EATING

DISORDERS
By
AYAZ UR RAHMAN
Facilitator: Sir Muhammad Shoaib Yazdani
 OBJECTIVES

At the end of this presentation, student will be able to;

 Defi ne Eating disorder.

 Describe epidemiology and types of eating disorder.

 Enlist sign and symptoms of various types of eating disorder.

 Elaborate causes of various types of eating disorder.

 Explain diagnosis and assessment of eating disorder.

 Discuss the medical and nursing management of eating

disorder.
 EATING DISORDERS

 Eating disorders are a range of psychological

conditions that cause unhealthy eating habits to
develop. They might start with an obsession with
food, body weight, or body shape.
 People with eating disorders can have a variety of
symptoms. Common symptoms include severe
restriction of food, food binges, and purging
behaviors like vomiting or over exercising.
 EPIDEMIOLOGY
 Eating disorder mostly eff ect female, although more
cases in men are emerging,
 Most eating disorder begins in adolescence.
 86% of cases report before age of 20
 Average age for onset is 15 to 30 years.
 The mortality rate in anorexia nervosa is higher than
any other psychiatric illness i-e 6% to 20%.
 Mortality rate for bulimia nervosa is range from 2 to
19%.
 Cause of death in eating disorder is most frequently
suicide.
 CONT.…

 Depression is diagnosed in 40 to 75% of individuals

with eating disorders.
 Two third of eating disorders client is diagnosed with
co morbid anxiety disorders, OCD, and social phobias.
 In anorexic patient OCD is the most frequent
diagnose.
 Substance abuse disorders is mostly seen in bulimic
patient.
 TYPES OF EATING DISORDERS

1. Anorexia nervous
2. Bulimia nervous
3. Binge eating disorder
4. Pica
 ANOREXIA NERVOSA

 Anorexia nervosa is likely the most well-known eating

disorder.
 It generally develops during adolescence or young adulthood
and tends to aff ect more women than men.
 People with anorexia generally view themselves as
overweight, even if they’re dangerously underweight. They
tend to constantly monitor their weight, avoid eating certain
types of foods, and severely restrict their calorie intake.
 CAUSES

 Exact cause is unknown

 Genetic factors

 Biological factors
 High level of enkephalin and endorphin

 Developmental factors

 Sociocultural factors
 SIGN AND SYMPTOMS
 v ery restric t ed ea ting p a t t erns

 int ens e f ea r o f g a ining w eig ht o r p e rsis te nt b eha vio rs t o a v o id

g a ining w eig ht , d esp it e b eing und erw e ig ht
 a hea vy infl uenc e o f b o d y w eig ht o r p e rc e ive d b o d y sha p e o n s elf-
es tee m
 D ec rea se b o d y t em p era t ure

 A m eno rrhea

 a d ist o rt ed b o d y im a g e, inc lud ing d enia l o f b eing serio usly

und erw eig ht
 DIAGNOSIS
 To be diagnosed with anorexia nervosa according to the
DSM-5, the following criteria must be met:
 1. Restriction of energy intake relative to requirements
leading to a signifi cantly low body weight in the context of
age, sex, developmental trajectory, and physical health.
 2. Intense fear of gaining weight or becoming fat, even
though underweight.
 3. Disturbance in the way in which one's body weight or
shape is experienced, undue infl uence of body weight or
shape on self-evaluation, or denial of the seriousness of
the current low body weight.
 BULIMIA NERVOSA

 Disorder in which you have episodes of binge eating

(consuming a large quantity of food in one sitting).
During these binges, you have no sense of control
over your eating. Afterward, you try inappropriate
ways to lose weight such as:
 Vomiting, Fasting, Enemas, Excessive use of laxatives
and diuretics, and Compulsive exercising
 CAUSES

 Exact cause is unknown

 Genetic cause
 Biological cause
 Depression and anxiety disorders
 Substance use disorders
 SIGN AND SYMPTOMS

 Dental problems

 Sore throat

 recurrent episodes of binge eating with a feeling of lack of

control
 recurrent episodes of inappropriate purging behaviors to
prevent weight gain
 a fear of gaining weight, despite having a typical weight

