NCMB317 LECTURE: Midterm Week
09
Eating Disorders
Bachelor of Science in Nursing 3YB
Professor: Donato Mirador MAN, RN & Vilma Miguel MAN, RN
EATING DISORDERS 2) Binge-purging subtype - Weight loss is through induce
- Disorders characterized by alteration in eating pattern and vomiting, use of laxatives, diuretics and enema
disturbance in body image that interferes with relationship
and occupational functioning. Bulimia Nervosa
- Occupational functions – everyday activities like selfcare, - an eating disorder characterized by recurrent episodes of
household chores binge eating at least twice a week for 3 months.
- Potential signs: - Symptoms include:
• Excessive exercise B – Binge eating
• Preoccupation with feeling fat U – Under strict dieting or vigorous exercise
• Abnormal electrolyte levels L – Lack control over eating
• Intense fear of gaining weight I – Induced vomiting
• Unusually large intake of food M – Moth-eaten appearance teeth
• Anxiety around or avoidance of eating. I – Increase and persistent concern of body
- Types of Eating Disorders according to the diagnostic A – Abuse of diuretics and laxatives
criteria of DSM 5 for eating disorders: Medical Complications Related to Weight Loss
1) Anorexia Nervosa (AN) Cardiac Metabolic Reproduction
2) Bulimia Nervosa (BN) - Hypotension -hypoglycemia - Amenorrhea
3) Binge Eating Disorder (BED) - Bradycardia - hypothyroidism
4) Other Specified Feeding and Eating Disorder (OSFED) -Cardiac > intolerance to
5) Pica arrythmias cold, body
6) Rumination Disorder weakness
7) Avoidant/Restrictive Food Intake Disorder (ARFID) Dermatology Musculoskeletal Neuropsychiatry
8) Unspecified Feeding or Eating Disorder (UFED) - dry, cracking - Loss of fat - Depression
9) Other related disorders: skin - Osteoporosis - Insomnia
• Muscle Dysmorphia - lanugo - Pathologic
• Orthorexia Nervosa (ON) - acrocyanosis fractures
Hematology Gastrointestinal Others
Anorexia Nervosa - leukopenia - Constipation - Electrolyte
- a life-threatening eating disorder characterized by body - anemia - Abdominal pain imbalances
weight 85% less than the expected or normal body weight. - - Diarrhea - Elevated BUN
- Symptoms includes: thrombocytopen - Hypertrophy of
A – Amenorrhea for at least 3 consecutive cycles ia Salivary gland
N – No organic factor accounts for weight loss
O – Obviously thin but feels fat Medical complications Related to Purging
R – Refusal to maintain body weight Dental Metabolic
E – Emotional expression is restrained - Perimyolysis (erosion of -Electrolyte abnormalities
X – Symptoms of depression and social withdrawal are dental enamel - Hypokalemia
present - Metabolic alkalosis
I – Intense fear of gaining weight. - Hypochloremic alkalosis
A – Always think of food and food related activities - Hypomagnesemia
- Preoccupied with foods: - Elevated BUN
• Grocery shopping Gastrointestinal Neuropsychiatric
• Collecting recipe or cookbooks - Salivary gland and - Seizures, fatigue, weakness
• Counting calories pancreas inflammation
• Creating fat free meals - esophagitis
- Unusual ritualistic food behaviors: - parotid gland
enlargement
• Refusing to eat around others
• Cutting food into small pieces
• Not allowing food to touch their lips
There are two (2) subtypes of Anorexia Nervosa
1) Restricting subtype - Weight loss is through fasting,
dieting and excessive exercise
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PSYCHIATRIC NURSING LECTURE: WK9 – EATING DISORDERS
Distinguishing Features of Anorexia and Bulimia - Rumination syndrome is a condition in which people
Anorexia Bulimia repeatedly and unintentionally spit up (regurgitate)
Ego syntonic Ego dystonic undigested or partially digested food from the stomach,
Early age of onset Later age of onset rechew it, and then either re swallow it or spit it out.
- 12 -20 year old - usually 20 year old or - It can occur in children, teens and adults. Rumination
or younger older syndrome is more likely to occur in people with anxiety,
Below normal body Near normal or normal body depression or other psychiatric disorders.
weight weight
Do not recognize the Recognize her altered eating Avoidant/Restrictive Food Intake Disorder (ARFID)
eating behavior as a pattern - Also known as Avoidant Restrictive Food Intake Disorder
problem (ARFID) and is previously known as feeding disorder
Less worried Worried of the opinion of others - It is a serious mental health condition that causes the
Starve Eat then purge individual to restrict food intake by volume and/or variety.
