Eating Disorders Overview

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Questions and Answers

What is a critical reason for hospitalization in a client with an eating disorder?

Inability to focus

Suicidal ideation (correct)

Loss of appetite

Maintaining ideal body weight

Which nursing diagnosis is most closely associated with clients suffering from eating disorders?

Impaired mobility

Ineffective airway clearance

Disturbed sleep pattern

Imbalanced nutrition (correct)

What percentage of ideal body weight should a patient with anorexia aim to achieve as a treatment goal?

90 - 95%

85 - 90% (correct)

70 - 75%

80 - 85%

What intervention is important for managing a patient with imbalanced nutrition in eating disorders?

Keeping a strict record of intake and output Signup and view all the answers

Which psychological assessment aspect is essential for understanding a patient with an eating disorder?

Insight into disordered eating Signup and view all the answers

Which of the following eating disorders is characterized by extreme weight loss and a morbid fear of obesity?

Anorexia Nervosa Signup and view all the answers

What is a common psychological issue often associated with bulimia nervosa?

Depression Signup and view all the answers

Which of the following behaviors is indicative of bulimia nervosa?

Self-induced vomiting after eating Signup and view all the answers

What distinguishes Binge Eating Disorder (BED) from bulimia nervosa?

BED does not involve purging behaviors. Signup and view all the answers

Which of the following symptoms is NOT typically associated with anorexia nervosa?

Binge eating episodes Signup and view all the answers

What is a common physical sign of bulimia nervosa that results from self-induced vomiting?

Russell's sign Signup and view all the answers

What is the typical BMI range for an individual classified as overweight?

25 to 29.9 Signup and view all the answers

Which of the following is NOT a characteristic of anorexia nervosa?

Rapid ingestion of food Signup and view all the answers

Which factor is considered a predisposing factor for eating disorders?

Genetics Signup and view all the answers

What is the primary treatment approach recommended for Binge Eating Disorder (BED)?

Medication such as fluoxetine Signup and view all the answers

What is a major concern when a malnourished patient begins to eat again?

Refeeding syndrome Signup and view all the answers

Which of the following symptoms is NOT associated with refeeding syndrome?

Increased appetite Signup and view all the answers

The Maudsley approach primarily targets which demographic?

Teenagers with anorexia nervosa Signup and view all the answers

Which measurable outcome is related to improving a patient's self-esteem?

Name two personal strengths Signup and view all the answers

What is the focus of Phase I in the Maudsley approach?

Weight restoration Signup and view all the answers

Which intervention is crucial for monitoring a patient during meals?

Staying with the patient for at least one hour after meals Signup and view all the answers

What role does family therapy play in the treatment of eating disorders?

It encourages family involvement in the treatment process. Signup and view all the answers

Which of the following medications is commonly used to treat Bulimia Nervosa?

Fluoxetine Signup and view all the answers

Which intervention specifically aims to address patients' self-harm behaviors?

Assess for suicidal thoughts Signup and view all the answers

What is the purpose of behavior modification in treating eating disorders?

To give the patient control in the treatment Signup and view all the answers

Which of the following is an example of a coping strategy taught to patients?

Visualization techniques Signup and view all the answers

Which of the following is a key symptom to monitor in patients at risk for refeeding syndrome?

Electrolyte imbalances Signup and view all the answers

In individual therapy for eating disorders, what is typically addressed?

Underlying psychological problems Signup and view all the answers

Which of the following is a common goal for patients with Bulimia Nervosa?

To maintain normal electrolyte balance Signup and view all the answers

Which of the following is a key indicator for the hospitalization of a patient with an eating disorder?

Severe electrolyte imbalance Signup and view all the answers

What nursing intervention is essential for properly managing a patient with imbalanced nutrition?

Monitor laboratory values for magnesium and phosphate Signup and view all the answers

Which outcome is most appropriate for a patient with anorexia as part of their treatment goals?

Normalize eating patterns by consuming 75% of meals daily Signup and view all the answers

Which factor is essential to assess in understanding disordered eating behaviors?

