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Questions and Answers
What is a critical reason for hospitalization in a client with an eating disorder?
What is a critical reason for hospitalization in a client with an eating disorder?
Which nursing diagnosis is most closely associated with clients suffering from eating disorders?
Which nursing diagnosis is most closely associated with clients suffering from eating disorders?
What percentage of ideal body weight should a patient with anorexia aim to achieve as a treatment goal?
What percentage of ideal body weight should a patient with anorexia aim to achieve as a treatment goal?
What intervention is important for managing a patient with imbalanced nutrition in eating disorders?
What intervention is important for managing a patient with imbalanced nutrition in eating disorders?
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Which psychological assessment aspect is essential for understanding a patient with an eating disorder?
Which psychological assessment aspect is essential for understanding a patient with an eating disorder?
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Which of the following eating disorders is characterized by extreme weight loss and a morbid fear of obesity?
Which of the following eating disorders is characterized by extreme weight loss and a morbid fear of obesity?
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What is a common psychological issue often associated with bulimia nervosa?
What is a common psychological issue often associated with bulimia nervosa?
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Which of the following behaviors is indicative of bulimia nervosa?
Which of the following behaviors is indicative of bulimia nervosa?
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What distinguishes Binge Eating Disorder (BED) from bulimia nervosa?
What distinguishes Binge Eating Disorder (BED) from bulimia nervosa?
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Which of the following symptoms is NOT typically associated with anorexia nervosa?
Which of the following symptoms is NOT typically associated with anorexia nervosa?
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What is a common physical sign of bulimia nervosa that results from self-induced vomiting?
What is a common physical sign of bulimia nervosa that results from self-induced vomiting?
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What is the typical BMI range for an individual classified as overweight?
What is the typical BMI range for an individual classified as overweight?
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Which of the following is NOT a characteristic of anorexia nervosa?
Which of the following is NOT a characteristic of anorexia nervosa?
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Which factor is considered a predisposing factor for eating disorders?
Which factor is considered a predisposing factor for eating disorders?
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What is the primary treatment approach recommended for Binge Eating Disorder (BED)?
What is the primary treatment approach recommended for Binge Eating Disorder (BED)?
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What is a major concern when a malnourished patient begins to eat again?
What is a major concern when a malnourished patient begins to eat again?
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Which of the following symptoms is NOT associated with refeeding syndrome?
Which of the following symptoms is NOT associated with refeeding syndrome?
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The Maudsley approach primarily targets which demographic?
The Maudsley approach primarily targets which demographic?
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Which measurable outcome is related to improving a patient's self-esteem?
Which measurable outcome is related to improving a patient's self-esteem?
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What is the focus of Phase I in the Maudsley approach?
What is the focus of Phase I in the Maudsley approach?
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Which intervention is crucial for monitoring a patient during meals?
Which intervention is crucial for monitoring a patient during meals?
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What role does family therapy play in the treatment of eating disorders?
What role does family therapy play in the treatment of eating disorders?
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Which of the following medications is commonly used to treat Bulimia Nervosa?
Which of the following medications is commonly used to treat Bulimia Nervosa?
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Which intervention specifically aims to address patients' self-harm behaviors?
Which intervention specifically aims to address patients' self-harm behaviors?
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What is the purpose of behavior modification in treating eating disorders?
What is the purpose of behavior modification in treating eating disorders?
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Which of the following is an example of a coping strategy taught to patients?
Which of the following is an example of a coping strategy taught to patients?
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Which of the following is a key symptom to monitor in patients at risk for refeeding syndrome?
Which of the following is a key symptom to monitor in patients at risk for refeeding syndrome?
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In individual therapy for eating disorders, what is typically addressed?
In individual therapy for eating disorders, what is typically addressed?
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Which of the following is a common goal for patients with Bulimia Nervosa?
Which of the following is a common goal for patients with Bulimia Nervosa?
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Which of the following is a key indicator for the hospitalization of a patient with an eating disorder?
Which of the following is a key indicator for the hospitalization of a patient with an eating disorder?