Amenorrhea No amenorrhea - This avoidance may be based on appearance, smell, taste,
texture, brand, presentation, fear of adverse consequences,
Binge Eating Disorder (BED) lack of interest in food, or a past negative experience with
- characterized by recurrent episodes of binge eating. The the food, to a point that may lead to nutritional deficiencies,
binge eating occurs, on average, at least once a week for 3 failure to thrive, or other negative health outcomes.
months. - The fixation is not caused by a concern for body
- The binge eating is not associated with the recurrent use of appearance or in an attempt to lose weight.
inappropriate compensatory behavior as in bulimia - an eating or feeding disturbance characterized by apparent
nervosa and does not occur exclusively during the course lack of interest in eating as manifested by persistent failure
of bulimia nervosa or anorexia nervosa. to meet appropriate nutritional and/or energy needs.
- BED is a severe, life threatening but treatable eating - The disorder is associated with one (or more) of the
disorder characterized by recurrent episodes of eating following:
large quantities of food often very quickly and to the point • Significant weight loss or failure to achieve expected
of discomfort. weight gain
- BED is one of the newest eating disorders formally • Significant nutritional deficiency.
recognized in the DSM 5 • Dependence on enteral feeding or oral nutritional
- It is the most common eating disorder in the United States. supplements.
- The binge-eating episodes: • Marked interference with psychosocial functioning.
• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full. Pica
• Eating large amounts of food when not feeling - Pica is characterized by persistent eating of nonnutritive,
physically hungry. nonfood substances over a period of at least 1 month. The
• Eating alone because of feeling embarrassed by how eating of nonnutritive, nonfood substances is inappropriate
much one is eating. to the developmental level of the individual.
• Feeling disgusted with oneself, depressed, or very guilty - If the eating behavior occurs in the context of another
afterward. mental disorder (e.g., intellectual disability [intellectual
developmental disorder], autism spectrum disorder,
• Marked distress regarding binge eating is present.
schizophrenia) or medical condition (including pregnancy),
it is sufficiently severe to warrant additional clinical
Rumination Disorder
attention.
- Rumination Disorder is an eating disorder characterized by
- Characterized by ingestion of non-nutritive substance or
repeated regurgitation of food over a period of at least 1
objects. Includes sand, paper, crayons, leaves, etc.
month.
- Result to malnutrition
- Regurgitated food may be re- chewed, re-swallowed, or
- Complications: intestinal obstruction and infections, lead
spit out. The repeated regurgitation is not attributable to an
poisoning
associated gastrointestinal or other medical condition (e.g.,
gastroesophageal reflux, pyloric stenosis). • Orthorexia involves an unhealthy obsession with
- Rumination does not occur exclusively during the course of healthy eating, mostly revolves around food quality, not
anorexia nervosa, bulimia nervosa, binge-eating disorder, quantity
or avoidant/restrictive food intake disorder. • Bigorexia when someone , usually a man, worries that
- If the symptoms occur in the context of another mental their body is too small and weak and tries to eat only
disorder (e.g., intellectual disability [intellectual foods that they believe will build bigger muscles
developmental disorder] or another neurodevelopmental • Diabulimia eating disorder in a person with type I
disorder), they are sufficiently severe to warrant additional diabetes, wherein the person purposefully restricts
clinical attention insulin in order to lose weight
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PSYCHIATRIC NURSING LECTURE: WK9 – EATING DISORDERS
Other Specified Feeding and Eating Disorder (OSFED) • Increase level of serotonin resulting to decrease satiety
- OSFED was previously known as Eating Disorder Not as seen in bulimia and other binge eating disorders
Otherwise Specified (EDNOS) • Decrease level of monoamine oxidase as seen in
- OSFED is a serious, life threatening but treatable eating bulimia, and binging and purging types of eating
disorder. disorders
- The category was developed to encompass those 4) Developmental Factors
individuals who did not meet strict diagnostic criteria for • Failure to develop autonomy
anorexia nervosa or bulimia nervosa but still had a • Failure to establish unique identity
significant eating disorder • Poor role modeling
- applies to presentations in which symptoms characteristic • Family dysfunction
of a feeding and eating disorder that cause clinically • Response to family conflict and problems
significant distress or impairment in social, occupational,
• Childhood adversities:
or other important areas of functioning predominate but do
o Sexual abuse
not meet the full criteria for any of the disorders in the
o Parental maltreatment
feeding and eating disorders diagnostic class
o Rejection
1) Atypical anorexia nervosa: All of the criteria for
o Excessive paternal control
anorexia nervosa are met, except that despite
o Over protectiveness
significant weight loss, the individual’s weight is within
o Failure to develop satisfying relationship with peers
or above the normal range.