Insight into feelings regarding weight Signup and view all the answers

What is a prioritized focus during a psychosocial assessment of an eating disorder patient?

Assessing family dynamics and support Signup and view all the answers

What is a primary characteristic of Anorexia Nervosa?

A morbid fear of obesity Signup and view all the answers

Which of the following is a common symptom associated with Bulimia Nervosa?

Binge eating followed by purging Signup and view all the answers

What distinguishes Binge Eating Disorder from other eating disorders?

Episodes of binge eating without compensatory actions Signup and view all the answers

What is the typical BMI range for individuals classified as normal weight?

20 to 24.9 Signup and view all the answers

Which eating disorder may involve episodes of excessive eating without any form of compensatory behavior?

Binge Eating Disorder Signup and view all the answers

Which of these factors is considered a predisposition for developing an eating disorder?

Genetics and neurobiological influences Signup and view all the answers

What is one potential health risk associated with the purging behaviors in Bulimia Nervosa?

Electrolyte imbalances Signup and view all the answers

What mental health issues are commonly comorbid with eating disorders?

Anxiety disorders and OCD Signup and view all the answers

Which physical sign may develop on the hands of individuals with Bulimia Nervosa due to self-induced vomiting?

Russell's sign Signup and view all the answers

What is the typical age range for the onset of eating disorders?

Adolescence to early adulthood Signup and view all the answers

What is a significant risk associated with the refeeding process in malnourished patients?

Electrolyte imbalances Signup and view all the answers

In the treatment of eating disorders, which intervention is essential for physical monitoring?

Consistent daily weigh-ins Signup and view all the answers

What is one of the desired measurable outcomes for patients with bulimia nervosa (BN)?

To refrain from binge and purge behaviors Signup and view all the answers

Which phase of the Maudsley approach focuses on assisting an adolescent in developing a healthy self-identity?

Phase III Signup and view all the answers

Which option describes a common emotional focus in individual therapy for eating disorders?

Psychological problems contributing to behaviors Signup and view all the answers

What is a critical component of client education for managing eating disorders?

Learn to administer medications correctly Signup and view all the answers

Which medication is commonly used for treating Binge-Eating Disorder (BED)?

Lisdexamfetamine (Vyvanse) Signup and view all the answers

What role does family therapy play in treating adolescents with anorexia nervosa?

Supporting weight restoration Signup and view all the answers

Which symptom is NOT typically monitored in patients at risk for refeeding syndrome?

Weight loss Signup and view all the answers

In behavior modification therapy for eating disorders, control issues are perceived as what?

Central to the etiology of the disorders Signup and view all the answers

Which statement reflects an essential therapeutic goal for patients with eating disorders?

Improve self-acceptance and manage anxiety Signup and view all the answers

What aspect of psychotherapy is particularly important for individuals with eating disorders?

Addressing maladaptive beliefs and thoughts Signup and view all the answers

In evaluating the effectiveness of treatment for eating disorders, reassessment should focus primarily on what?

Behaviors for which the client sought treatment Signup and view all the answers

What is the primary goal of interventions aimed at improving a patient's self-esteem in eating disorder treatment?

To identify and articulate personal strengths Signup and view all the answers

Study Notes

Eating Disorders

Persistent disturbance in eating behaviors that cause distressing thoughts and emotions
Can cause serious physical, psychological, and social dysfunction
Occur on a continuum

Eating Disorders in DSM 5

Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Avoidant Restrictive Food Intake Disorder
Other Specified Feeding and Eating Disorder
Pica
Rumination Disorder

Influences on Eating Behaviors

Society and culture
Complex system involving hunger and satiety

Predisposing Factors and Theories

Genetics
Neurobiological & Neuroendocrine
Psychological and Psychosocial

Epidemiology

Eating Disorders often start in adolescence and early adulthood
Eating Disorders commonly present with comorbid psychiatric disorders
More frequent in females
Male population with anorexia and bulimia is 25%
Male population with binge eating is 36%
BED increases risk for obesity

