eating disorder

Eating Disorder Overview

Anorexia Nervosa

• Discovery: Identified by Sir William Gull

• Definition: "Anorexia" means loss of appetite.

• Body Weight: 85% or less than expected for age and height.

• Age of Onset: Typically between 10 – 40 years, average is 16, often during adolescence.

• Pre-morbid Traits: Perfectionist, introverted, issues with self-esteem and peer relationships.

DSM Criteria

1. Refusal to maintain body weight at or above the minimum normal weight for age and height.

2. Intense fear of gaining weight or becoming fat, despite being underweight.

3. Distorted body image, overvaluation of shape or weight, or denial of the seriousness of low weight.

4. For females, absence of at least three consecutive menstrual cycles (amenorrhea).

Amenorrhea Theories

• Lack of nutrition slows the functioning of the pituitary gland.

• A woman needs to maintain at least 17% body fat to menstruate; levels below this lead to amenorrhea.

Types of Anorexia Nervosa

• Restricting Type: Often normal weight range before onset; engage in rigid exercise programs to lose weight.

• Binge Eating/Purging Type: Usually overweight before onset; use methods like vomiting or excessive laxatives.

Objective Signs

• Deliberate weight loss

• Amenorrhea, low levels of LH and FSH

• Anemia, constipation, hypotension, bradycardia, hypothermia, dehydration

• Dry, cracked skin, lanugo, delayed gastric emptying, pitting edema

• Insomnia, early morning waking

• Osteopenia or osteoporosis, kyphosis, ventricular dilation

• Preoccupation with food and eating, bizarre behavior

Treatment and Prognosis

• Medical Management: Focus on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances.

  • Supervised access to the bathroom.

• Psychotherapy: Family therapy, Cognitive Behavioral Therapy (CBT).

Bulimia Nervosa

• Definition: "Bulimia" means insatiable appetite; involves massive overeating, also known as binge eating or "bulimarexia".

• Weight: Usually normal.

• Awareness: Individuals are aware of their eating pathology and hide it.

• Age of Onset: 15 to 24 years, typically 18-19, often during college.

• Course: Chronic and intermittent.

DSM Criteria

1. Recurrent episodes of binge eating.

2. Feeling of lack of control during eating binges.

3. Binge eating and compensatory behaviors at least twice a week for 3 months.

4. Compensatory behaviors include vomiting, laxatives, diuretics, strict dieting, fasting, vigorous exercise, or diet pills.

5. Self-evaluation unduly influenced by body shape and weight.

Types of Bulimia Nervosa

• Purging Type: Use of vomiting, laxatives, diuretics.

• Non-Purging Type: Use of other methods like fasting or excessive exercise.

Psychotherapeutic Management

• Initial Goal: Medical stabilization, then psychotherapy.

• Approach: Multidisciplinary, involving physicians, nurses, dietitians, and psychotherapists.

• Therapeutic Nurse-Patient Relationship (TNPR): Establish trust, help patients identify feelings, accept patients, encourage positive self-qualities, and teach about bulimia.

Milieu Therapy

• Goal: Establish normal eating patterns, interrupt binge-purge cycles.

• Hospitalization Reasons: Treat psychiatric or medical crises, provide order, allow examination of living situations, offer treatments not available elsewhere.

Management Principles

• Adhere to meal and snack schedules.

• Prevent binge eating by regularizing eating.

• Follow dietitian guidelines.

• Encourage patients to seek support from staff.

• Encourage group therapy attendance.

Binge Eating Disorder (BED)

• Definition: Eating disorder not fitting criteria for anorexia or bulimia.

• Criteria: Recurrent binge eating at least 2 days per week for 6 months, plus at least 3 of:

  • Eating rapidly

  • Eating until uncomfortably full

  • Eating large amounts when not hungry

  • Eating alone due to embarrassment

  • Feeling disgusted, depressed, or guilty after eating

Primary Goal of Therapy

• Establish a regular, healthful eating pattern.

Other Eating-Related Problems

• Pica: Eating non-nutritious food.

• Muscle Dysmorphia (Bigorexia): Worrying excessively about being small despite having good muscle mass.

• Orthorexia Nervosa: Pathological fixation on eating proper, "pure" foods.

• Night Eating Disorder: Lack of appetite for breakfast due to overeating the night before.

• Anorexia Athletica: Obsession with exercise.

• Nocturnal Sleep-Related Eating Disorder: Eating while asleep.

• Rumination Syndrome: Regurgitating food back into the mouth and swallowing it again.

• Gourmand's Syndrome: Obsession with fine foods.

• Prader-Willi Syndrome: Incessant eating due to a congenital problem.

• Chewing and Spitting: Tasting food but spitting it out without swallowing.

Eating Disorder CBQ

• A: Amenorrhea

• N: No organic factor accounts for weight loss

• O: Obviously thin but feels fat

• R: Refusal to maintain normal body weight

• E: Epigastric discomfort

• X: Symptoms

• I: Intense fear of gaining weight

• A: Always thinking about food

• B: Binge eating

• U: Under strict dieting or vigorous exercise

• L: Lacks control over eating binges

• M: Minimum of 2 binge eating episodes a week for 3 months

• I: Increased persistent concern over body size/shape

• A: Abuse of diuretics and laxatives