EATING DISORDERS

NOTES ABOUT EATING DISORDERS
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

ANOREXIA NERVOSA
: Loss of appetite

•Signs and symptoms:
–Fear of becoming fat
–Body image disturbance
–Amenorrhea
–Depressed mood, social withdrawal, irritability and insomnia
–Preoccupation with thoughts of food
–Feelings of ineffectiveness
–Strong need to control the environment
–Constipation and abdominal pain
–Cold intolerance
–Lethargy
–Emaciation
–Hypotension, hypothermia, bradycardia
–Hypertrophy of salivary glands

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Refusal to maintain body weight
•Intense fear of gaining weight
•Overvaluing of shape or weight or denial of seriousness of loss of weight
•Absence of 3 consecutive menstrual cycles

TYPES OF ANOREXIA NERVOSA

Restricting type: (-) binge eating or purging
Binge-eating/Purging type: (+) binge eating/purging

Etiology:
•Biologic
-Obesity and diet
-Overprotective family
-beauty, thinness
-fitness and preoccupation of achieving ideal body
•Biochemical:
- Increased CSF levels of 5-hydroxyindoleacetic acid (5-HIAA)
•Psychoanalytical
(-)autonomy and identity
dissatisfaction of body image
possible childhood sexual abuse

•Onset:
Ages of 14 to 18 years old
Denies anxiety over appearance and gaining weight

•Treatment:
–Psychotherapy
–Psychopharmacology

BULIMIA NERVOSA
-(+) bingeing or purging episodes with strong emotions and followed by guilt, remorse, shame or self-contempt

SIGNS AND SYMPTOMS OF BULIMIA NERVOSA
•Recurrent episodes of bingeing and purging
•Compensatory behaviors
•Usually within normal weight range, possible underweight or overweight
•Depressive and anxiety symptoms
•Possible substance abuse
•Loss of dental enamel
•Menstrual irregularities
•Esophageal tears
•Fluid and electrolyte abnormalities

TYPES OF BULIMIA NERVOSA
Purging type: (-) binge eating or purging
Non-Purging type: (+) binge eating/purging

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
•Recurrent episodes of binge eating
•A feeling of lack of control over eating behaviors during eating binges
•Recurrent inappropriate compensatory behavior in order to prevent weight gain
•Twice a week for 3 months
•Self evaluation influenced by body shape

Etiology:
•Biologic
:Obesity
:Dieting at an early age
:Substance abuse
:History of personality disorders and anxiety disorders
B. Biochemical:
:serotonin and norepinephrine disturbances
:decreased hypothalamic glucose utilization
:a satiety center disturbance
C. Psychoanalytical
Dissatisfaction of body image
Inability to develop identity

•Onset:
–Late adolescents or early adulthood

Medical Complications of Eating Disorders
•Anorexia Nervosa:
–Arrythmias
•Bulimia Nervosa:
–Metabolic alkalosis
–Metabolic acidosis

Nursing Interventions for Bulimia Nervosa and Anorexia Nervosa:
•Weigh client daily.
•Basic nutritional needs.
•Harmful effects of dieting, bingeing and purging.
•Strengthened family ties.
•Acceptance of different personalities and constant affirmation of child.
•Importance of professional help
•Be alert for attempts to hide food or inflate weight.
•Journal
•Relaxation techniques.


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