EATING DISORDERS

This module aligns with key elements of APNA’s “Growth & Development” and “Clinical Decision Making” (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Assessment of Eating Disorders
• Problems Associated with Eating Disorders
• Treatment of Eating Disorders

Module Learning Outcomes

• Describe the signs and symptoms of Eating Disorders
• Identify the common nursing problems associated with Eating Disorders
• Summarize the treatment of Eating Disorders.

Concepts

• Nutrition
• Self
• Coping

Overview

In this chapter, we will discuss matters related to eating disorders to include their clinical presentation, problems, and treatment options. Our discussion will include an overview of anorexia nervosa, bulimia nervosa, and binge eating disorder, but will focus on the treatment of anorexia nervosa and bulimia nervosa.

Eating disorders are very serious, yet relatively common mental health disorders, particularly in Western society, where there is a heavy emphasis on thinness and physical appearance. While there is no exact cause for eating disorders, the combination of biological, psychological, and sociocultural factors has been identified as major contributors in both the development and maintenance of eating disorders. This chapter serves as an introduction to two of the most common eating disorders (i.e., anorexia nervosa and bulimia nervosa), their etiology, and treatment.

Anorexia Nervosa

Balasundaram and Santhanam (2022) describe several key components of Anorexia Nervosa. Anorexia nervosa has two subtypes (restricting type and binge eating/purging type). The restricting type involves food restriction. The binge eating/purging involves consuming large amounts of food followed by a means of purging (i.e., self-induced vomiting or laxatives). Individuals may also use non-purging behaviors such as excessive exercise Anorexia nervosa leads to significantly low body weight relative to the individual’s age, sex, and development. This restriction is often secondary to an intense fear of gaining weight or becoming fat, despite the individual’s low body weight.

Some emotional and behavioral symptoms include dramatic weight loss, preoccupation with food, weight, calories, etc., frequent comments about feeling “fat,” eating a restricted range of foods, makes excuses to avoid mealtimes, and often does not eat in public. Physical changes may include dizziness, difficulty concentrating, feeling cold, sleep problems, thinning hair/hair loss, and muscle weakness, to name a few.

 Bulimia Nervosa

Unlike anorexia nervosa where there is solely restriction of food, bulimia nervosa involves a pattern of recurrent binge eating behaviors. Individuals with bulimia nervosa often report a sense of lack of control over-eating during these binge-eating episodes. While not always, these binge-eating episodes are usually followed by a feeling of disgust with oneself, which leads to a compensatory behavior in an attempt to rid the body of the excessive calories. These compensatory behaviors include vomiting, use of laxatives, fasting (or severe restriction), or excessive exercise.

Signs and symptoms of bulimia nervosa are similar to anorexia nervosa. These symptoms include but are not limited to hiding food wrappers or containers after a binging episode, feeling uncomfortable eating in public, developing food rituals, limited diet, disappearing to the bathroom after eating a meal, and drinking excessive amounts of water or non-caloric beverages. Additional physical changes include weight fluctuations both up and down, difficulty concentrating, dizziness, sleep disturbance, and possible dental problems due to purging post binge eating episode.

Symptoms of bulimia nervosa typically present later in development- late adolescence or early adulthood. Similar to anorexia nervosa, bulimia nervosa initially presents with mild restrictive dietary behaviors; however, episodes of binge eating interrupt the dietary restriction, causing bodyweight to rise around normal levels. In response to weight gain, patients engage in compensatory behaviors or purging episodes to reduce body weight. This cycle of restriction, binge eating, and calorie reduction often occurs for years before seeking help.

Binge-Eating Disorder (BED)

Binge-Eating Disorder is similar to Bulimia Nervosa in that it involves recurrent binge eating episodes along with feelings of lack of control during the binge-eating episode; however, these episodes are not followed by a compensatory behavior to rid the body of calories.

National Eating Disorders Association. (2018). Warning signs & symptoms of an eating disorder [Video]. YouTube. https://youtube.com/watch?v=nJMtReAg1DI&si=EnSIkaIECMiOmarE

Instruments

The Eating Attitudes Test inventory can evaluate eating disorder treatment outcomes (Videbeck. 2020).

Problems

Problems associated with an Eating disorder diagnosis are:

• Ineffective coping
• Risk for injury
• Altered nutrition

Treatment

The immediate goal for the treatment of anorexia nervosa is weight gain and recovery from malnourishment. This is often established via an intensive outpatient program, or if needed, through an inpatient hospitalization program where caloric intake can be managed and controlled. Both the inpatient and outpatient programs use a combination of therapies and support to help restore proper eating habits. Just as anorexia nervosa treatment initially focuses on weight gain, the first goal of bulimia nervosa treatment is to eliminate binge eating episodes and compensatory behaviors. Of the most common (and successful) treatments are Enhanced Cognitive-Behavioral Therapy (CBT-E) and Family-Based Therapy (FBT). Psychopharmacological agent may be used to help with comorbid diagnoses such as depression and anxiety.

CBT-E

CBT-E is the first line treatment for eating disorders (Balasundaram and Santhanam, 2022). Some of the behavioral strategies include recording eating behaviors—hunger pains, quality and quantity of food—and emotional behaviors—feelings related to the food. In addition to these behavioral strategies, it is also important to address the maladaptive thought patterns associated with their negative body image and desire to control their physical characteristics. Changing the fear related to gaining weight is essential in recovery.

FBT

FBT is also an effective treatment approach, often used as a component of individual CBT, especially for children and adolescents with the disorder. FBT is especially helpful for helping children and adolescents diagnosed with anorexia nervosa (Balasundaram and Santhanam, 2022).

Psychotropics

Fluoxetine is approved to treat Bulimia Nervosa and Binge eating disorders (Balasundaram and Santhanam, 2022). Other psychotropic classes such as antidepressants, antipsychotics, and mood stabilizers may treat comorbid psychiatric diagnoses (Balasundaram and Santhanam, 2022).

Nutritional Therapy

Nutrition therapy is indicated for all eating disorders. If indicated, supplemental nutrition will typically include nasogastric feeding or total parenteral nutrition in the case of gastrointestinal dysfunction (Balasundaram and Santhanam, 2022). Refeeding should be a gradual process with a weight gain goal of 2 to 3 lbs. a week (Balasundaram and Santhanam, 2022). It is also imperative to monitor electrolyte levels.

Psych Hub. (2020). Treatment for eating disorders [Video]. YouTube. https://youtube.com/watch?v=n9o_ZtUlsgI&si=EnSIkaIECMiOmarE

Additional Resource

Check out the website below to learn more about eating disorders.

• National Eating Disorders Association (NEDA)

Adapted from Fundamentals of Psychological Disorders 2nd Edition- Module 10 by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow .