MODULE 12: 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).
- 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.
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.
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. /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.
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.
Below is an overview of a nurse’s consideration for the assessment, problems, and treatment of eating disorders.
See Balasundaram and Santhanam (2022) to read more about this topic.
Assessment of an individual with a known or suspected eating disorder will typically reveal the patterns of behavior from the following characteristics. Please note some characteristics are common to a particular eating disorder and will be denoted in the paratheses following the characteristic.
- Extremely underweight (Anorexia Nervosa)
- Amenorrhea, osteopenia, brittle hair/nails, dry skin, constipation, hypotension, bradycardia, hypothermia, lanugo hair, infertility, or muscle wasting (Anorexia Nervosa)
- Underweight, normal weight or slightly overweight (Bulimia Nervosa)
- Sore throat, swollen salivary glands, tooth decay, acid reflux, severe dehydration, electrolyte imbalance, and hormonal disturbances (Bulimia Nervosa)
- Intense fear of weight gain
- Distorted body image
- Food restriction, binging, or use of compensatory behaviors
- Preoccupation with food and weight (Balasundaram and Santhanam, 2022).
National Eating Disorders Association. (2018). Warning signs & symptoms of an eating disorder [Video]. YouTube. https://youtube.com/watch?v=nJMtReAg1DI&si=EnSIkaIECMiOmarE
The Eating Attitudes Test inventory can evaluate eating disorder treatment outcomes (Videbeck. 2020).
Problems associated with an Eating disorder diagnosis are:
Risk for injury
- Altered nutrition
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 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 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).
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).
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
Check out the website below to learn more about eating disorders.
Key Takeaways and Concept Map Activity
You should have learned the following in this section:
- Anorexia nervosa involves the restriction of food, which leads to significantly low body weight relative to the individual’s age, sex, and development, and an intense fear of gaining weight or becoming fat.
- Bulimia nervosa is characterized by a pattern of recurrent binge eating behaviors.
- Binge-eating disorder is characterized by recurrent binge eating episodes along with a feeling of lack of control but no compensatory behavior to rid the body of the calories.
- Some treatment options for eating disorders include CBT-E, FBT, and Nutrition therapy.
Concept Map Activity
- Create a concept map that depicts the assessment and treatment of Eating Disorders.
- If needed, see the INTRODUCTION for a concept map tutorial.
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 .
Binge eating can be defined as a discrete period of time where the amount of food consumed is significantly more than most people would eat during a similar time period.