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What nursing intervention is essential for properly managing a patient with imbalanced nutrition?
What nursing intervention is essential for properly managing a patient with imbalanced nutrition?
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Which outcome is most appropriate for a patient with anorexia as part of their treatment goals?
Which outcome is most appropriate for a patient with anorexia as part of their treatment goals?
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Which factor is essential to assess in understanding disordered eating behaviors?
Which factor is essential to assess in understanding disordered eating behaviors?
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What is a prioritized focus during a psychosocial assessment of an eating disorder patient?
What is a prioritized focus during a psychosocial assessment of an eating disorder patient?
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What is a primary characteristic of Anorexia Nervosa?
What is a primary characteristic of Anorexia Nervosa?
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Which of the following is a common symptom associated with Bulimia Nervosa?
Which of the following is a common symptom associated with Bulimia Nervosa?
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What distinguishes Binge Eating Disorder from other eating disorders?
What distinguishes Binge Eating Disorder from other eating disorders?
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What is the typical BMI range for individuals classified as normal weight?
What is the typical BMI range for individuals classified as normal weight?
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Which eating disorder may involve episodes of excessive eating without any form of compensatory behavior?
Which eating disorder may involve episodes of excessive eating without any form of compensatory behavior?
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Which of these factors is considered a predisposition for developing an eating disorder?
Which of these factors is considered a predisposition for developing an eating disorder?
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What is one potential health risk associated with the purging behaviors in Bulimia Nervosa?
What is one potential health risk associated with the purging behaviors in Bulimia Nervosa?
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What mental health issues are commonly comorbid with eating disorders?
What mental health issues are commonly comorbid with eating disorders?
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Which physical sign may develop on the hands of individuals with Bulimia Nervosa due to self-induced vomiting?
Which physical sign may develop on the hands of individuals with Bulimia Nervosa due to self-induced vomiting?
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What is the typical age range for the onset of eating disorders?
What is the typical age range for the onset of eating disorders?
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What is a significant risk associated with the refeeding process in malnourished patients?
What is a significant risk associated with the refeeding process in malnourished patients?
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In the treatment of eating disorders, which intervention is essential for physical monitoring?
In the treatment of eating disorders, which intervention is essential for physical monitoring?
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What is one of the desired measurable outcomes for patients with bulimia nervosa (BN)?
What is one of the desired measurable outcomes for patients with bulimia nervosa (BN)?
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Which phase of the Maudsley approach focuses on assisting an adolescent in developing a healthy self-identity?
Which phase of the Maudsley approach focuses on assisting an adolescent in developing a healthy self-identity?
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Which option describes a common emotional focus in individual therapy for eating disorders?
Which option describes a common emotional focus in individual therapy for eating disorders?
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What is a critical component of client education for managing eating disorders?
What is a critical component of client education for managing eating disorders?
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Which medication is commonly used for treating Binge-Eating Disorder (BED)?
Which medication is commonly used for treating Binge-Eating Disorder (BED)?
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What role does family therapy play in treating adolescents with anorexia nervosa?
What role does family therapy play in treating adolescents with anorexia nervosa?
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Which symptom is NOT typically monitored in patients at risk for refeeding syndrome?
Which symptom is NOT typically monitored in patients at risk for refeeding syndrome?
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In behavior modification therapy for eating disorders, control issues are perceived as what?
In behavior modification therapy for eating disorders, control issues are perceived as what?
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Which statement reflects an essential therapeutic goal for patients with eating disorders?
Which statement reflects an essential therapeutic goal for patients with eating disorders?
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What aspect of psychotherapy is particularly important for individuals with eating disorders?
What aspect of psychotherapy is particularly important for individuals with eating disorders?
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In evaluating the effectiveness of treatment for eating disorders, reassessment should focus primarily on what?
In evaluating the effectiveness of treatment for eating disorders, reassessment should focus primarily on what?
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What is the primary goal of interventions aimed at improving a patient's self-esteem in eating disorder treatment?
What is the primary goal of interventions aimed at improving a patient's self-esteem in eating disorder treatment?
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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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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.
