.
Certain problems , such as lack of stimulation
of the infant, neglect, and high-stress family
situations, have associated w/ the disorder.
May also occur in adults.

Symptoms
Repeated bringing up (regurgitating)
food
Repeatedly rechewing food
Symptoms must go on for at least 1
month to fit the definition of
rumination disorder.
People do not appear to be upset,
retching, or disgusted when they
bring up food. It may appear to
cause pleasure.

Exam and Tests

Rumination disorder can cause
malnutrition.
The following lab tests can measure
how severe the malnutrition is
determine what nutrients need to be
increased:
Blood test for anemia
Endocrine- hormone functions
Serum electrolytes

Treatment
Rumination disorder is treated with
behavioral techniques.
Other techniques include improving
the environment (if there is abuse or
neglect) and counselling the parents.
In some cases rumination disorder
will disappear on its own, and the
child will go back to eating normally
without treatment. In other cases,
treatment is necessary.

Feeding disorder
In infancy or early childhood is a childs
refusal to eat food groups, textures,
solids or liquids for a period of at least
one month, which causes them to not
gain enough weight or grow naturally.
Feeding disorders resemble failure to
thrive, except that in feeding disorder
there is no medical or physiological
condition that can explain the very small
amount of food the children consume or
their lack of growth.

Symptoms
Children attempting to swallow
different food textures often vomit,
gag, or choke while eating.
Other symptoms include difficulty in
chewing or vomiting and spitting
whilst eating.
In severe cases child seems to feel
socially isolated.

Types : Divided into 6 sub-types

1. Feeding disorder of state regulation
2. Feeding disorder of reciprocity
(neglect)
3. Infantile anorexia
4. Sensory food aversion
5. Feeding disorder associated with
concurrent medical condition
6. Post-traumatic feeding disorder

Associated problems

Gastrointestinal motility disorder

Oral-motor dysfunction
Failure to thrive
Prematurity
Food allergies
Behavioral management issues
Sensory problems

Diagnosis
A barium swallow test: is often perform,
where the child is given a liquid or food
w/ barium in it. to trace the swallowfunction on an x-ray or other
investigative system such as a CAT Scan.
An endoscopy assignment test: can also
be performed, where an endoscope is
used to view the esophagus and throat
on a screen. It can also allow viewing of
how the patient will react during feeding.

Treatments
Increasing the number of foods that
are accepted,
Increasing the amount of calories
and the amount of fluids
Checks for vitamin or mineral
deficiencies
Finding out what the illnesses or
psychosocial problems are.

Psychosexual Disorder

a.Gender identity
disorder
b.Sexual
dysfunctions
c.paraphillas

Psychosexual disorder
Any form of sexual dysfunction that is
caused by a psychological issue and does
not stem from an actual physical illness.
Factors such as stress, anxiety, or feelings
of guilt can sometimes contribute to the
development of a psychosexual disorder.
Symptoms vary widely from person to
person and from one gender to another
and may include inability to climax, loss of
libido, or even physical pain when
attempting to engage in intercourse.

Gender identity
A person feels a discrepancy
between his anatomical sex and the
gender that he ascribes to himself.
This disorder is much more common
in males than females.
The individual claims that he is a
member of the opposite sex- a
female mind trapped in a male
body.

Paraphilias
Sexual deviation
Unusual fantasies, urges, or behaviors that
are recurrent and sexually arousing.
Is a condition in w/c the sexual instinct is
expressed in ways that are socially prohibited
or unacceptable or are biologically
undesirable.
Paraphiliacs might be men or women
Paraphiliac activity might be limited to a
period of stress rather than following a chronic
or repetitive pattern.

 Paraphilias usually begin in

adolescence and there is evidence
that mood disorders, anxiety, and
impulse disorders, substance-related
disorders, and personality disorders,
especially the antisocial and cluster
C personality disorders (avoidant,
dependent, OCD), are comorbid
diagnosis.

Sexual dysfunction
Is broadly defined as the inability to fully
enjoy sexual intercourse, specially, sexual
dysfunctions are disorders that interfere
with a full sexual response cycle.
These disorders make it difficult for a
person to enjoy or to have sexual
intercourse. While sexual dysfunction
rarely threatens physical health, it can
take a heavy psychological toll, bringing
on depression, anxiety, and debilitating
feelings of inadequacy.

