EATING DISORDERS

notb 10/10/26

eating disorders

mental illness involving a severe and persistent disturbance in eating behaviors associated by distressful thoughts and feelings. often, people with these disorders go to great lengths to camouflage their conditions, other times, people may not even realize they have a problem. social events that involve eating may trigger apprehension, fear, and avoidance in these clients. discerning normal eating with one of these can be done via examining behavior (bizarre or secretive), obsessions (fixations on food, weight/size, and calorie counting), and functionality (school or work performance declines; client feels physically and mentally sick; socially withdrawn). has one of the highest morality rates in all mental health disorders (1 death every 52 min). comprehensive physical exams are warranted for AN and BN.

ED warning signs

include an obvious increase or decrease in weight that is not related to a medical condition and abnormal eating habits (severe dieting, ritualized mealtime behaviors, fear of dietary fat, secretive binging, lying about food, etc). the quantity, frequency, duration, and severity of disordered eating activities become a clue that there may be a clinical problem developing.

ED health consequences

can range from dry skin to heart failure. DM is one of the most threatening issues, which can lead to DKA and comas. malnutrition and binging-purging cycles can lead to GI and digestive issues, kidney failure, and cardiovascular and pulmonary issues. electrolyte imbalances can trigger seizures, cardiac arrest, and even death. MSK can show osteoporosis, bone fractures, and dental erosion. amenorrhea, thyroid dysfunction, alopecia, blood sugar regulation dysfunction, and brain atrophy can also occur.

ED risk factors

has an early age onset, usually occurring during adolescence or young adulthood. tend to have a gradual and rather inconspicuous onset. risk of relapse in these disorders is extremely high (50% in first year of posttreatment in AN). current trends show an increased risk in females (usually young), children, males, trans populations, veterans, and those involved in occupations related to weight (athletes, gymnasts, dancers, and models). most people are affected by BED, followed by BN, and then AN.

genetic and biological factors

tends to be a familial tendency in EDs. a single causative gene has not yet been discovered, but research continues to pursue identifying genetic vulnerabilities and its effects on neurobiological functioning. studies show serotonin deficits can affect brain function and appetite control. personality traits such as being ritualistic, avoidant, perfectionistic and impulsive (BN and BED) can cause EDs.

sociocultural factors

includes religion and culture, which can both play a huge role in one’s eating habits (mardi gras, ramadan, etc.), and can even promote restrictions (kosher, halal, etc). western US culture tends to emphasize being thin and physically fit, with teens and young adults being especially vulnerable to being warped by these ideologies. prevalence of these ideologies is growing in asia and middle eastern countries as well.

developmental/occupational factors

includes factors such as being a part of activities or employment that demand a low body weight (models, dancers, gymnasts, wrestlers, horse jockeys, etc.). dysfunctional family relationships (overprotectiveness, enmeshment/no emotional boundaries, intrusiveness, lack of responsiveness, etc.) can also contribute. other correlative factors include exposure to trauma, SA, and others who already have EDs.

avoidant restrictive food disorder (ARFID)

characterized by a persistent failure to meet appropriate nutritional or energy needs, inflexible eating behaviors, and fear based food restrictions. sometimes seen as extremely picky eating. involves a strong sensory aversion and underlying reasons that are associated with the avoidance of certain food items.

orthorexia

involves an obsession with healthy diets, or “clean eating”, which can result in a significant disturbance in adequate nutritional intake and weight loss.

diabulimia

an ED in which a person who had T1DM reduces or stops taking their insulin in order to lose weight

pica

consuming inedible objects, such as clay, dirt, or paint, and is more commonly exhibited by children.

rumination disorder

involves intentionally regurgitating food in a repetitive manner. the person will proceed to chew, re-swallow, or spit out the food that has been regurgitated.

anorexia nervosa (AN)

self-induced starvation leading to weight loss that is drastically below the ideal target weight for height and developmental age. in some situations, the weight could be less than 50% of the expected normal weight, creating a skeletal appearance. people who have this can be preoccupied with thoughts about food and spend most of their day being concerned about food, weight, and their body shape or size. excessively study food labels and meticulously count calories. often wear layered or baggy clothing due to cold sensitivity or trying to hide themselves. can be restricting or binge-purge.

atypical AN

clients who meet all of the criteria for AN except for significant weight loss. nurses should be aware that clients with this disorder experience many of the same psychological manifestations of AN, but are often misdiagnosed due to their body weight being in an above or normal range.