 Irregular periods
 DIAGNOSIS
 Ac c o rd i n g t o t h e D S M - 5 , t h e o ffi c i a l d i a g n o s t i c c r i t e r i a fo r b u l i m ia
n e r v o s a a re :
 Re c u rre n t e p i s o d e s o f b i n g e e a t i n g . A n e p i s o d e o f b i n g e e a t i n g i s
characterized by both of the following:
1. E a t i n g , i n a d i s c re t e p e r i o d o f t i m e ( e . g . w i t h i n a n y 2 -h o u r p e r i o d ) , an
a m o u n t o f f o o d t h a t i s d e fi n i t e l y l a rg e r t h a n m o s t p e o p l e w o u l d e a t
d u r i n g a s i m i l a r p e r i o d o f t i m e a n d u n d e r s i m i l a r c i rc u m s t an c e s .
2. A s e n s e o f l a c k o f c o n t ro l o v e r e a t i n g d u r i n g t h e e p i s o d e ( e . g . a fe e l i n g
t h a t o n e c a n n o t s t o p e a t i n g o r c o n t ro l w h a t o r h o w m u c h o n e i s
e at i n g ) .
 Re c u rre n t i n a p p ro p r i a t e c o m p e n s a t o r y b e h a v i o r i n o rd e r t o p re v e n t
w e i g h t g a i n , s u c h a s s e l f- i n d u c e d v o m i t i n g , m i s u s e o f l a x at i v e s ,
d i u re t i c s , o r o t h e r m e d i c a t i o n s , f a s t i n g , o r exc e s s i v e exe rc i s e .
 T h e b i n g e e a t i n g a n d i n a p p ro p r i a t e c o m p e n s a t o r y b e h av i o r s b o t h o c c u r ,
o n av e r ag e , a t l e a s t o n c e a w e e k f o r t h re e m o n t h s .
 BINGE EATING DISORDER
 Binge eating disorder is the most prevalent form of eating
disorder and one of the most common chronic illnesses
among adolescents .
 It typically begins during adolescence and early adulthood,
although it can develop later on.
 Individuals with this disorder have symptoms similar to those
of bulimia or the binge eating subtype of anorexia.
 For instance, they typically eat unusually large amounts of
food in relatively short periods of time and feel a lack of
control during binges.
 People with binge eating disorder do not restrict calories or
use purging behaviors, such as vomiting or excessive
exercise, to compensate for their binges
 CAUSES

 Exact cause is unknown.

 Family history (CYFIP2 gene)

 Reduce myelination

 Dieting

 Triggers for bingeing can include stress, poor body self-

image and the availability of preferred binge foods.
 gender
 SIGN AND SYMPTOMS

 Eating large amounts of food rapidly, in secret, and until

uncomfortably full, despite not feeling hungry
 Feeling a lack of control during episodes of binge eating

 Feelings of distress, such as shame, disgust, or guilt, when

thinking about the binge eating behavior
 No use of purging behaviors, such as calorie restriction,
vomiting, excessive exercise, or laxative or diuretic use,
to compensate for the binge eating
 DIOGNOSIS
TheDSM-5 criteria for binge eating disorder are:
 Recurrent episodes of binge eating. An episode of binge
eating is characterized by both of the following: o
1. Eating, in a discrete period of time (e.g., within any
2-hour period), an amount of food that is defi nitely
larger than what most people would eat in a similar
period of time under similar circumstances.
2. A sense of lack of control over eating during the
episode (e.g., a feeling that one cannot stop eating or
control what or how much one is eating).
 CONTINUE
 The binge eating episodes are associated with three
(or more) of the following:
 Eating much more rapidly than normal.
 Eating until feeling uncomfortably full.
 Eating large amounts of food when not feeling
physically hungry.
 Eating alone because of feeling embarrassed by how
much one is eating.
 Feeling disgusted with oneself, depressed, or very
guilty afterward.
 PICA
 Pica is an eating disorder that involves eating things that
are not considered food and that do not provide
nutritional value.
 Individuals with pica crave non-food substances such as
ice, dirt, soil, chalk, soap, paper, hair, cloth, wool,
pebbles, laundry detergent, or cornstarch.
 Pica can occur in adults, children, and adolescents.
 Individuals with pica may be at an increased risk of
poisoning, infections, gut injuries, and nutritional
defi ciencies. Depending on the substances ingested, pica
may be fatal.
 CAUSES

 Culture or learned behavior

 Stress, anxiety
 Negative condition during childhood
 Nutritional defi ciencies
 Medical condition such as pregnancy or sickle cell
anemia
 SIGN AND SYMPTOMS

 Anemia (low iron).