Description
Sexual dysfunction takes different forms in men and
women.
A dysfunction can be life-long and always present,
acquired, situational, or generalized, occurring despite
the situation. A man may have a sexual problem if he:
Ejaculates before he or his desires
Does not ejaculate, or experience delayed ejaculation
Is unable to have an erection sufficient for pleasurable
intercourse
Feels pain during intercourse
Lacks or loses sexual desire

 A woman may have a sexual

problem if she:
Lacks or loses sexual desire
Has difficulty achieving orgasm
Feels anxiety during intercourse
Feels pain during intercourse
Feels vaginal or other muscles
contract involuntarily before or
during sex
Has inadequate lubrication

 The most common sexual

dysfunctions in men include:
Erectile dysfunction
Premature ejaculation: rapid
ejaculation with minimal sexual
stimulation before, on , or shortly
after penetration and before the
person wishes it.

Causes and symptoms

Both physical and psychological
natures, can affect sexual response
and performance.
Injuries, ailments, and drugs are
among the physical influences
Psychological factors: may have roots
in traumatic events such as rape or
incest, guilt feelings, a poor self-image,
depression, chronic fatigue, certain
religious beliefs, or marital problems.

Treatment
Treatments break down into two main :
behavioral psychotherapy and physical.
Sex therapy: which is ideally provided by a
member of the American Association of
Sexual Educators, Counselors, and
Therapist (AASECT), universally
emphasizes correcting sexual
misinformation, the importance of improved
partner communication and honesty, anxiety
reduction, sensual experience and pleasure,
and interpersonal tolerance and acceptance.

 Medications underlying physical

cause include:
Clomipramine and fluoxetine for
premature ejaculation.
Papaverine and prostaglandin for
erectile difficulties
Hormone replacement therapy for
female dysfunctions
Viagra, a pill approved in 1998 as a
treatment for impotence.

Alternative treatment
Acupuncture and homeopathic
treatment can be helpful by focusing on the
energetic aspects of the disorder.
Yoga and meditation provided needed
mental and physical relaxation for several
conditions, such as vaginitis.
Relaxation therapy eases and relieves
anxiety about dysfunction.
Massage is extremely effective at reducing
stress, especially if performed by the
partner.

Abuse and
Violence
Sexual
abuse

Marital
rape

Physic
al
abuse
Spouse
abuse

Emotional
abuse

Clinical Picture of abuse and

Violence
Victims of abuse or violence certainly can have
physical injuries needing medical attention, but
they also experience psychological injuries w/
broad range of responses.
Some clients are agitated and visibly upset;
others are withdrawn and aloof, appearing
numb or obvious to their surroundings.
Often, domestic violence remain undisclosed
for months or even years because victims
fear their abusers
Victims frequently suppress their anger and
resentment and do not tell anyone.

Characteristi
cs of

Violent
Families
:
Social
Isolation
Abuse of
power and
control
Alcohol and
other drug

Social Isolation
Members of these families keep to
themselves and usually do not invite
others into the home or tell them
what is happening.
Abuser threaten victims with even
greater harm if they reveal the
secret.

Abuse of Power and

Control

The abusive family member almost always

holds a position of power and control over
the victim (child, spouse, or elderly parent).
The abuser is often the only family member
who makes decisions, spends money, or
spends time outside the home with other
people.
The abuser belittles and blames the victim,
often by using threats and emotional
manipulation.

Alcohol and Other Drug

abuse
Substance abuse, especially alcoholism, has
been associated with family violence. This
finding does not imply a cause-and effect
relationship.
Alcohol does not cause the person to be
abusive; rather, an abusive person also is likely
to use alcohol or other drugs.
Although alcohol may not cause the abuse,
many researchers believe that alcohol may
diminish inhibitions and make violent behavior
more intense or frequent (Martin Institute,
2006)

Intergenerational
Transmission Process
Shows patterns of violence are perpetuated
from one generation to the next through role
modeling and social learning (van der kolk,
2005).
Intergeneration transmission suggest the family
violence is a learned pattern of behavior.
For ex. Children who witness violence between their
parents learn that violence is a way to resolve
conflict and is an integral part of a close
relationship.
Statistic shows that 1/3 of abusive men are likely to
have come from violent homes where they
witnessed wife-beating or were abused themselves.

SPOUSE OR PARTNER
ABUSE
Is the mistreatment or misuse of one person

by another in the context of an intimate

relationship.
The abuse can be emotional or
psychological, physical, sexual, or
combination (which is common).
Psychological abuse (emotional abuse)
includes name-calling, belittling, screaming,
yelling, destroying property, and making
threat s as well as subtler forms such as
refusing to speak or ignoring the victim.

