1. Eating Regulation Responses and Eating Disorders, Chapter 24

2. Eating Regulation Responses & Eating Disorders
Eating Disorders occur across the life span
Bulimia and Anorexia may be present in the same patient
Both are ↑risk in first-degree female relatives with eating disorders
Patient with eating disorders often have depression, anxiety and substance abuse

3. Eating Regulation Responses & Eating Disorders
> females
50-75% of people with Anorexia or Bulimia have depression
OCD can be found in 25% of patients with Anoroxia Nervosia
Exhibit rigidity, ritualism, and meticulousness – often from early childhood

4. Eating Regulation Responses & Eating Disorders
Binge eaters often report fluctuation of self-esteem
Sexual abuse reported in 20-50% of patients with Anorexia or Bulimia
Nurses first must examine their own feelings about weight and size

5. Eating Regulation Responses & Eating Disorders
Eating disorders include:
Anorexia nervosa
Bulimia nervosa
Bing eating disorder
Night eating syndrome

6. Overlapping Relationships Among Eating Disorders(Stuart, 2013, p. 480)

7. Eating Regulation Responses & Eating Disorders
Anorexia Nervosa
Intense irrational beliefs about body, shape
Intense fear of gaining weight even when under weight
Body weight 15% below expected minimal normal weight for age and height
Female menstrual cycle absent for at least 3 consecutive cycles
Use denial as their coping mechanism

8. Eating Regulation Responses & Eating Disorders
Anorexia (cont)
Many anorexia nervosa patients recover within 5 years but for some this can be a chronic illness
May consume as little as 200 calories daily
Many are preoccupied by food and are employed in the food industry

9. Eating Regulation Responses & Eating Disorders
Bulimia Nervosa
More common than anorexia nervosa
Binge eating then purge
Self-induced vomiting
Check for callus on a finger
Misuse of laxatives, diuretics, enemas
Chewing and spitting
Early treatment = good response

10. Eating Regulation Responses & Eating Disorders
Binge Eating Disorder
Consume large amounts of calories and do not attempt to prevent weight gain
Chronic in nature
19-40% obese people who seek help with weight to control binge eat
Assess-what is meant by a binge (calories)

11. Eating Regulation Responses & Eating Disorders
Night Eating Syndrome
In the new DSM-V
Night eaters experience 2 awakenings a night associated with food
Symptoms associated with night eating syndrome
Morning anorexia
Difficulty staying asleep
Depression in the evening

12. Eating Regulation Responses & Eating Disorders
Assessment
Full physical examination
Dental examination
Psychiatric history
Weight history
Pattern of menstruation
Compulsive exercise patterns
Use of laxatives, diuretics, diet pills

13. Eating Regulation Responses & Eating Disorders
Important assessment with eating disorders is the patient’s motivation to change their behavior
Anorexia is about controlling life and fears
For some the only control they have is their food
Bulimia patients have problems with their weight and resort to purging/laxatives, etc.

14. Eating Regulation Responses & Eating Disorders
Medical Complications
Anorexia - metabolic and endocrine abnormalities result from malnutrition/starvation
Bulimia – potassium depletion and hypokalemia : related to purging, laxative, or diuretic abuse
Excess weight – HTN, cardiac problems, sleep apnea, mobility, diabetes

15. Eating Regulation Responses & Eating Disorders
Interventions
Nutrition stabilization
Exercise- physical fitness not calories
Cognitive behavioral interventions
Body image interventions
Body image distortion- discrepancy between the patient’s actual size and the perceived body size
Body dissatisfaction-degree of unhappiness that a person feels about body size

16. Eating Regulation Responses & Eating Disorders
Interventions (cont)
Family involvement
Families should be engaged and included
Group therapy
CBT, psychoeducational, psychodynamic, and interpersonal models
Encourage patients to express their feelings
Medications
SSRIs have had considerable to modest to no effect