Eating Disorders

Trisha Ireland
 Learning Outcomes
• Identify the major eating disorders and cause
of same
• Discuss physical effects of eating disorders
• Understand different treatment approaches
and nursing care of clients with eating
disorders
• http://youtu.be/CcN-ijsoAw0
 Major Eating Disorders
The term ‘eating disorder’ encompasses a range of
psychiatric disorders associated with disturbances in
eating behaviour. It includes:
• Anorexia Nervosa
• Bulimia Nervosa
• Eating disorders not otherwise specified (EDNOS)
 Eating Disorders Facts
• Anorexia nervosa has the highest level of mortality of
any psychiatric disorder, with an estimated mortality
rate of up to 20 percent over a 20-year period
• Eating disorders have high levels of psychiatric co-
morbidity in addition to associated physical
complications
• Bulimia nervosa is roughly 10 times as common as
anorexia nervosa but tends to occur in an older age
group
• Up to 50 percent of cases remain unrecognised in a
clinical setting as they are frequently concealed or
denied (Marks et al 2003)
• KAREN CARPETER
• Went on a water diet to lose weight
and, as she put it, to appear more
attractive. Continued to diet even
after losing 20 lbs, until her death at
the age of 32. She died of cardiac
arrest due to anorexia and weighed
only 80 lbs

Brazil model Ana Carolina Reston,

who weighed only 88 pounds, dies at
21 because of generalized infection as
a result of anorexia
 Anorexia Nervosa
• Two types of anorexia nervosa:

– Restricting type loses weight by severely limiting the amount of food

consumed
– Binge-eating-purging type engages in binges (large amount of food
consumed) following by purging (vomiting or use of laxatives)
– (APA, 2000)

• Lifetime prevalence of anorexia nervosa is less than 1% and is 10

times more frequent in women than in men

Ch 9.3
 Anorexia Nervosa
• Anorexia nervosa is linked to depression
• Anorexia nervosa can have severe physical
effects including
– Altered electrolyte levels (potassium and sodium)
lead to changes in nerve and muscle function
• Prognosis: 70% of anorexia nervosa patients
recover

Ch 9.4
 Anorexia Nervosa

 Refusal to maintain normal body weight – 15% or more

below normal body weight
 Intense fear of gaining weight or of being fat
 Body image disturbance or denial of seriousness of low
weight
 Absence of three consecutive menstrual cycles
 Other characteristics – Depression, obsessive thoughts or
compulsive behaviour, rigid thinking, perfectionism.
 May use weight loss as a means of controlling their bodies
 Associated Features and Facts
 Begins Early in Adolescence
 Perfectionistic High-Achievers
 All-or-None Thinking
 Obsessive and Orderly
 Comorbid DSM Disorders
– Depression
– Obsessive-Compulsive Disorder
– Substance Abuse
 Causes
 Social and Cultural Factors
– Thinness Equals Success
– Has Increased Over Time
 Media
– Sets Impossible Idealized Images
 Causes
 When Food is Restricted
– We Become Preoccupied With It!
 Causes
 Family Influences
– Successful and Driven
– Concerned About Appearances
– Eager to Maintain Harmony
– Deny or Ignore Conflicts
– Lack of Open Communication
 Aetiology – Eating Disorders
• Unknown – ?? biological, psychological, familial, socio-cultural
theories
• ? Major stressors or change in client’s life – puberty, first
sexual encounter, leaving home, loss
• Obesity (perceived or real) and dieting at an early age are risk
factors
• ? Familial – intense relationships, overprotective, rigid, lacking
conflict resolution
• ? History of sexual abuse in 30% clients (Ross, 2009)
 Anorexia Nervosa– other factors
• More common in industrialized countries
• Onset usually in adolescent and young females
• May be restricted to an acute episode or may be lifelong
chronic illness; can occur with Bulimia Nervosa
 Anorexia Nervosa Assessment
• Weight loss • Epigastric distress
• Body weight 15% or more less • Retaining faeces, urine or
than ideal body weight concealing weights to
• Refusal to eat increase weight
• Vomiting, difficulty swallowing measurement
• Use or abuse of laxatives • Denial of illness or
• Denial of being too thin resistance to treatment
• Excessive exercise • Guilt, shame or remorse
• Inability to respond to internal about eating certain foods.
stimuli related to hunger or
nutritional needs
 Physical Assessment
• Physical effects may be life threatening- include
malnutrition, starvation, pale, dry skin and poor skin
turgor, lanugo

