1125 Notes on Eating Disorders for Exam Preparation

Psychobiological Disorders: Eating Disorders Notes

Definition of Eating Disorders

  • Eating disorders are mental illnesses characterized by severe and persistent disturbances in eating behaviors, often accompanied by distressful thoughts and feelings.

Normal Eating Behavior

  • According to the National Eating Disorders Association (NEDA):

  • "Normalized, non-disordered eating" refers to a diet that includes a variety of foods, with the ability to eat mindfully in response to hunger and stop when feeling full.

Impacts of Eating Disorders

  • Eating disorders affect physical, psychological, and social health systems.

  • It can lead to:

    • Physical effects including malnutrition and medical complications.

    • Psychological impacts such as anxiety and depression.

    • Social consequences including isolation and difficulty maintaining relationships.

Key Indicators of Eating Disorders

  • Behaviors:

  • Obsession with food, weight, or body shape.

  • Significant restriction of food intake.

  • Functionality:

  • Impairment in social, occupational, or other important areas of functioning.

Warning Signs of an Eating Disorder

  • Dramatic weight fluctuations.

  • Preference for separate meals or avoidance of usual food.

  • Excessive food restrictions and secretive eating habits.

  • Expressions of extreme dissatisfaction concerning body image.

  • Feelings of guilt after eating and frequent self-weighing.

The Progression of Eating Disorders

  1. Internalized weight stigma: Belief that "fat" is bad and "thin" is good.

  2. Severe body dissatisfaction: Body comparison and focus on weight.

  3. Pursuit of thinness: Engaging in restrictive diets and unhealthy behaviors to control weight.

  4. Prolonged clinical behaviors: Continuous disturbance in eating habits.

  5. Disruption to daily life: Medical issues and psychological distress arise.

Risk Factors for Developing Eating Disorders

  • Occupational choices (e.g., athletes, models).

  • History of obesity or family history of mental health issues.

  • Cultural influences emphasizing thinness.

  • Gender differences, where women are more often affected than men.

  • Underlying mental health conditions (anxiety, depression).

Diathesis-Stress Model

  • The diathesis-stress model suggests that mental disorders arise from a combination of genetic predispositions and stressful life circumstances.

Primary Categories of Eating Disorders

  1. Anorexia Nervosa (AN)

  • Characterized by self-induced starvation leading to significant weight loss.

  • Excessive preoccupation with body image and weight, meticulous calorie counting.

  • Clinical features: thin appearance, hypotension, bradycardia, dehydration, distorted body image.

  1. Bulimia Nervosa (BN)

  • Involves a binge-purge cycle with frequent episodes of binge eating followed by compensatory behaviors.

  • Typically, individuals maintain a weight near their ideal.

  • Clinical manifestations include GI disturbances, electrolyte imbalances, dental issues (Russell's sign).

  1. Binge-Eating Disorder (BED)

  • Characterized by recurrent episodes of consuming large amounts of food without purging.

  • Often driven by psychological distress.

  • Common consequences: obesity, GI problems, and feelings of guilt.

DSM-5-TR Criteria for Binge-Eating Disorder

A. Recurrent episodes of binge-eating characterized by:

  1. Eating a large amount of food in a distinct period (within 2 hours) that is much larger than normal.

  2. A sense of lack of control over the eating during the episode.
    B. Associated with three or more of the following:

  3. Eating quickly and beyond comfort.

  4. Eating large amounts when not physically hungry.

  5. Eating alone due to embarrassment.

  6. Post-binge feelings of disgust or guilt.
    C. Marked distress regarding binge eating.
    D. Occurs at least once a week for three months.
    E. Not associated with compensatory behaviors typical of BN or AN.

Clinical Manifestations of Eating Disorders

  • Anorexia Nervosa: extreme thinness, hypotension, hypothermia, electrolyte imbalances, gastrointestinal issues, and amenorrhea.

  • Bulimia Nervosa: dental issues, GI disturbances, electrolyte imbalances, and mental health concerns.

  • Binge-Eating Disorder: obesity risks, gastrointestinal distress, heart disease, and diabetes.

Labs and Diagnostics

  • Common tests include measurements of electrolytes, blood glucose levels, liver function, and metabolic status.

  • Criteria for acute treatment

    • weight loss 20% if ideal body weight or less than 10% body fat

    • unsuccessful weight gain

    • vital signs w/BR less than 50/min less than 90 mmHG

    • body temp less than 96.8 F

    • ECG changes

    • Electrolyte disturbances

    • Psychiatric criteria, server depression, suicide behavior, psychosis, family crises

Treatment and Nursing Care

  • Structured environment: develop trusting relationships with patients.

  • Initiate realistic weight goals and promote cognitive therapies.

  • Monitor vital signs, intake/output, and collaborate with dietitians.

  • Behavioral contracts may be used to modify eating behaviors.

Pharmacotherapy

  • SSRIs (e.g., Fluoxetine (prozac) for BN and BED).

  • No FDA-approved medications for AN.

  • Cautiously prescribe laxatives if needed.

  • Vitamins and minerals may be administered to correct deficiencies.

Refeeding Syndrome

  • A metabolic complication from reintroducing nutrition after severe malnutrition.

  • Signs include electrolyte imbalances, vitamin deficiences, and it can lead to impaired organ function if not addressed.