 Ascariasis (roundworm infection).
 Constipation.
 Electrolyte imbalance..
 Lead poisoning.
 Small intestine and large
intestine obstruction/blockage.
 DIAGNOSIS

TheDSM-5 criteria for pica are:

 There are no laboratory tests for pica.

 Instead, the diagnosis is made from a clinical history of

the patient.
 Diagnosing pica should be accompanied by tests for
anemia, potential intestinal blockages, and toxic side
eff ects of substances consumed (i.e., lead in paint,
bacteria or parasites from dirt).
 ASSESSMENT OF EATING
DISORDERS

1. History

2. General Appearance and Motor Behavior

3. Thought Processes and Content

4. Judgment and Insight

 CONT.…

5. Self-Concept

6. Mood and Aff ect

7. Roles and Relationships

8. Physiologic and Self-Care Considerations

 MANAGEMENT OF EATING
DISORDERS
Multidisciplinary approach needed for eating disorders include,

physicians, psychotherapist, and nutritionist.

1. Biological therapy:
 Not known pharmacotherapy for eating disorders, although

antidepressant and appetite stimulant medication may some time helpful

2. Psychological therapy
 Cognitive behavioral therapy and family therapy.

3. Nutritional therapy
 NURSING MANAGEMENT

 Establishing Nutritional Eating Patterns:

o Sit with the client during meals and snacks.

o Off er liquid protein supplement if client is unable to

complete meal.
o Observe client following meals and snacks for 1 to 2 hours.

o Weigh client daily in uniform clothing.

o Be alert for attempts to hide or discard food or infl ate

weight.
 CONT.…

 Helping the client identify emotions and develop

non–food-related coping strategies
o Ask the client to identify feelings.

o Self-monitoring using a journal

o Relaxation techniques

o Distraction

o Assist client to change stereotypical beliefs

 CONT.…

 Helping the client deal with body image issues

o Recognize benefi ts of a more near-normal weight.

o Assist to view self in ways not related to body image.
o Identify personal strengths, interests, talents
 CONT.…

Client teaching: Family teaching :

 Basic nutritional needs  Provide emotional support.

 Harmful eff ects of restrictive  Express concern about

eating, dieting, and purging client’s health

 Realistic goals for eating  Become informed about

 Acceptance of healthy body eating disorders.

 Do not force the client to eat.

image
 NURSING DIAGNOSIS AND
OUTCOMES
1. Imbalanced Nutrition Less 1. The client will increase
than Body Requirements caloric and nutritional intake.
related to refusal to eat. 2. The client will establish
2. Imbalanced Nutrition More regular nutritional eating
than Body Requirements patterns.
related to undesirable 3. The client will evidence
eating patterns. improvement in physical
status related to
3. Disturbed Body Image
complications of obesity or
related to fear of being bulimia.
overweight.
4. The client will identify
4. Compromised Family Coping alternatives to present
related to enabling coping patterns.
behaviors.
 REFERENCES
 DSM-5 Diagnostic Criteria for Eating Disorders Anorexia Nervosa Bulimia

Nervosa Evaluation & Diagnosis . (2019).

h t t p s : / / w w w. b re a t h e t h e r a p i e s . c o. u k / w p - c o n t e n t / u p l o a d s / 2 0 1 9 / 0 6 / D S M - 5 -

[Link]

 M a r y C . To w n s e n d , K . I . M . ( 2 0 1 8 ) . · A s s e s s m e n t · C a r e P l a n s · M e d i c a t i o n s

Index of Client Behaviors .