5) Sociocultural Factors
2) Bulimia nervosa (of low frequency and/or limited
• Advertisements, magazines, and movies that feature
duration): All of the criteria for bulimia nervosa are met,
thin models reinforce the cultural belief that slimness is
except that the binge eating and inappropriate
attractive.
compensatory behaviors occur, on average, less than
• Peer pressure
once a week and/or for less than 3 months.
6) Family Dysfunction
3) Binge-eating disorder (of low frequency and/or limited
• Response to family conflict and problems
duration): All of the criteria for binge-eating disorder are
met, except that the binge eating occurs, on average, • Childhood adversities:
less than once a week and/or for less than 3 months. - Sexual abuse
4) Purging disorder: Recurrent purging behavior to - Parental maltreatment
influence weight or shape (e.g., self-induced vomiting: - Rejection
misuse of laxatives, diuretics, or other medications) in - Excessive paternal control
the absence of binge eating. - Over protectiveness
5) Night eating syndrome: Recurrent episodes of night - Failure to develop satisfying relationship with peers
eating, as manifested by eating after awakening from
sleep or by excessive food consumption after the Nursing Process of Eating Disorders
evening meal Assessment
Anorexia Bulimia
Area
Factors influencing Eating Disorders - Perfectionist with - Pleasing to others
1) Biologic Factor above average and avoiding
• Genetic vulnerability result from a personality type. intelligence conflicts
• Lateral hypothalamus dysfunction results to decrease - Goal oriented - Has history of
desire in eating (Anorexia) Dependable impulsive behavior
History - Seeking approval such as substance
• Ventromedial dysfunction leads to excessive eating,
- Parents describe abuse and
weight gain and decreased Responsiveness to the
client as being shoplifting
satiety (Bulimia and other binge eating disorders)
“good” and - History of anxiety,
• Tend to run in families with eating disorders
“causing us no depression and
• History of mood or anxiety disorders
trouble” personality disorders
2) Neurochemical changes
- Appears slow, - With normal or near
• Hypothalamus dysfunction
fatigued and normal body weight
• Deficit in lateral hypothalamus – decrease desire in emaciated - Normal physical
eating - Slow to respond appearance
• Disruption of ventromedial hypothalamus – leads to General to questions - Appears open and
excessive eating, weight gain and decreased Appearance - Often wear loose willing to talk
responsiveness to the satiety (Bulimia) and behavior fitting clothes - About problem with
3) Neurochemical Changes regardless of eating pattern
• Decrease level of norepinephrine resulting to decrease whether to hide
appetite as seen in anorexia and other restricting eating weight loss and to
disorders keep them warm
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PSYCHIATRIC NURSING LECTURE: WK9 – EATING DISORDERS
- Usually sad, - Normal mood and Psychosocial Domain
anxious and affect - Nursing Diagnosis
worried - May express • Anxiety
Mood and - Seldom smile and intense guilt, shame • Disturbed body image
affect serious most of the and embarrassment • Ineffective coping
time when discussing • Chronic low self esteem
bingeing and purging - Planning
• Client will demonstrate reduced anxiety
- Have paranoid - Preoccupied with • Client will verbalize acceptance of body image with
ideas about their dieting, food and • stable body weight
family, friends and food related behavior • Client will demonstrate non-food related coping
health care - Altered body image • mechanism
Thought professionals
• Increase self esteem
process and - Preoccupied with
content dieting, food and
Nursing Intervention
food related
1) Help client identify emotions and develop a non food
behavior
related coping strategies
- Altered body
a) Help client identify and express feeling. Alexithymia
image
difficulty expressing feeling
- Mild confusion - Alert and oriented b) Self monitoring using a journal to raise clients’
- Inability to - Intact intellectual awareness about behavior and help them regain a
Mental concentration functioning sense of control
process and - Poor self-concept - Poor self-concept c) Manage emotions through relaxation and distraction
self-concept - Decrease techniques
attention and 2) Help client deal with body image issues
concentration a) Recognize benefits of a normal or near normal body
- Withdraw from - Feels great shame weight
peers and pay little about their bingeing b) Identify personal strength, interest and talents to
attention to and purging broadened clients’ perception of themselves
friendship behaviors c) Increased self esteem
Roles and - Failure at school - Time spent buying 3) Provide health education
relationships which is in contrast and eating food and a) Client:
to previously purging interfere
• Basic nutritional needs
successful clients’ role
• Harmful effects of restrictive dieting and purging
academic performance
• Benefits of normal body weight.
achievement
• Acceptance of healthy body image
b) Family and Friends
Nursing Interventions for client with eating disorders
Imbalance nutrition: less than body requirement • Provide emotional support
- Planning - Client will establish adequate nutritional eating • Become informed about eating disorders
pattern • Express concern about client’s health .