 Physical abuse: ranges from

shoving and pushing to severe
battering and choking and may
involve broken limbs and ribs,
internal bleeding, brain damage, and
even homicide.
Sexual abuse: includes assaults
during sexual relations such as biting
nipple, pulling hair, slapping and
hitting, and rape

CYCLE OF ABUSE AND

VIOLENCE
Is another reason often cited for
women have difficulty leaving
abusive relationships.

 A typical pattern exists:

HONEYMOON PERIOD: usually, the initial
episode of battering or violence is a followed
by a period of the abuser expressing regret,
apologizing, and promising it will not happen
again. He professes his love for his wife and
even engage in romantic behavior (e.g.
Buying gifts and flowers).
TENSION-BUILDING PHASE: begins; there
may arguments, stony silence, or complaints
from the husband. The tension ends in
another violent episodes.
VIOLENT EPISODES OR EXPLOSIONS

 Honeymoon period it will last

weeks or even months, causing
the woman to believe that the
relationship has improved and
her husbands behavior has
changed. Over time, however,
the Violent episodes are more
frequent, the period of remorse
disappears altogether, and the
level of violence and severity of
injuries worsen.

Treatment and Intervention

Dos of working w/ Victims of Partner
abuse
Do ensure and maintain the clients confidentiality
Do listen, affirm and say, Iam sorry you have been hurt.
Do express, Im concerned for your safety.
Do tell the victim, You have a right to be safe and respected.
Do say, the is not your fault.
Do recommend a support group or individual counselling
Do identify community resources and encourage the client to
develop a safety plan.
Do offer to help the client contact a shelter, the police or
other resources.

 Restraining order (protection order): a

woman can obtain a restraining order from
her county of residence that legally prohibits
the abuser from approaching or contacting
her.
Provides only limited protection, abuser may
decide to violate the order and severely injure
or kill the woman before police can intervene.
Civil orders of protection are more
effective in preventing future violence when
linked w/ other interventions such as
advocacy counselling, shelter, talking w/ their
health care provider.

CHILD ABUSE
Or MALTREATMENT generally is defined
as the intentional injury of a child.
It include:
Physical abuse or injuries
Neglect or failure to prevent harm
Failure to provide adequate physical and
emotional care or supervision
Abandonment
Sexual assault or intrusion
Overt torture or maiming

Types of Child abuse

Sexual abuse: involves sexual acts performed by
an adult on a child younger than 18 yrs.
Include incest rape, and sodomy performed
directly by the person or w/ an object, oral-genital
contact, and acts of molestation such as rubbing,
fondling, or exposing the adults genitals.
Neglect : is malicious or ignorant withholding of
physical, emotional, or educational necessities for
childs well-being.
Psychological abuse (emotional abuse): includes
verbal assaults, such as blaming, screaming,
name-calling, and using sarcasm.

Treatment and
Intervention
The first part of treatment for child abuse or

neglect is to ensure the childs safety and

well being.
Removing the child from home, which also
can be traumatic.
Given the high risk for psychological
problems, a thorough psychiatric evaluation
also is indicated.
A relationship of trust between the therapist
and the child is crucial to help the child deal
w/ trauma of abuse.

 LONG TERM TREATMENT: involves professional

from several disciplines such as psychiatry, social
work, and psychology.
The very young child may communicate best through
PLAY THERAPY, where he or she draws or acts out
situations w/ puppets or dolls rather than talks about
what happened or his her feelings.
Social service agencies: are involved in determining
whether returning the child to the parental home is
possible based on whether parents can show benefit
from treatment.
Family therapy: may be indicted if reuniting the
family is feasible. Parents may require psychiatric or
substance abuse treatment. If the is unlikely to return
home, short-term or long term foster care services
may be indicated.

Elder abuse

Is maltreatment of older adults by family

members or caregivers.
It may include physical and sexual
abuse, psychological abuse, neglect,
self-neglect, financial exploitation, and
denial of adequate medical treatment.
Elders are often reluctant to report
abuse, even when they can, because the
abuse usually involves family members
whom the elder wishes to protect.

Clinical
Picture
The victim may have
bruises or fracture;
May be denied food,
fluids, or medications;
May be restrained in a
bed or chair.
The abuser may use the
victims financial
resources for his or her
own pleasure while the
elder can not afford food
or medications.
Abuser may withhold
medical care itself from an
elder w/ acute or chronic
illness.

Treatment and
Intervention
Elder abuse may develop gradually as the
burden of care exceeds the caregivers physical
and emotional resources.
Relieving the caregivers stress and providing
additional resources may help to correct the
abusive situation and leave the caregiving
relationship intact.
In other cases, the neglect or abuse is
intentional and designed to provide personal
gain to the caregiver, such as access to the
victims financial resources. In these situations,
removal of the elder or caregiver is necessary.