AN clinical presentation

clients may engage in excessive exercise, show an intense fear of gaining weight, have a distorted body image, and generally may not see themselves as thin and deny the seriousness of the condition. severity is determined by BMI (mild is a BMI greater than 17, severe is one less than 15). s/s can include a thin appearance, hypotension, bradycardia, hypothermia, dysrhythmias, cardiomyopathy, electrolyte imbalances, anemia, neutropenia, edema, lanugo, and hypoglycemia. menstrual irregularities and infertility can also be present. nurse will often observe cognitive distortions.

bulimia nervosa (BN)

characterized by having a distorted body image and fear of gaining weight while being at or near their ideal body weight, causing this ED to be hard to detect. primarily chracterized by a binge-purge cycle, with excessive amounts of food being consumed in an uncontrollable, short period of time in which the person feels emotionally out of control, that is followed by purging or compensatory behaviors to prevent weight gain (vomiting, laxative use, diuretic misuse). these episodes take place at least weekly during a 3 month or longer period and can lead to dangerous health consequences.

BN clinical presentation

clients may show GI issues (bowel elimination irregularities, digestive impairment, esophageal bleeding, ulcers, possible gastric rupture), laxative dependence, enzyme abnormalities due to amylase build up, glucose irregularities, electrolyte imbalances, kidney dysfunction, and arrhythmias. parotid glands may swell causing a “chipmunk cheek” appearance, and russell’s sign (calluses and scars on knuckles from sticking fingers down throat) along with dental caries. client will have a lacking self concept and display issues with interpersonal relationships.

binge-eating disorder (BED)

involves repeated and rapid consumption of large amounts of food with an absence of purging behaviors to “undo” the binge. episodes typically include on average at least 1000 kcal but can get up to 6000 kcal or more. consumption may not be associated with natural hunger and does not usually stop until the individual experiences severe physical discomfort. distressing feelings, powerlessness, and a lack of control are often associated with episodes, with disgust and guilt following after. emotional triggers rather than hunger cause episodes. occurs a minimum of once a week for three months. is underdiagnosed, even though it is considered more prevalent than anorexia nervosa and bulimia nervosa combined. not all individuals who have this disorder are overweight.

BED clinical presentation

may be challenging to detect due to the secrecy of this ED; the outward appearance of an individual does not always reflect what is going on inside. the common nature of consuming large amounts of sweets during the binge causes individuals to have dental caries and acne, as well as nutritional deficiencies. other s/s include GI issues (abdominal pain, bloating, nausea, GERD), stomach dilation/rupture, constipation/diarrhea, IBS, HTN, DM, obesity, joint pain, and hyperlipidemia. emotional s/s include depression, anxiety, low self esteem, and a lack of self control.

SCOFF exam

a tool used to screen for ED by asking clients a series of questions about eating habits. involves asking if clients make themselves sick after a meal, if they worry they have lost control over how much they eat, if they have lost one stone in a three month period, if they feel they are too fateven when others say they are thin, and if they feel that food dominates their life.

AN inpatient criteria

includes the client having a HR less than 50 during the day and 45 during the night, a SBP less than 90, orthostatic changes in pulse greater than 20/min, a body temp less than 96, body fat less than 10%, a less than 75% IBW, arrhythmia, low food intake, and an unsuccessful outpatient therapy.

refeeding syndrome

a dangerous shift of fluids and electrolytes that occurs within the body when calories are reintroduced too quickly, which can result in HF and death. since the body has been in a state of prolonged starvation, the heart has atrophied, and it may become overloaded with the restoration of fluid and nutritional intake. in order to prevent this, the treatment team must closely monitor dietary, weight, and lab patterns, as well as observe any early warning signs like edema.