Psychology of Eating Disorders

Temporal Lobe and Eating Disorders

• Eating disorders are associated with behaviors and affective disorders such as Major Depressive Disorder, Bipolar II Disorder, Anxiety Disorder, Substance Use Disorder, and Personality Disorders.

Etiologies for Feeding and Eating Disorders

• Biological Factors (genetic and neurobiology)
• Psychological factors (perfectionism, novelty seeking, obsessive-compulsive)
• Psychodynamic influence (overcontrolling parents)
• Developmental factors (childhood sexual abuse)
• Socio-cultural factors (cultural preference, western culture where women should be smaller, and exposure to media)

Anorexia Nervosa

• Most familiar and well-studied eating disorder
• Usually develops in adolescents
• Occurs more in women than men, but research shows an increase in men
• May present with obsessive-compulsive symptoms

Bulimia Nervosa

• More common than anorexia in the population
• Starts in adolescence or early adulthood
• Occurs more in women compared to males
• Characterized by episodic, uncontrolled, and rapid ingestion of large quantities of food over a short period of time (bingeing) followed by inappropriate compensatory behaviors (e.g., self-induced vomiting, misuse of laxatives, diuretics, or enemas)

Predisposing Factors for Eating Disorders

• Biological, psychological, psychodynamic, developmental, and socio-cultural factors contribute to the development of eating disorders

Pathophysiology of Bulimia Nervosa

• Low self-esteem
• Pressured to conform to a certain weight or shape

Assessment Findings of the Client with Bulimia Nervosa

• Fasting (nonpurging type)
• Excessive exercise (nonpurging type)
• Excessive vomiting, laxative, or diuretic use (may lead to electrolyte imbalances) (purging type)
• Normal weight, slightly underweight, slightly overweight
• Enamel erosion
• Abrasion to the knuckles (Russell’s sign)

Case Scenario

• Ann Taylor, a 17-year-old female, presented to the Emergency Department with a weight of 110 pounds (5’8” tall), temperature 97.9°F, and heart rate of 54
• Relevant cues: refusal to eat, preoccupation with food, BMI of 16, and concern about being overweight
• Immediate concern: client’s low body mass index (BMI) and heart rate
• Client condition consistent with the cues: anorexia nervosa

Etiologies for Feeding and Eating Disorders

• Behaviors and affective disorders associated with eating disorders: Major Depressive Disorder, Bipolar II Disorder, Anxiety Disorder, Substance Use Disorder, and Personality Disorders

Anorexia Nervosa

• Most familiar and well-studied eating disorder
• Usually develops in adolescents
• Occurs more in women than men, but research shows an increase in men
• Might present with obsessive-compulsive symptoms

Bulimia Nervosa

• More common than anorexia in the population
• Starts in adolescence or early adulthood
• Occurs more in women compared to males
• Characterized by episodic, uncontrolled, and compulsive rapid ingestion of large quantities of food over a short period, followed by inappropriate compensatory behaviors

Binge Eating Disorder (BED)

• The most common eating disorder
• Usually begins in adolescence
• Occurs twice more often in females than males
• One-third of BED clients are males

Predisposing Factors for Eating Disorders

• Biological Factors: genetic and neurobiology
• Psychological factors: perfectionism, novelty seeking, obsessive-compulsive
• Psychodynamic influence: overcontrolling parents
• Developmental factors: childhood sexual abuse
• Socio-cultural factors: cultural preference, western culture where women should be smaller, and exposure to media

Pathophysiology of Bulimia Nervosa

• Low self-esteem
• Pressured to conform to a certain weight or shape

Assessment Findings of the Client with Bulimia Nervosa

• Fasting (non-purging type)
• Excessive exercise (non-purging type)
• Excessive vomiting, laxative, or diuretic (may lead to electrolyte imbalances) (purging type)
• Normal weight, slightly underweight, slightly overweight
• Enamel erosion
• Abrasion to the knuckles (Russell's sign)

Learning Outcomes and Objectives

• Discuss predisposing factors implicated in the etiology of eating disorders
• Correlate adaptive/maladaptive responses for clients with eating disorders
• Understand the role of the professional nurse in the psychiatric mental health setting while caring for a client and family with an eating disorder
• Apply the nursing process while caring for a client with an eating disorder
• Design a comprehensive plan of care for a client with eating disorder

Case Scenario

• Ann Taylor, a 17-year-old female, presented to the Emergency Department with a weight of 110 pounds (5'8" tall), temperature 97.9 degrees Fahrenheit, and heart rate of 54
• Refuses to eat and is preoccupied with food
• BMI is 16

Review Questions

• Which assessments would the nurse closely monitor when caring for a hospitalized client diagnosed with bulimia nervosa?
• What part of the brain controls when you are hungry, sated, or not hungry? (Answer: Hypothalamus)
• What client condition is consistent with the cues? (Answer: Anorexia Nervosa)

Follow-Up Care

• Issues of control are central to the etiology of eating disorders; include the client in the plan of care
• Highest relapse may occur in the first 18 months following treatment
• Cognitive Behavioral Therapy
• Family Therapy
• Support Groups (i.e., Overeaters Anonymous and National Eating Disorders Association)

Pathophysiology of Binge Eating Disorder

• Occurs due to difficulty in the reward processing center and inhibitory control
• Etiology is unknown
• May be an illness of addiction
• Brain imaging may reveal increased activity in the orbitofrontal cortex (associated with reward and pleasure)

Assessment Findings of the Client with Binge-Eating Disorder

• Do not engage in behaviors to rid the body of excess calories
• 50% of individuals with Binge-Eating Disorder have a history of depression

Nursing Diagnoses

• Imbalance Nutrition: Less than Body Requirement
• Deficient Fluid Volume
• Denial
• Disturbed Thought Process
• Obesity
• Disturbed Body Image