Rape and Sexual Assaults

Rape : is a crime of violence and humiliation of
the victim expressed through sexual means.
Rape : is the perpetration of an act of sexual
intercourse w/ female against her will and w/out
her consent, whether her will is overcome by
force, fear of force, drugs, or intoxicants.
It is considered rape if the woman is incapable
of exercising rational judgment because of
mental deficiency or when she is younger than
the age of consent ( which varies among states
from 14 to 18 yrs; van der kolk, 2005)

Rape victims

Dynamics of Rape
Most men who commit rape are 25 to 44 years
of age.
Recent research (van der kolk, 2005) has categorized
male rapist in to four categories:
1. Sexual sadists who aroused by the pain of their
victims.
2. Exploitive predators who impulsively use their victims
as objects for gratification
3. Inadequate men who believe that no woman would
voluntarily have sexual relations with them and who
are obsessed with fantasies about sex
4. Men for whom rape is a displaced expression of anger
and rage.

Common Myths about

Rape

When a woman submits to rape, she really wants

it to happen
Women who dress provocatively are asking for
trouble
Some women like rough sex but later call it rape
Once a man is aroused by a woman, he can not
stop his actions.
Walking alone at night is an invitation for rape.
Rape is exciting for some women
Rape only occurs between heterosexual couples.
If a woman has an orgasm it cant be rape.

Treatment and Intervention

Therapy usually is supportive in approach and
focuses on restoring the victims sense of control;
Relieving feelings of helplessness, dependency, and
obsession with the assault that frequently follow
rape;
Regaining trust;
Improving daily functioning;
Findings of guilt, shame, and anger.
Group therapy with other women who have been
raped is a particularly effective treatment.
Some cases survivors of rape have long term
consequences, such as Post Traumatic Stress
Disorder (PTCD).

Torture and Ritual abuse

TORTURE
the act of causing severe physical pain as a form of
punishment or as a way to force someone to do or
say something
something that causes mental or physical suffering
: a very painful or unpleasant experience.
Interrogation
If one person knows something that another person
does not know, and that person would like to know
that thing as well, torture is usually the answer.

 RITUALS
a brutal form of abuse of children,
adolescents, and adults, consisting of
physical, sexual, and psychological
abuse, and involving the use of rituals.
It usually involves repeated abuse over
an extended period of time. The physical
abuse is severe, sometimes including
torture and killing. The sexual abuse is
usually painful, sadistic, and humiliating,
intended as means of gaining dominance
over the victim.

 The psychological abuse is devastating

and involves the use of
ritual/indoctrination, which includes
mind control techniques and mind
altering drugs, and ritual/intimidation
which conveys to the victim a profound
terror of the cult members and of the evil
spirits they believe cult members can
command. Both during and after the
abuse, most victims are in a state of
terror, mind control, and dissociation in
which disclosure is exceedingly difficult.

GENERAL NURSING ACTIONS TO

HELP ABUSED PERSONS
1. Ensure safety: the survivor of abuse will be
confused and fearful.
The nurse needs to reassure the patient that
everything possible is being done to ensure the
patients safety.
Obtain a list of people who are considered safe
by the patient.
If the patient wishes to press charges, offer
assistance with making the appropriate phone
calls.
Maintain a calm milieu.

2. Know your own thoughts and feelings

about abuse: the nurse is responsible for
helping the patient through this initial horrifying
experience.
A nurse who has been an abused or who has
been an abuser may find it difficult to be
therapeutic for the patient.
Remember that you may be treating two people:
the survivor as well as the abuser. Abusers are in
need of our help as much as the person who is
abused.
We as nurses must be aware of our own mental
health to avoid the possibility of becoming
abusive of those in our care.

3. Remaining nonjudgmental/ show empathy:

This is a crisis situation in many ways.
Recalling your communication skills and helping
the patient to verbalize any concerns, thoughts,
and feelings are crucial.
Remaining technically correct in performing any
procedures or sample collections is imperative to
avoid contamination.
Maintaining professionalism and confidentiality
for both the survivor and the abuser is
mandatory.
Calling for help from counselors, advocates, or
people chosen by the patients will help maintain
a calm milieu.

4. Know your agency policy:

Every clinic, emergency room, and
urgent care center has its own
policies and procedures for dealing
with abused patients.
Familiarity with these policies and
procedures will help save time and
convey confidence.