Eating Disorders: Anorexia and Bulimia - Key Notes
Eating Disorders Overview
- Key Topics:
- Anorexia Nervosa (AN) & Bulimia Nervosa (BN)
- Treatment options
- Nurse’s role
- Safe medication practices
- Clinical placement prep
Anorexia Nervosa (AN) vs. Bulimia Nervosa (BN)
- Anorexia Nervosa:
- Body Weight: Low (BMI < 18.5)
- Behaviours: Restriction ± purging
- Perception: Intense fear of weight gain, distorted body image
- Complications: Malnutrition, refeeding syndrome, amenorrhea, bradycardia, osteoporosis
- Mortality Risk: High
- Menstruation: Often absent
- Bulimia Nervosa:
- Body Weight: Normal or overweight
- Behaviours: Binge + purge cycle
- Perception: Dissatisfaction with body, guilt after eating
- Complications: Electrolyte imbalance, dental erosion, GI issues
- Mortality Risk: Moderate
- Menstruation: Usually present
Key Signs & Symptoms
- Anorexia Nervosa:
- Behavioural: food obsession, calorie counting, excessive exercise, avoiding meals
- Physical: underweight, fatigue, hair loss, dry skin, lanugo, low BP/HR, amenorrhea
- Psychological: fear of weight gain, distorted body image
- Complication: refeeding syndrome (electrolyte shifts → cardiac risk)
- Bulimia Nervosa:
- Behavioural: binge eating + purging (vomiting, laxatives, diuretics)
- Physical: GI issues, sore throat, dental erosion
- Psychological: guilt/shame after eating, body dissatisfaction
Treatment Overview
- Similarities (Both):
- Multidisciplinary team (MDT)
- CBT (first-line), DBT, FBT
- Nutritional rehabilitation
- Psychoeducation (pt & family)
- Regular monitoring (weight, ECG, electrolytes)
- Differences:
- Anorexia:
- Main goal: Weight restoration, prevent starvation effects
- Medications: SSRIs after weight gain (limited effect)
- Hospitalisation: More common due to medical risk
- Weight gain: Central focus
- Bulimia:
- Main goal: Break binge–purge cycle
- Medications: SSRIs (e.g. Fluoxetine) helpful
- Hospitalisation: Less common unless severe or suicidal
- Weight gain: Usually not needed
Nurse’s Role in Eating Disorders
- Therapeutic Relationship: Build trust, be non-judgmental, validate emotions
- Early Intervention: Recognise withdrawal, food avoidance, weight loss. Respond to suicidal ideation
- Physical Monitoring: Weekly weights, VS, bloods (electrolytes, iron, ECGs)
- Family Involvement: Educate & involve family, reduce blame/guilt
- Support Recovery: Reintegration to school/social life. Encourage community participation (e.g. arts, peer groups)
- Reduce Stigma: Promote mental health literacy and hope
Admission Criteria & Indicators
- Physical: severe weight loss, dehydration, electrolyte imbalance, fainting
- Psychological: suicidal ideation, obsessive weight concerns
- Behavioural: meal skipping, isolation, control-seeking through food
- Communication: disclosures of distress
- (≥2 "yes" = likely ED)
- Sick from fullness?
- Control lost over eating?
- Lost One stone (6.35kg) in 3 months?
- Does Food dominate your life?
- Think you're Fat when others disagree?
- Use in a private, non-judgmental setting.
Inpatient Management Goals
- Medical stabilisation: rehydrate, correct electrolytes
- Psychological support: safety planning, therapy
- Nutritional rehab: supervised meals
- Psychoeducation
- Discharge planning with outpatient support
Safe Medication Practices
- Understand psychotropic meds (e.g. SSRIs for bulimia)
- Monitor for side effects, especially in malnourished patients
- Educate patients/families about med purpose, adherence
- Check for med contraindications (e.g. low BMI + QT prolongation risk)
- Document properly, administer safely
Student Nurse Responsibilities
- Be prepared and professional
- Respect confidentiality and boundaries
- Practice within scope – escalate risks (SI, malnutrition)
- Observe, participate in MDT care
- Ask for support from preceptors
Memory Triggers
- AN = Absence of food → Absence of period
- BN = Binge–barf–blame cycle
- SCOFF = Sick, Control, One stone, Food, Fat
- CBT = Core therapy for Both
- Weight gain = central for AN, not for BN