 Psychiatric–Mental Health Nursing . (n.d.).

 Suliswati. (2005). Basic Concepts of Mental Health Nursing .

 h t t p s : / / w w w. h e a l t h l i n e . c o m / n u t r i t i o n / c o m m o n - e a t i n g - d i s o rd e r s # s i g n s

 h t t p s : / / w w w. w e b m d . c o m / m e n t a l - h e a l t h / e a t i n g - d i s o rd e r s / b u l i m i a - n e r v o s a / m e n
Thank You All
 NCLEX-STYLE QUESTIONS
1. T h e m o t h e r o f a t e e n w i t h a n e a t i n g d i s o rd e r ex p re s s e s a c o n c e rn t h a t t h e
f a m i l y i s re s p o n s i b l e f o r t h e p ro b l e m . W h i c h q u e s t i o n w i l l b e s t h e l p t h e
n u r s e i d e n t i fy a n o t h e r i n fl u e n c e t h a t i s l i ke l y t o h a v e p l a y e d a ro l e i n t h e
t e e n a g e r ’ s e a t i n g d i s o rd e r ?
a. “Does she have an after-school job?”
b. “Does she have access to nutritious foods?”
c. “Is there a family history of underweight adults?”
d. “Is your daughter interested in clothes and fashion?”
2. Lo n g - t e rm p ro g n o s i s f o r e a t i n g d i s o rd e r s i s i m p ro v e d d r a m a t i c a l l y w h e n
t re a t m e n t i n c l u d e s l o n g - t e rm c o g n i t i v e - b e h a v i o r a l t h e r a p y. W h a t
s t a t e m e n t p ro v i d e s t h e b e s t ex p l a n a t i o n t o t h e p a t i e n t f o r t h i s c o m p o n e n t
t o t h e t re a t m e n t p l a n ?
a. “This will help you identify a healthy, weight restoration diet.”
b. “Medication alone will not help you from relapsing back to your old
habits.”
c. “In order to manage your disorder, you have to understand the root
 NCLEX-STYLE QUESTIONS
3. The nurse is identifying outcomes for a teenager diagnosed with
anorexia nervosa. Which outcome has the greatest impact on long-
term prognosis?
a. Verbalize underlying psychological issues.
b. Demonstrate eff ective coping skills related to confl ict
management.
c. Demonstrate improvement in body imagine refl ecting a realistic
viewpoint.
d. Consume adequate calories appropriate for age, height, and
metabolic needs.
4. Which statement is the basis for the cross-cultural assessment
practices of eating disorders?
a. Mediterranean cultures are more likely to exhibit symptoms.
b. Male-dominated cultures are more likely to accept this disorder.
 NCLEX-STYLE QUESTIONS
5. The nurse observes a distorted thinking pattern in a teenage
patient diagnosed with an eating disorder. Which statement
characterizes personalization by the patient?
a. “I’ve got to be thin to get a good job.”
b. “There is no such thing as a healthy carbohydrate.”
c. “My mother and dad fi ght all the time because I’m fat.”
d. “My whole family will be disgraced if I don’t get into a good
college.”
6. A 16-year- old patient has anorexia nervosa. Which term used to
describe the menstrual history is characteristic of this disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Premenstrual syndrome
d. Heavy menstrual fl ow
 NCLEX-STYLE QUESTIONS
7. A nursing intervention that will be planned to occur early in the
nurse-patient relationship with a patient with an eating disorder is:
a. Using confrontation to attack denial
b. Placing the patient in a therapeutic group
c. Formulating a therapeutic nurse-patient alliance
d. Attacking enmeshment by separating patient and family
8. A patient is being assessed for a binge-eating–associated eating
disorder. Which assessment question is directed towards collecting
data on the most commonly abused substance among this patient
population?
a. “How much alcohol do you drink on a weekly basis?”
b. “Do you use amphetamines to help control your weight?”
c. “Do you rely on laxatives to control your bowel movements?”
d. “How many packs of cigarettes do you smoke on a daily basis?”
 NCLEX-STYLE QUESTIONS KEY
1. D
2. C
3. B
4. C
5. C
6. A
7. B
8. C