Body Mass Index

Normal weight BMI is 20 to 24.9
Anorexia nervosa is often characterized by a BMI of 17 or lower, or less than 15 in extreme situations
Obesity is defined as a BMI of 30 or greater

Anorexia Nervosa

Characterized by morbid fear of obesity
Extreme weight loss, more than 15% of expected weight
Perfectionistic tendencies, amenorrhea, underweight, and gross distortion of body image
Symptoms: emaciated, preoccupation with food, refusal to eat, hypothermia, bradycardia, hypotension, edema, a variety of metabolic changes, and lanugo
Lanugo: fine, neonatal-like hair growth; type of compensation by body to stay warm
Amenorrhea is typical and may even precede significant weight loss
Obsession with food
Anxiety and depression are common

Bulimia Nervosa

Characterized by episodes of binge eating followed by purging behaviors
Binging: uncontrolled, compulsive, rapid ingestion
Purging: inappropriate compensatory behaviors to rid the body of excess calories (self-induced vomiting or misuse of laxatives, diuretics, enemas, fasting, excessive exercise)
Normal BMI for most patients with Bulimia
Comorbidities: common, such as depression and substance use disorder
Excessive vomiting, laxatives, and/or diuretics may lead to dehydration, electrolyte imbalances, cardiac arrhythmias, hypotension, hypothermia, suicidal ideation, damaged tooth enamel, Russell's sign, and tears in gastric or esophagus

Binge Eating Disorder (BED)

Characterized by episodes of binge eating large amounts of food without compensatory/purging behaviors
BED differs from bulimia nervosa, the individual does not engage in behaviors to rid the body of excess calories leading to obesity or being overweight
Medications: fluoxetine, high-dose SSRIs, lisdexamfetamine, topiramate

Assessment for Bulimia: SCOFF Questionnaire

S: Sick: Do you make yourself sick or vomit after a meal because you feel uncomfortable full?
C: Control: Do you fear loss of control over how much you eat?
O: One stone: Has the patient lost more than 14 lbs. in a 3-month period?
F: Fat: Do you believe you are fat even when others tell you that you are too thin?
F: Food: Does food dominate your life?

Assessment Guidelines for Eating Disorders

Safety: medical and psychiatric stabilization (may need hospitalization), vital signs and fluid balance, pertinent lab work and EKG, BMI, medical complications, co-existing disorders
Insight into disordered eating & feelings regarding weight
Psychosocial assessment

Nursing Diagnoses for Eating Disorders

Imbalanced Nutrition
- Interventions: Strict record of intake and output, daily weights, stay with patient during meals and for 1 hour after, lab monitoring (Mg, Phosphate), VS, water for refeeding syndrome
Deficient fluid volume
Risk for injury
Distorted body image
Negative/low self-image
Ineffective coping
Anxiety
Denial

Goals for Anorexia

The patient will:
- Refrain from suicidal behaviors or self-harm
- Normalize eating patterns by eating 75% of 3 meals / day plus 2 snacks
- Achieve 85 - 90% of ideal body weight
- Be free of physical complications, including refeeding syndrome
  - Refeeding syndrome: series of negative intracellular shifts associated with aggressive renourishment in a malnourished patient
  - Refeeding syndrome can happen when someone who has been malnourished begins feeding again.
  - Symptoms: electrolyte imbalances (hypokalemia, hypocalcemia, etc.)
- Demonstrate improved self-acceptance
- Address maladaptive beliefs, thoughts, and activities

Goals for Bulimia and BED

The patient will:
- Obtain/maintain normal electrolyte balance and stable VS
- Refrain from binge (BN and BED) and purge (BN) behaviors
- Be free of self-harm behaviors and suicide ideation
- Demonstrate at least two new skills for managing stress/anxiety/shame in a non-food-related way
- No longer demonstrate high levels of anxiety related to fear of gaining weight
- Demonstrate improved self-esteem by naming two personal strengths
- Verbalize desire to participate in ongoing treatment