- Nursing interventions • Avoid talking about weight, food intake and calories
• Establish nutritional eating pattern • Encourage client to seek professional help.
o Set specific time for meals Evaluation
o Sit with the client during meals and snacks 1) Demonstrate alternative methods of dealing with stress
o Observe client ff. meals and snacks (1- 2 hours) 2) Demonstrate more satisfying relationships
o Weight client daily in uniform clothing - provide 3) Develop a positive self concept
positive and negative reinforcement with weight 4) Find new ways of effective coping
compliance 5) Acceptance of a healthy body image
o Offer liquid protein supplement if unable to 6) Maintain a normal body weight
complete required calories Disturbed sleep pattern
• Adhere to treatment program guidelines regarding - Planning - Client will establish adequate sleep pattern
restrictions - Nursing interventions
o No food substitutions • Set a regular time for sleeping hour
o No energy drinks o Go to sleep at the same time each night and awaken
o Prevent hoarding, hiding or discarding foods at the same hour each morning
o Refrain exercise o Provide a non-interrupted sleep during the night
o Limit daytime sleep by providing activity that
promote wakefulness
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PSYCHIATRIC NURSING LECTURE: WK9 – EATING DISORDERS
o Provide for naps during the day, if indicated, to meet Bulimia
sleep requirements
• Provide comfort
o Sleep in loose, comfortable clothing
o Sleep in a comfortable bed
o Take a warm bath before going to bed
o Relaxation techniques: avoid taking worries to bed
o Exercise daily
• Provide a conducive environment
o Provide calm, quiet environment
o Provide dim lights as desired
o Maintain a comfortable temperature
• Instruct patient what to avoid
o Avoid caffeine during the day because the
• Cognitive Behavioral Therapy – strategies designed to
stimulating effects of caffeine can linger for as long
change the client’s thinking (cognition) and action
as 12 hours
• Psychopharmacology:
o Avoid heavy meals before bedtime
o Avoid alcohol before bedtime • TCA – Desipramine (Norpramin), Imipramine (Tofranil)
• SSRI – Fluoxetine (Prozac), Sertraline (Zoloft)
Unspecified Feeding or Eating Disorder (UFED) Terminologies
- Unspecified Feeding or Eating Disorder (UFED) is • Acrocyanosis. Bluish or purple coloring of hands and feet
diagnosed when an individual’s symptoms do not line up caused by slow blood circulation
with those of another disorder, or when there is simply not • Agnosia. Inability to interpret sensations and hence to
enough information to determine a more specific diagnosis. recognize things, typically as a result of brain damage
- This UFED label can change once more information is • Anomia: A problem with word finding. Impaired recall of
gathered, or as symptoms change over time. words with no impairment of comprehension or the
Muscle Dysmorphic capacity to repeat the words
- The individual is preoccupied with the idea that his or her • Aphasia. Deterioration of language functions
body build is too small or insufficiently muscular. • Apraxia. Loss of ability to perform purposeful activities
- This specifier is used even if the individual is preoccupied despite intact motor abilities
with other body areas, which is often the case. • Amnestic Disorder. A disturbance in memory due to
Orthorexia Nervosa (ON) general medical conditions or substance effects
- Orthorexia nervosa (ON) is a condition that is characterized • Anorexia. Lack or loss of appetite
by a pathological obsession with eating foods one • Anorexia nervosa. An emotional disorder characterized by
considers healthy marked by exaggerated emotional an obsessive desire to lose weight by refusing to eat
distress in relationship to food choices perceived as • Assertiveness. A response that seeks to maintain an
unhealthy; weight loss may ensue as a result of dietary appropriate balance between passivity and aggression
choices • Assertiveness training. A form of behavior therapy
designed to help people stand up for themselves—to
Treatment empower themselves, in more contemporary terms.
Anorexia • Alzheimer's disease. An irreversible, progressive brain
1) Medical management - focuses on weight restoration, disorder that slowly destroys memory and thinking skills
nutritional rehabilitation, rehydration and correction of and, eventually, the ability to carry out the simplest tasks.
electrolyte imbalances. In most people with the disease—those with the late-onset
2) Psychopharmacology type—symptoms first appear in their mid-60s.
