Types of Eating Disorders

Anorexia Nervosa-
 Intense drive for thinness
 Morbid Fear of Gaining Weight
Bulemia-
 Excessive intake of calories (binge eating) followed by self-induced
purging
Binge Eating Disorder-
 Symptoms of bulemia with impaired control behaviors
Obesity-
 Body weight 20% over ideal
Morbid Obesity-
 Body weight 100% over ideal
 BMI 30 or above
Overall Prevalence
Clinical Profile
Life threatening! The average age of onset is 15. and 86% of people show
symptoms by the age of 20.
Physical Changes:
Malnutrition
Cardiac arrhythmias
Cold intolerance
Sleep disturbances
Peripheral edema- due to fluid shift
Teeth and gum problems- found in bulimics
Skin changes- there skin becomes hypermeloize,
Menstrual irregularities
Co-Morbidities
 Depression:
 Co-morbid in 40%-75% of those with eating disorders; more with
binge eating disorder than anorexia
 Bulimics tend to have more depression and anorexia are more a
thought disorder.
 OCD
 Personality Disorders:
 Borderline Personality Disorder
 Avoidant personality disorder
 Obsessive-compulsive personality disorder
 Other:
 Suicidal behaviors/ among anorexics
 Childhood Sexual Abuse in 25-30% of patients/ particular the
anorexics
 All eating disorders is in the axis one.
Etiology
 Psychodynamic: Major deficits in self-identity, autonomy with underlying
dependency, fear of loss of love, powerlessness (Bruch,1970)
-The two main issues are identify and autonomy. She saw underline dependency for the
parents.
 Genetic: family and twin studies suggest genetic influence (Bulik, 2006)
 Neuroendocrine:
 Possible primary hypothalamic dysfunction (Halmi, 2008)- which is a rise in
cfs cresol.
 Possible serotonerigic or dopaminergic dysfunction (Romano, 2002)SSRI helps
these patients
 Socio-cultural:
 Diet/thinness industry
 Fashion
 Developmental peer pressure
 Media
 A family disease- in anorexia
 Different dynamics in different cultures
Psychological Profile
Delusional disturbance of body image
Perfectionist
“model child”
Over-obedient
Feelings of Helplessness, powerlessness isolation
Struggle for control- you eat is something you can control
Low self esteem
Obsessive-compulsive traits
Profound negative thinking
Family Issues
Assessment of Eating Disorders
 1. History- we are interested in their eating, trauma, drug use, social and family
 2. Characteristics of disorder
 Preoccupation with food
 Vomiting- how often
 Laxative, diuretic use
 Abuse of amphetamines or otc stimulants
 Exercise patterns
 Body-weight distortion- your body image
 Menstrual history
 Sleep patterns
 Sexuality
 Addictive behaviors
 Condition of teeth- related to bulimia and purging
 Maladaptive social functioning
 Family functioning
 Related disorders
Multidimentional Eating Disorders
Assessment
Weight status
Body Image Disturbance- what degree is it and how
does it look
Dietary (Past and Present)
Physical Sequelae- the physical disterbances that
occupy
Treatment
Psychotherapy
 Psychodynamic
 Cognitive Behavioral- tend to work the best for anorexia
 Family Therapy- is always used in people with eating disorder, unless they do
not have a family. Family must be included in the therapy
 Group Therapy- they can see universality, you can monitor your success in the group. And it is
done in a inpatient setting.
Nutrition Counseling- every one get this councling
Occupational Therapy- which keeps them busy and develop new skills.
Support Groups
Pharmacologic
 SSRIs- prevent relapse in wt.-restored individuals- Prozac is know
to be a good medication for anorexia which has to above 60mg
 Atypicals- severe anorexia with severe body image disturbance
Pirans et al. (1999)
Relational-Empowerment Model
- Which works on the self issues and empowerment
Strengths-based Model of Treatment
 Identify and overcome sources of negative influences in
person’s lived experience
Group, individual, residential, family therapies- you
would want to pull them out of their environment and
put them in a confined area.****
- You want to get them away from the toxic environment
Medical Needs Treatment- adequate nutrition,
especially potassium.
 Kater, 2006
Model for Healthy Body Image (MHBI)
Preventive, holistic health promotion perspective for prevention
of eating disorders
Based on idea that “ any viable solution must recognize that
unhealthy weight , values and choices about eating and physical
activity, the pervasive thin “ideal” negative body image, the diet
mentality, and weightism are not separate concerns, but are
part of one dynamic, interrelated problem.”
Desired outcomes:
 Acceptance of innate body
 Enjoying eating well
 Creating physically active lifestyle
 Developing autonomy, self-esteem, confidence, critical thinking
Females vs Males with Eating
Disorders
Males with
Anorexia/Bulemia/Obesity
Nursing Dx
Altered nutrition:
Less than body requirements related to reduced food
intake
Less than body requirements related to bingeing and
purging
 Behavior mod. for gradual weight gain 2lbs a week
 Monitor vital signs and weight ( we do not let them weigh
themselves)
 I&O
 Supervise meals
 Supportive, firm approach in regulating eating behavior

Nourishment via nasogastric tube if necessary

Nursing Dx
Disturbed self concept related to perfectionism,
overdependence on approval of others, inadequate
social skills
Assist client to identify feelings and situations
associated with binge-purge episodes
Encourage verbalization of feeings when client feels
need to binge eat or vomit
Monitor meals and 90 minutes post-menal
Monitor vital signs, I&O, electrolytes
Assist client in realistic visualization of body
Nursing Dx
Altered thought process related to obsesions,
intellectualization, overgeneralization, depression,
malnutrition
 Help client identify strengths and limitations
 Help client see relationship between unrealistic expectations
and feelings of inadequacy(this is based on the way they
were raised)
 Encourage client to make decisions and choices for self
 Promote social skills through role playing, support groups,
group therapy
 Redirect client away from obsessive thought patterns
involving food and weight
Nursing Dx
Ineffective coping related to unmet developmental
needs (trust, autonomy)
Medication management
Support permission to try out new behaviors (you
engorage them to do new things)
Offer positive reinforcement for independent decision-
making and problem solving
Role model appropriate ways of dealing with stressors
Nursing Dx
Altered family process related to enmeshed family
system, denial of problems, unresolved control issues,
dysfunctional communication
Refer for family therapy
Teach assertiveness skills
Encourage family members to speak for themselves
Explore ways of decreasing parental over-involvement
Encourage expression of positive and negative feelings
Confront inappropriate boundaries