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Mental Health Nursing II

NURS 2310
Unit 9
Eating Disorders
Anorexia Nervosa
Prolonged loss of appetite; self-starvation
with a disruption in metabolism due to
inadequate calorie intake.

Incidence & Population Affected

 Increased in the past 30 years
 Affects approximately 1% of young women
– Occurs predominantly in females aged twelve
to thirty
– Less than 10 percent of cases are males
Etiology & Characteristics
 Morbid fear of obesity
 Gross distortion of body image; sees self as “fat”
when obviously underweight
 Preoccupation/obsession with food
– hoarding or concealing food
– preparing elaborate meals for others while severely
restricting self
 Refusal to eat; marked weight loss
 May include extensive exercising
 Physiological symptoms include amenorrhea,
hypothermia, bradycardia, hypotension, edema,
lanugo, and metabolic changes
Diagnostic Criteria
 Refusal to maintain body weight at or
above a minimally normal weight for age
and height
 Intense fear of gaining weight or becoming
fat, even though underweight
 Disturbance in the way in which one’s body
weight or shape is experienced, undue
influence of body weight or shape on self-
evaluation, or denial of the seriousness of
the current low body weight
 Amenorrhea
Bulimia Nervosa
Excessive, insatiable appetite; episodic,
uncontrolled, compulsive, rapid ingestion
of large quantities of food over a short
period of time, followed by inappropriate
compensatory behaviors to rid the body
of the excess calories.
Incidence & Population Affected
 More prevalent than anorexia nervosa
 Affects approximately 4% of young women
– Onset occurs in late adolescence or early
– Occurs mainly in populations with an abundant
availability of food, and in which the ideal of
beauty is thinness
Etiology & Characteristics
 Persistent overconcern with personal
 Weight fluctuations common due to
alternating binges and fasts
 Excessive vomiting and laxative/diuretic
abuse may lead to problems with
dehydration and electrolyte imbalances
 Gastric acid in vomitus contributes to the
erosion of tooth enamel
 Individual may experience tears in the
gastric or esophageal mucosa
Diagnostic Criteria
 Recurrent episodes of binge eating
 Recurrent inappropriate compensatory
behavior in order to prevent weight gain,
such as self-induced vomiting; misuse of
laxatives, diuretics, enemas, or other
medications; fasting; or excessive exercise
 The binge eating and inappropriate
compensatory behaviors both occur, on
average, at least twice a week for 3 months
 Self-evaluation is unduly influenced by body
shape and weight
Chronic disease defined by having a Body Mass
Index (BMI) of more than 30.

Incidence & Population Affected

 61% of the U.S. population age 20 or older
are overweight; 27% are obese; 4.7% are
morbidly obese
 Affects black women more than white
women, and white men more than black men
 6 times more prevalent among lower
socioeconomic classes
Etiology & Characteristics
 May have a genetic component
 Lifestyle factors; lack of physical activity
 Leads to problems with hyperlipidemia,
hyperglycemia, diabetes mellitus,
osteoarthritis due to trauma to weight-
bearing joints, angina and respiratory
insufficiency due to increased workload of
the heart and lungs
 Food is considered a social outlet
 Depression/low self-esteem
 May involve binge-eating disorder
Diagnostic Criteria
(Binge-Eating Disorder)
 Recurrent episodes of binge eating in which one
does not feel in control of what/how much is
being consumed
 Binge-eating episodes are associated with
– eating much more rapidly than normal
– eating until feeling uncomfortably full
– eating alone because of being embarrassed by
how much one is eating
– feeling depressed or guilty after overeating
 Marked distress regarding binge eating
 The binge eating occurs, on average, at least 2
days a week for 6 months
Nutritional Deficits
 Electrolyte imbalances

 Nutrient deficits

 Malnutrition

 Poor glucose control

 Deficiency in vital fats

 Vitamin deficiencies
Treatment Modalities
 Education
– Learning healthy eating patterns
 Weight management
– Nutrition education
– Exercise program
– Surgery
 Individual therapy
– Cognitive-behavioral therapy (CBT)
– Coping with thoughts and feelings
 Family therapy
 Psychopharmacology
– Antidepressants
– Anxiolytics
Milieu Therapy
*Focuses on behavior modification
 Changing maladaptive eating behaviors
 Empowering client to take control of treatment
 Contract for privileges based on weight gain or
weight maintenance
 Goals of therapy agreed upon by client and staff
 System of rewards and privileges can be earned
by client, who is given ultimate control
– Client chooses whether or not to abide by the
– Client is made accountable for choices and