Interventions for Eating Disorders

Acknowledge emotional and physical difficulty
Assess mood and for any suicidal thoughts/behaviors
Monitor physiological parameters
Weigh patient consistently/daily (same clothes and time, before eating and bathing)
Monitor labs, VS, watch for refeeding syndrome
Monitor I&Os
Monitor/stay with patient during and after meals (at least 1 hour afterwards)
- Monitor for purge
Recognize patient's distorted image without minimizing or challenging patient's perceptions
Work with patients to identify strengths

Psychotherapy

An integral part of the treatment plan for eating disorders
Usually used in conjunction with other treatments (e.g., behavior modification, psychopharmacology)
Can be helpful in exploring the underlying issues that contribute to disordered eating

Client/Family Education

Management of the illness
- Principles of nutrition
- Ways the client may feel in control of life
- Importance of verbalizing/expressing fears and feelings, rather than holding them inside
- Alternative coping strategies
- Correct administration of prescribed medications
- Indication for, and side effects of, prescribed medications
- Relaxation techniques (visualization, progressive muscle relaxation, deep breathing)
- Problem-solving skills
For the obese client
- Planning a reduced-calorie, nutritious diet
- Reading food content labels
- Establishing a realistic weight loss plan
- Establishing a planned program of physical activity
Support services
- National Eating Disorders Association
- National Association of Anorexia Nervosa and Associated Disorders
- Weight Watchers International
- Overeaters Anonymous

Evaluation of Eating Disorders

Evaluation of the client with an eating disorder requires reassessment of the behaviors for which the client sought treatment
Behavioral change will be required by the client and family members

Treatment Modalities for Eating Disorders

**Family therapy, CBT, behavior modification, and psychopharmacology **

Treatment Modalities: Behavior Modification

Issues of control are central to the etiology of eating disorders
For the program to be successful, the client must perceive that they are in control of the treatment
Successful when the client is allowed to contract for privileges based on weight gain, has input into the care plan, and clearly sees what the treatment choices are
Client has control over eating, amount of exercise pursued, and whether to induce vomiting
Staff and client agree on goals and a system of rewards

Treatment Modalities: Family Therapy

Maudsley Approach: Treatment for adolescents with anorexia nervosa
- Usually used for teenagers
- Evidence-based outpatient treatment program
- Phase I: Focused on weight restoration
- Phase II: When the child accepts parental demands for increased food intake and demonstrates steady weight gain and there is a change in family mood (relief at having taken charge; both teen and parents identify reduced anxiety)
- Phase III: Once the teen demonstrates the ability to maintain above 95% of ideal weight, the shift to phase III focuses on assisting the adolescent to develop a healthy self-identity
The Maudsley Approach is conducted as an intensive outpatient program and involves three different phases of treatment

Treatment Modalities: Individual Therapy

Helpful when underlying psychological problems are contributing to maladaptive behaviors

Treatment Modalities: Psychopharmacology

Medication research has not yet identified a medication that results in definitive improvement in core symptoms but some have demonstrated effectiveness

Pharmacological Interventions for Eating Disorders

Anorexia Nervosa (Medications may be tried for associated symptoms or comorbid depression):
- Fluoxetine (SSRI)
- Olanzapine
Bulimia Nervosa (Medications need to be at a higher dose to work):
- Fluoxetine (SSRI)
- Amitriptyline or Desipramine (Tricyclic antidepressants)
- Topiramate (anticonvulsant)
Binge-Eating Disorder:
- Fluoxetine (SSRI)
- Topiramate (anticonvulsant)
- Lisdexamfetamine (Vyvanse)
SSRI Teaching: Take it exactly as prescribed; monitor for suicidal ideation

Eating Disorders

Persistent disruptions in eating behavior, accompanied by distressing thoughts and feelings
Can severely impact physical, psychological, and social functioning
Exist on a spectrum ranging from mild to extreme