• Cardiovascular effects as a result of loss of potassium and

electrolytes. Weakness, tiredness, mitral and triscupsid
valve prolapse, cardiac arrhythmias, bradycardia or
tachycardia, hypotension

• Kidney dysfunction – dehydration or kidney failure

• Gastrointestinal effects – swollen salivary glands;

abdominal pain, painful swallowing; heartburn; feeling
bloated
 Physical Assessment (contd)
• Endocrine effects – disrupted menstrual cycle – irregular or
amenorrhoea; changes in thyroid production

• Musculoskeletal effects – muscle wasting and loss of bone density;

fractures

• Dental effects – dental carries as a result of vomiting

• Skin effects – lanugo: fine downing hair on face and body. Also dry
skin and loss of hair

• Neurological effects – pins and needles, muscle spasms and seizures

• Mentally – decreased concentration

 Bulimia Nervosa
• Recurrent episodes of binge-eating; short time, large
amount
• Purging – vomiting, laxative abuse, fasting or
excessive exercise
• May be at, near or under ideal body weight
• Feeling lack of control over eating behavior
• Recurrent, inappropriate compensatory behavior to
prevent weight gain – fear of gaining weight
 Bulimia Nervosa (contd)
• Bingeing and compensating occur at least twice
weekly over three months
• Self-evaluation overly influenced by body shape and
size
• Often ashamed of eating behaviours and try and
keep them secret
• May have increased risk for mood disorders and
substance abuse and history (or family history) of
substance abuse, affective disorders
 Bulimia Nervosa (Contd)
• Usually female
• Onset late adolescence or early 20s
• Course of disorder – long term with intermittent or chronic
symptoms
• Prevalence of bulimia nervosa is 1 – 2% of the female
population and only 1% of male population
 Assessment – Imbalanced nutrition
• Weight gain or loss More or less than body
• Overuse of laxatives, diet requirements?
pills, diuretics
• Binge/compulsive eating
• Guilt, remorse or shame
after eating
• Inadequate nutritional
intake
• Excessive caloric intake
• Secrecy around eating
• Vomiting after eating
 Physical Signs and Symptoms
• Ulceration, scarring on • Esophageal tears,
dorsal surface of hand esophagitis, erosions,
• Hypertropy of salivary gland bleeding, perforation
• Erosion of dental enamel, • Disturbance in hormone
ulceration around mouth levels, irregular menses
and cheeks • GI problems, constipation,
• Fluid and electrolyte colitis, malabsorption,
imbalances delayed gastric emptying,
• Cardac problems, heart bleeding, ulcers, rupture
failure, hypotension, ECG • Dehydration
disturbances
 Eating Disorders Otherwise not Specified