• Cyproheptadine (Periactin) • Biofeedback - Designed to help the sufferer recognize
• Amitriptyline (Elavil) when they are not relaxed,
• Olanzapine (Zyprexa) • Bulimia nervosa. An eating disorder characterized by
• Flouxetine (Prozax) recurrent episodes of binge eating at least twice a week for
3) Psychotherapy 3 months.
• Family therapy • Cognitive behavioral therapy (CBT). CBT challenges
• Individual therapy sufferers to rethink their beliefs and behaviors in order to
bring about positive change.
• Confabulation. Filling up gaps of memories
• Cortisol. Body's main stress hormone and serve a as
nature's built-in alarm system.
• Creutzfeldt-Jakob disease. A degenerative brain disorder
that leads to dementia and, ultimately, death
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PSYCHIATRIC NURSING LECTURE: WK9 – EATING DISORDERS
• Decatastrophizing. Techniques that involves learning to • Positive self-talk. Therapeutic approach by reframing
assess situations realistically rather than assuming a negative thoughts to positive thoughts.
catastrophe will happen • Reframing. Offering explanations for events or situations
• Delirium. A disturbance of consciousness and cognitive • Relaxation therapy - Sufferers of insomnia disorder are
abilities that develops rapidly over a short period of time often highly aroused - relaxation therapy may help
• Dementia. A cognitive deficits primarily memory deactivate the arousal system through techniques like
impairment that develops gradually imagery training and progressive muscle relaxation.
• Distraction. Rechanneling client’s attention and energy to • Reminiscence Therapy. A treatment that uses all the
a more neutral topic. senses — sight, touch, taste, smell and sound to help
• Echolalia. Meaningless repetition of another person's individuals with dementia remember events, people and
spoken words as a symptom of psychiatric disorder. places from their past lives
• Ego syntonic. Refers to instincts or ideas • Role play. An educational tool that is used to visualize and
that are acceptable to the self; that are compatible with practice different ways of handling a situation. In this
one's values and ways of thinking method, each participant takes a role or persona and acts
• Ego-dystonic. Refers to thoughts, impulses, and behaviors and reacts to situations and other participants in the
that are felt to be repugnant, distressing, unacceptable or exercise.
inconsistent with one's self-concept • Self-reliance. Having confidence in and exercising one's
• Executive function. Self-regulated skills of the mental own powers or judgment.
processes that enable a person to plan, focus attention, • Splitting. Extreme idealization and devaluation
remember instructions, and juggle multiple tasks. • Thought stopping. Technique to alter the process of
• Gender Role. Behaviors or roles that result in our negative or self-critical thought patterns (shout “STOP”)
becoming men and women • Time away. Involves leaving the client for a short period
• Going along. Providing emotional reassurance to clients and then returning to them to re-engage in interaction
without correcting their misperception or delusion • Vascular dementia. A general term describing problems
• Heterosexuality. Sexual attraction between man and with reasoning, planning, judgment, memory and other
woman. thought processes caused by brain damage from impaired
• Homosexuality. Sexual attraction members of one’s own blood flow to your brain.
sex
• Huntington's disease. A rare, inherited disease that
causes the progressive breakdown (degeneration) of nerve
cells in the brain
• Korsakoff Syndrome. An alcohol induced amnestic
disorder that results from a chronic thiamine or Vit. B
deficiency
• Neurocognitive disorders. A general term that describes
decreased mental function due to a medical disease other
than a psychiatric illness
• Orthorexia nervosa. Obsession with eating only “clean,
healthy, pure” foods to achieve “ideal” health.
• Parkinson's disease. A progressive nervous system
disorder that affects movement. Symptoms start gradually,
sometimes starting with a barely noticeable tremor in just
one hand. Tremors are common, but the disorder also
commonly causes stiffness or slowing of movement
• Perimyolysis. Decalcification of the teeth from exposure
to gastric acid in people with chronic vomiting
• Period. Time it takes to complete the sleep wake cycle
• Personality. The complex of all attributes of an individual:
behavioral, temperamental, emotional and mental that
characterize a person to be unique human being
• Personality traits. Patterns of behaving, thinking,
perceiving, and relating
• Pick's disease (FTD, frontotemporal dementia) is a
specific pathology that is one of the causes of
frontotemporal lobar degeneration
• Polysomnography. measure the physiologic changes of
sleep-wake cycle
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