EATING DISORDERS
Hari Krishna G L
Definition of eating disorders
Refers to group of conditions defined by
abnormal eating habits that may involve
either insufficient or excessive food intake to
the detriment of an individual’s physical and
mental health
(Sadock, 2003)
Classification
1. ANOREXIA NERVOSA
2. BULIMIA NERVOSA
3. OBESITY
4. BINGE EATING DISORDER
5. PICA
6. RUMINATION
ANOREXIA NERVOSA
Definition
A disorder characterized by preoccupation
with body weight and food characterized by
certain behavior which is directed towards
Losing weight
Peculiar pattern of handling food
Weight loss
Intense fear of gaining weight
Disturbance in body image
Epidemiology
Only case register studies
Prevalence
5/1000 – females
5/10000 – males
1/250 girls at puberty
94 to 96% of anorexic girls are females
Onset in early teens (14 – 18 years)
(Halmi, 2003)
Etiology
Biological influence:
Genetics
Common among sisters & mothers of those with this
disorder
1st degree relatives
Neuro endocrine
Primary hypothalamic dysfunction
Neuro chemical
Decreased levels of endogenous opiods in spinal
fluids
Epinephrine & nor epinephrine
(Mawsonin, 1974)
Psychodynamic influence:
Early disturbance in mother – infant interaction
leads to retarded ego
Hence behaviors associated with food & eating will
serve to provide feelings of control over one’s life
Family influence:
Reinforced in an effort to avoid spousal conflict
Can be a factor among children also
Passive father – dominating mother – overly
dependant child
Endocrinal hypothesis:
Estrogen
Progesterone
FSH
All these hormones are decreased
Clinical picture
The term is a misnomer
Behavior:
Drastic dieting
Secretive actions (hiding or disposing food)
Mirror gazing
Thought process:
Gross distortion of body image
Pre occupation with slimness
Denial of illness
Perception:
Perceive as well even when they look cachexic
Emotional:
Morbid fear
Crying spells
Sleep disturbances
Sad mood
Physiological:
Amenorrhea
Constipation
Dry skin
Hypotension
Hypothermia
Bradycardia
Cachexic
High energy despite cachexia
Poor sexual adjustment
Management
Behavior therapy:
Operant conditioning
System of rewards
Response prevention technique
Individual therapy:
Helpful when underlying psychological problems
are the contributing factors
Encouraging to explore unresolved conflicts
Recognizing mal adaptive eating behaviors as
defense mechanisms used to ease emotional pain
Family therapy:
Psycho education
Assess functional operation within the family
Psychopharmacology:
No specific medications
Fluoxetine and Clomipramine (Halmi, 2003)
Cyproheptadine – appetite stimulant
Chlorpromazine
Olanzapine (Barbarich, 2004)
TCA’s
BULIMIA NERVOSA
Bulimia Nervosa
Also called “Dietary Chaos Syndrome”
Bulimia derived from Latin word – “terrible
hunger”
Described 1st by Gerald Russell in 1979
An eating disorder characterized by
restraining of food intake for a long period of
time followed by an over intake or binging
period that results in feelings of guilt and low
self esteem
(Barker, 2003)
An episodic, uncontrolled, compulsive, rapid
ingestion of large quantities of food over a
short period of time followed by inappropriate
compensatory behavior to get rid the body of
the excess calories
(Sadock & Sadock, 2003)
Etiology
Similar to that of Anorexia nervosa
Specifically
Substance abuse & dependence in relatives of
patients with bulimia nervosa
Clinical picture
Chronic gastric reflux after eating
Dehydration and hypokalemia
Electrolyte imbalance
Esophagitis
Constipation
Delayed emptying
Infertility
Enlarged glands in the neck
Swollen salivary gland
Eating binges
Russell's sign
Use of laxatives, enemas, diuretics
Management
Behavior therapy
Token economy
Contingency contract
modeling
Individual therapy
Family therapy
Evaluating family structure
Psycho educational approach
Similarities between anorexia &
bulimia
Both begin after a period of dieting by people
who are fearful of becoming obese
Preoccupied with food, weight, and
appearance
Struggling with feelings of depression,
anxiety, and the need to be perfect
Belief that they weigh too much and look too
heavy regardless of their actual weight or
appearance
Differences
People with bulimia nervosa tend to be more
concerned about pleasing others, being
attractive to others, and having intimate
relationships
Tend to be more sexually experienced and
active than people with anorexia nervosa
People with bulimia nervosa display fewer of
the obsessive qualities
More than one-third of bulimics display the
characteristics of a personality disorder
OBESITY
Not classified as a psychiatric disorder
Due to strong emotional component, classified
under psychological factors affecting medical
conditions (DSM-IV)
It is a medical condition in which excess body
fat is accumulated to the extent that it may
have an adverse effect on health, leading to
reduced life expectancy and / or increased
health problems (WHO, 2000)
BINGE EATING DISORDER (BED)
3rd category considered in DSM IV (not in ICD
10)
1st described in 1956 by Albert Stunkard
No diagnostic criteria
Obesity is a factor in BED as individual binges
food, but does not engage to get rid the body
of excess calories
Syndrome picture
No control over consumption of food
Eats when depressed or bored
Eats alone
Guilt over binge eating
Rapid weight gain
Impaired socialization
Treatment
Whether they want to lose weight or not, BED
patients should seek advice from
Physicians
Nutritionist
Psychiatrist
CBT
Teaching to keep track of eating
Changing unhealthy eating habits
Drugs
Least choice
Low dose tricyclics
PICA
Persistent ingestion of non nutritive
substances for a period of at least 1 month at
an age in which this behavior is
developmentally inappropriate.
Originated from Latin word “Magpie” ( A bird
which almost eats everything)
Common terms
Ingestion of
Starch Amylophagia
Faeces Coprophagia
Soil, clay, chalk Geophagy
Glass Hyalophagia
Urine Urophagia
Wood, paper Xylophagia
Etiology
Mineral deficiency (Eg. Fe deficiency)
Pregnant woman (Influence of hormones?)
OCD and Schizophrenia (compulsive
phenomenon vs psychosis?)
Treatment
Positive and negative reinforcement
Drugs (SSRI)
Treat mineral deficiency
Physical restraints
Behavior therapy
RUMINATION SYNDROME
Also called “Merycism”
Characterized by the voluntary or involuntary
regurgitation and rechewing of partially
digested food that is either reswallowed or
expelled
Historically documented as affecting infants,
young children
The regurgitant does not taste sour or bitter
A diagnosis of rumination requires that the
behavior must persist for at least 1 month,
with evidence of normal functioning prior to
onset
Occurs within a few minutes postprandial and
may last 1-2 hours
APPLICATION OF NURSING PROCESS
Assessment
History
Nutrition
Menstruation
Stress
Drug use
Occupation
Family conflicts
Physical examination
Lab values
Perception of body image
Co morbid psychiatric illness
Nursing diagnosis
Imbalanced nutrition
Ineffective coping
Body image disturbance
Anxiety
Nutritional interventions
Therapeutic contract (time, procedure for
gaining weight)
Schedule for meal timings
Own menu selection
Realistic goals
Consel on healthy eating pattern
Teach effects of poor nutrition
Motivate to make own shopping list
Weight patient daily
Same scale, preferably morning after voiding
Strict intake and output chart
Topics for patient education
Nature of illness
Cause and symptoms
Effects of illnes on body
What constitutes obesity
Management
Principles of nutrition
Verbalizing fears
Medications
Stress management techniques
Problem solving skills