• Symptoms do not match diagnostic criteria for

Anorexia Nervosa or Anorexia Bulimia eg
regular menstrual cycles

24
 Other Factors to consider
• Some never purge; just restrict intake and exercise
• Some continue to menstruate
• Treat depression, anxiety, neglect, and domestic violence
along with the eating disorder
• Perfectionism may lead them to deny illness if they do not
meet all criteria
• May recognize body image distortion, but be unable to stop
destructive behavior
• Some do not have rituals about eating
• Dishonesty is a hallmark of the illness
• Honesty is the key to recovery
 Treatment
Based on the evidence, treatment principles for service provision include:
• Multi-skilled and multidisciplinary staff
• early intervention
• community treatment settings, when safe and appropriate
• a multidimensional approach, for example, covering:
– medical issues
– weight restoration
– family therapy
– dietary advice
– cognitive behavioural therapy
– treatment for psychiatric co-morbidity
• a strengths-based, rather than punitive, approach
• specialist joint supervision of the treatment team including the GP or
primary care staff and inpatient (medical and psychiatric) staff.
 Inpatient Care
The role of inpatient care includes:
• medical stabilisation
• close medical monitoring
• weight restoration in a safe environment
• a step up from community residential care.
 Nursing Interventions
• Monitor caloric intake and electrolyte status
• Observe for purging or other compensation
• Weigh at regular intervals in hospital
• Diminish focus on weight after re-feeding
• Work with dietician
• Encourage therapy and support group
• Promote decision-making not related to food
• Promote positive self-concept
 Nursing Interventions (contd)
• Therapeutic relationship
• Ensure safety of client
• Monitoring vital signs and acting appropriately when vital signs
indicate medical instability
• Monitor emotional status and provide support for client and family
• Monitor weight gain
• Administer prescribed medication, check adherence and observe
for side effects
• Maintain positive regard for clients who can be quite resistive to
care.
• Normalisation of eating patterns
 Psychotherapeutic techniques and
treatments
• Supportive therapy
• Goal setting – keeping a journal
• Socratic questioning
• Cognitive Behaviour Therapy
• Interpersonal therapy
• Motivational enhancement therapy
• Psychoeducation
• Family therapy and support
• Self help programmes
• Pharmacotherapy
 Services in NZ
• Public services

• Treatment for eating disorders is generally treatment

within a primary care or general mental health setting.

• If the eating disorder is severe, input from a specialist

service may be needed

• New Zealand has three specialist eating disorder services,

covering the South Island and Northern and Central
regions
 Services in New Zealand
• The Auckland Eating Disorders Service is a tertiary
level regional specialist service funded by the three
Auckland DHBs. This service provides direct patient
treatment for individuals
• Day patient and out-patient treatment programmes
for those 11 and over with DSM diagnosis of
Anorexia or Bulimia Nervosa – accessed through
professional referral and must fit criteria
 Services in New Zealand
• No hospital specialist beds exist. General psychiatric
beds available at Starship; Ashburn Hall in Dunedin,
Capri in Auckland are private options
• Short-term medical inpatient care available in North
Shore, MMH, Auckland City Hospital and Starship –
for medical stabilisation
• In CMDHB – Eating Disorders Liaison Nurse at
Whirinaki
 Other Services
• Thrive – Challenge Trust facility in Auckland – public funding –
referral through local mental health team

 Several NGO and voluntary organisations provide support and

information about eating disorders
 http://nzeatingdisorderspecialists.co.nz/news/2006/03/14/eating-
disorder-clinic-opened/
 http://www.starship.org.nz/Clinical%20Guideline%20PDFs/Anorexi
a%20Nervosa%20and%20Eating%20Disorders.pdf
 Intensive Structural Therapy

• Treats individual and influential members

• Assesses pressures in the individual’s life
• Addresses dysfunctional patterns for example with
therapeutic lunch sessions
• Sets new patterns for the family
• Ends therapy when new patterns set not just the
individual stopping their behaviour
• http://nzeatingdisorderspecialists.co.nz/infor
mation
/
 Other Treatments
• Mandometer - Introduced in Sweden.
Device which monitors how a person eats and measures
satiety – and feeds back.
• Clinics in Sweden and Australia
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 References/Resources
• MOH - National Framework for Eating Disorder Services
Consultation document, Wellington: May 2006. This
document is available on the Ministry of Health’s website:
http://www.moh.govt.nz
• http://www.health.govt.nz/yourhealth-topics/mental-health/
eating-disorders

• http://www.ed.org.nz/ (Eating Disorders Association,NZ)

Thank you!