Psych- Eating Disorders

What are the types of eating disorders?

• Anorexia nervosa 

• Bulimia nervosa 

• Binge eating disorder 

• Pica 

How is someone classified as having Anorexia Nervosa? 

• Refusal to maintain normal body weight 

• Intense fear of gaining weight or of being fat, although underweight 

• Body image disturbances or denial of seriousness of low weight

• Absence of three consecutive menstrual cycles 

What is amenorrhea?

The absence of three consecutive menstrual cycles 

One of the biggest factors for any eating disorders is? 

Control 

Are females or males more affected by anorexia? 

Females are more impacted 

How is someone classified to have Bulimia nervosa? 

• Recurrent episodes of binge eating; short time, large amount, then compensating through purging or overexercise 

• Feeling lack of control overeating behavior 

• Recurrent, inappropriate compensating behavior to prevent weigh gain (binging and purging)  

• Binging and compensating occurring at least twice weekly over 3 months 

• Self-evaluation overly influences by body shape and size

What may occur dental wise with someone who has Bulimia? 

Have cavities due to the acid being brought up from the vomiting 

How is someone classified to have a binge eating disorder? 

• Eating lots of food in a short amount of time 

• Loss of control for overeating- as in they can’t stop the overeating episode 

• Demonstrates extreme rapid eating 

• Eating with an absent sensation of hunger 

• Eating alone so not as embarrassed and when not hungry 

• Feelings of self disgust, guilt or depression 

A normal BMI range?

20 to 24.9

The BMI range for obesity?

30 or greater

The BMI for someone who may have Anorexia? 

Normally 17 or lower and less than 15 in extreme cases 

Nursing interventions for eating disorders?

• Monitor daily caloric intake and electrolyte status 

• Avoid rapid weight gain as that is not good 

• Observe for signs of food avoidance, purging or other ways to compensate

• Monitor activity level (can compensate with over exercising as well)

• Encourage diminished focus on weight after re-feeding 

• Plan to meet with a dietitian

When dealing with those who have an eating disorder what is something to keep in mind? 

They can be manipulative at times 

What are things we can positively encourage for those with an eating disorder? 

uDiscuss realistic healthy diet.

uEncourage use of therapies and support groups.

uPromote decision-making concerning issues other than food.

uPromote positive self-concept, perceptions of body, and interactions with others.

uAvoid power struggles centered around food.

uBuild self esteem

How can we have good communication with the patient?

uConvey warmth and sincerity.

uListen empathically.

uBe tactfully honest.

uHelp patient identify positive qualities.

uCollaborate with patient in treatment planning.

uTeach patient about the disorder.

uTalk about feelings

• Determine patient’s ability to know weight

• uHelp patients identify and express bodily sensations and feelings related to their disorders.

  uIdentify non–weight-related interests.

Why is it vital to set appropriate behavioral limits? 

So that patients know what is expected them and can get the proper care 

What are things we can give rewards for?

For gaining weight and not purging

For someone who has anorexia how is that typically treated? 

Medical management for anxiety, depression, somatic disturbances or other comoroid conditions 

• Mainly use antidepressants 

Is there a direct agent that can treat anorexia nervosa? 

None that are approved specifically 

What medication treatment has shown some success for bulimia or binge eating? 

Olanzapine (Zyprexa) 

What can be used to decrease the anxiety associated with fueling the need for binging and purging? 

• Anxiolytics, but antidepressants are typically safer and more effective 

How can we as nurses provide the milieu management to help support these individuals? 

uOrient patients to the unit.

uProvide a warm, nurturing environment.

uClosely observe patient for avoidance and compensatory behaviors.

uEncourage patient to contact nurse if wanting to purge.

uInvolve the family in treatment, as appropriate.

uPromote staff consistency.

uBe consistent in patient’s treatment regimen.

uEncourage participation in art, recreation, and other therapies.

uInvolve dietitian in treatment plan.

uEncourage attendance in therapeutic groups following weight gain

Stepped care approach to treatment might be used—simple to intensive treatment

When is someone is a bulimic what is something you want to look for? 

They may not purge, but will over compensate with exercising and restricting food intake 

When you have female patients why is it important to ask about there menstration cycle?

Cause some continue to menstruate while other don’t, it usually isn’t consistent with every female 

When someone has an eating disorder what may they be compensating it for? 

Dealing with coexisting issues of depression, anxiety, neglect and domestic violence. Can get OCD along with it  

Why is perfectionism a big issue with this condition? 

If patient does not meet the criteria they have made for themselves then it can lead patient to deny illness

What obsession do these patients have?

Very focused on weight

What is the major underlying hallmark of an eating disorder?

Denial

What is the key to recovery?

Honesty and coming to terms with it

What are some patient and family teachings we want to give when addressing an eating disorder? 

uCycle of eating disorders can be life-threatening.

uTreatment is difficult because the thought of gaining weight can be terrifying for patients.

uAll eating disorder patients share common issues, e.g., low self-esteem, fear of maturity, and conflict avoidance.

uRecognize that anxiety can reinforce the person’s urge to control food intake.

uTerrified of gaining weight and on IV fluids

When you are working with someone who has an eating disorder, what are ways you can specifically communicate with the patient to give them a better experience? 

uDetermine patient’s ability to know weight.

uReward weight gain with meaningful privileges.

uModel and teach appropriate social skills.

uHelp patients identify and express bodily sensations and feelings related to their disorders.

uIdentify non–weight-related interests.

How would you implement planning for someone dealing with imbalanced nutrition and a deficit of fluid volume? 

• Determine appropriate calories to provide adequate nutrition and weight gain.

• Do not focus on food and eating specifically.

• Keep a strict record of intake and output.

How to implement planning for someone with a disturbed body image and low self esteem due to anorexia or bulimia?

• Promote feelings of control

• Help client realize perfection is unrealistic 

How to implement planning for someone with a disturbed body image and low self esteem due to BED?

• Help identify positive attributes

• Refer client to a support or therapy group

What to do for interventions for someone who has an eating disorder? 

uIssues of control are central to the etiology of these disorders.

uFor the program to be successful, the client must perceive that he or she is in control of
the treatment.

How to handle someone who is in denial about having an eating disorder? 

• Establish trusting relationship.

• Avoid arguing or bargaining with the client.

How to provide support for someone with obesity? 

• Encourage diary of food intake.

• Provide instruction about medications.