DSM-5 Eating Disorders

Anorexia Nervosa: Morbid fear of obesity, extreme weight loss (more than 15% of expected weight), perfectionistic tendencies, amenorrhea, distorted body image
Bulimia Nervosa: Characterized by binge eating followed by purging behaviors (self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, excessive exercise)
Binge Eating Disorder (BED): Characterized by episodes of binge eating large amounts of food without compensatory or purging behaviors, often leading to obesity or being overweight.
Avoidant Restrictive Food Intake Disorder
Other Specified Feeding and Eating Disorder
Pica: Persistent eating of non-nutritive substances
Rumination Disorder: Regurgitation of food followed by rechewing or swallowing

Predisposing Factors and Theories for Eating Disorders

Genetics
Neurobiological and Neuroendocrine:
- Brain regions like the hypothalamus and limbic system play a role in regulating appetite and energy balance
- Neurotransmitters like serotonin and dopamine are also implicated
Psychological and Psychosocial:
- Low self-esteem, negative body image, perfectionism, and a history of trauma or abuse

Epidemiology

Eating disorders often begin in adolescence or early adulthood.
Commonly present with co-occurring psychiatric disorders like depression, anxiety, and substance use disorders.
More prevalent in females, but males also experience these disorders.
BED specifically increases the risk for obesity.

Body Mass Index (BMI)

Normal weight range: 20 to 24.9
Anorexia Nervosa: BMI of 17 or lower, or less than 15 in extreme cases
Obesity: BMI of 30 or greater

Anorexia Nervosa

Key Characteristics:
- Perfectionistic tendencies
- Amenorrhea
- Underweight
- Gross distortion of body image
Symptoms:
- Emaciation
- Preoccupation with food and refusal to eat
- Hypothermia
- Bradycardia
- Hypotension
- Edema
- Metabolic changes
- Lanugo: fine, neonatal-like hair growth, common adaptation to keep the body warm due to weight loss
Amenorrhea is typical and might even precede significant weight loss
Obsession with food
Common feelings of anxiety and depression

Bulimia Nervosa

Key Characteristics:
- Binging: Uncontrolled, compulsive, rapid ingestion of large amounts of food.
- Purging: Inappropriate compensatory behaviors to rid the body of excess calories (self-induced vomiting, laxatives, diuretics, enemas, fasting, excessive exercise).
Most individuals with bulimia have a normal BMI
Common comorbidities include depression and substance use disorders
Excessive vomiting, laxative, and/or diuretic abuse can cause:
- Dehydration
- Electrolyte imbalances
- Cardiac arrhythmias
- Hypotension
- Hypothermia
- Suicidal ideation
- Damaged tooth enamel and poor dentition due to gastric acid
- Russell's sign: calluses on the dorsal surface of the hands, typically on knuckles, caused by repeated self-induced vomiting
- Tears in the gastric or esophagus

Binge Eating Disorder (BED)

Key Characteristics:
- Episodes of binge eating large amounts of food without compensatory or purging behaviors.
- Leads to obesity or being overweight.
Medications:
- Fluoxetine (SSRI)
- Other high-dose SSRIs
- Lisdexamfetamine (Vyvanse)
- Topiramate

Assessment for Eating Disorders

Safety:
- Medical and psychiatric stabilization (hospitalization might be necessary)
- Monitoring of vital signs and fluid balance
- Pertinent lab work & EKG
- BMI
- Assessment for medical complications
- Co-existing disorders
Insight into disordered eating & feelings about weight
Psychosocial assessment

Nursing Diagnoses for Eating Disorders

Imbalanced nutrition: Know interventions:
- Keep strict record of intake and output
- Weigh daily (same time, clothes, scale, after morning void)
- Stay with the patient during meals and for 1 hour afterward
- Monitor labs: Mg, Phosphate
- Monitor vital signs, watch for refeeding syndrome
Deficient fluid volume
Risk for injury
Distorted body image
Negative/low self-image
Ineffective coping
Anxiety
Denial

Goals for Anorexia Nervosa

Patient will:
- Refrain from suicidal behaviors or self-harm
- Normalize eating patterns by eating 75% of 3 meals/day plus 2 snacks
- Achieve 85-90% of ideal body weight
- Be free of physical complications, including refeeding syndrome:
  - Refeeding syndrome occurs when a malnourished individual begins feeding again, resulting in electrolyte imbalances like hypokalemia, hypocalcemia, etc.
- Demonstrate improved self-acceptance
- Address maladaptive beliefs, thoughts, and activities

