Eating Disorders

Eating provides nourishment for both the body and soul, but for some individuals, it becomes a source of distress.
Eating disorders are characterized by disruptions in normal eating patterns.
Presenting issues:
- Significantly disturbed perceptions of body shape or size.
- Intense fear of weight gain.

Differentiate between the signs and symptoms of anorexia nervosa and bulimia nervosa.
Identify priority assessments for individuals with an eating disorder to facilitate safe and effective care.

Definition: A life-threatening eating disorder characterized by refusal or inability to maintain a minimal normal body weight.
Key Features:
- Intense fear of gaining weight or becoming fat despite being underweight.
- Disturbance in body image.
- Denial of the seriousness of the disorder.
Body Weight: Typically 85% less than expected for age and height.
Menstrual Irregularity: Amenorrhea for at least three consecutive cycles.
Preoccupation with Food:
- Extreme focus on food-related activities (grocery shopping, counting calories).
- Engagement in unusual food behaviors (cutting food into small pieces, avoiding eating around others).
Types of Anorexia:
1. Restricting Type: Weight loss through drastic food restriction or excessive exercise without binge eating/purging.
2. Binge-Eating/Purging Type:
- Engages in binge eating (consuming large amounts of food in a short time, typically two hours) and purging (self-induced vomiting, misuse of laxatives, enemas, diuretics).
- Some individuals do not binge but engage in purging alone.

Emotional Symptoms:
- Profound fear of gaining weight.
- Distorted body image.
- Facts contributing to depression and anxiety.
- Feeling of ineffectiveness.
Physical Symptoms:
- Constipation, abdominal pain, cold intolerance, lethargy, emaciation.
- Vital Signs:
- Hypotension, hypothermia, bradycardia.
Additional Indicators:
- Electrolyte imbalances, leukopenia, mild anemia, elevated liver function tests.
- Lanugo (fine body hair) or dry and cracking skin.

Definition: An eating disorder characterized by recurrent episodes (at least twice a week for three months) of binge eating followed by inappropriate compensatory behaviors to prevent weight gain.
Characteristics of Bulimia:
- Engages in binge-eating episodes, followed by purging behaviors such as vomiting, fasting, or excessive exercise.
- Binge-eating episodes are often triggered by strong emotions, leading to guilt, remorse, or shame.
Physical Indicators:
- Weight often remains in the normal range despite the disorder.
- Damage to dental enamel due to vomiting, leading to dental caries and chipped teeth.
- Dentists often identify bulimia early due to these physical signs.

Emotional Symptoms:
- Self-evaluations excessively influenced by body shape and weight.
- Symptoms of depression and anxiety.
- Possible use of substances, including alcohol or stimulants.
Physical Symptoms:
- Loss of dental enamel, increased dental caries, menstrual irregularities, and dependence on laxatives.
- Presence of esophageal tears and fluid/electrolyte imbalances.
- Mildly elevated amylase levels.

Genetic Factors: Higher prevalence in families with a history of eating disorders (especially females).
Biological Factors: Possible disturbances in serotonin and norepinephrine.
Environmental Factors:
- Societal pressure to maintain an ideal body image.
- Participation in athletics, particularly at a competitive level.
Interpersonal Relationships: Pressure from peers and family, emotional support systems play a significant role.
Psychological Factors: Anxiety, perfectionism, rigidity, and low self-esteem prevalent in individuals with anorexia nervosa.
Developmental Risk Factors: Struggles with developing autonomy and control over one's environment.

Challenges in Treatment: Patients often resist treatment and deny their eating disorder.
Physical Assessment (start on page 199):
- Monitor vital signs: hypotension, bradycardia, hypothermia.
- Inspect head, neck, mouth, and throat for dental erosion or decay.
- Cardiac assessment may reveal dysrhythmias.
- Skin, hair, and nails may appear poor in condition and quality.

Nutritional Management:
- Establish nutritional eating patterns, emphasizing the importance of adequate nutrition as a top priority.
- Contract with patient for a gradual approach to caloric intake over six months.
- Teach balanced diet principles.
- Supervise meals and monitoring for one to two hours post-eating.
- Discourage food rituals and promote eating with others.
- Monitor for attempts to hide or discard food.
Psychological Support:
- Help the client identify and express emotions.
- Develop non-food-related coping strategies such as journaling.
- Encourage participation in non-judgmental therapeutic relationships.
- Support clients in recognizing the benefits of achieving a near-normal weight.
- Assist clients in identifying strengths unrelated to body image.