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.