Goals for Bulimia Nervosa and Binge Eating Disorder

Patient will:
- Obtain/maintain normal electrolyte balance and stable vital signs
- Refrain from binge (BN & BED) and purge (BN) behaviors
- Be free of self-harm behaviors and suicidal ideation
- Demonstrate at least two new skills for managing stress/anxiety/shame in a non-food-related way
- No longer demonstrate high levels of anxiety related to fear of gaining weight
- Demonstrate improved self-esteem by naming two personal strengths
- Verbalize a desire to participate in ongoing treatment

Interventions for Eating Disorders

Acknowledge emotional and physical difficulties.
Assess mood and for any suicidal thoughts/behaviors
Monitor physiological parameters
Weigh patients consistently/daily (same time, clothes, scale, before eating & bathing)
Monitor labs, vital signs, watch for refeeding syndrome
Monitor intake & output
Monitor/stay with patient during and after meals (at least 1 hour afterward)
Recognize the patient's distorted image without minimizing or challenging their perceptions
Work with patients to identify their strengths
Psychotherapy
Family Therapy

Client and Family Education

Management of the illness:
- Principles of nutrition
- Ways the client can feel in control of their lives
- Importance of expressing fears and feelings
- Alternative coping strategies
- Correct administration of prescribed medications
- Indication for and side effects of prescribed medications
- Relaxation techniques: visualization, progressive muscle relaxation, deep breathing
- Problem-solving skills
For the obese client:
- Plan a reduced-calorie, nutritious diet
- Read food content labels
- Establish a realistic weight loss plan
- Establish a planned program of physical activity
Support services:
- National Eating Disorders Association
- National Association of Anorexia Nervosa and Associated Disorders
- Weight Watchers International
- Overeaters Anonymous

Evaluation for Eating Disorders

Reassessment of the behaviors for which the client sought treatment
Behavioral change is necessary for both the client and family members

Treatment Modalities for Eating Disorders:

Know these: Family therapy, CBT, behavior modification, psychopharmacology

Behavior Modification (Issues of control are central to the etiology of eating disorders)

The client must feel in control of the treatment for it to be successful.
Successful program components:
- Incentive system based on weight gain
- Client input into the care plan
- Clear treatment options
Client has control over:
- Eating
- Amount of exercise
- Whether to induce vomiting
Agreement between staff and client about goals and reward system

Family Therapy

The Maudsley approach for treating adolescents with anorexia nervosa:
- Evidence-based outpatient treatment program
- Phase I: Focused on weight restoration
- Phase II: Once the child accepts parental demands regarding food intake and demonstrates consistent weight gain, with a change in family mood (reduced anxiety, both adolescent and parents feel relief), the focus shifts to developing communication and problem-solving skills.
- Phase III: Once the teen maintains 95% of ideal weight, the focus shifts to developing a healthy self-identity.
Conducted as an intensive outpatient program

Individual Therapy

Helpful for addressing underlying psychological issues that contribute to maladaptive behaviors.

Psychopharmacology

No medication definitively improves core symptoms, but some show effectiveness.

Pharmacology Interventions for Eating Disorders (Know these)

Anorexia Nervosa: Medications are often used for associated symptoms or comorbid depression.
- Fluoxetine (SSRI)
- Olanzapine
Bulimia Nervosa: Medications need higher doses to be effective.
- Fluoxetine
- Amitriptyline or Desipramine (TCAs)
- Topiramate (anticonvulsant)
Binge Eating Disorder:
- Fluoxetine
- Topiramate
- Lisdexamfetamine (Vyvanse)
SSRI Teaching: Take medications exactly as prescribed, monitor for suicidal ideation.

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Description

Explore the complexities of eating disorders, their classifications in DSM 5, and the various influences on eating behaviors. This quiz covers the epidemiology, predisposing factors, and the societal implications of these disorders.