Chapter 10

10.2 EATING DISORDERS

Dr. Radhakrishnan G. Assistant Professor & Mrs. K.Sugavanaselvi, Ph.D. Scholar

10.1 INTRODUCTION

Eating disorders are serious health problems among adolescents. Maladaptive eating pattern can
significantly leads serious physical and mental health problem. Eating disorders include
Anorexia Nervosa, Bulimia nervosa, binge-eating and atypical eating disorder. Anorexia
nervosa and Bulimia nervosa are two commonest eating disorders among teenagers. It is
estimated that approximately 5-10 million adolescent and young women affected in Western
countries.

10.2 WHAT IS ANOREXIA NERVOSA? Anorexia

nervosa leads to highest mortality among any
psychiatric illness. It is a fatal and life-threatening
illness characterized by unusual perception of body
image and strong fear of gaining body weight. They
are unable to accept the gravity of the health
problem even when it is real to them. It occurs in at least one percent of the adolescents and it is
ten times more common among female than in males.

10.3 WHAT IS BULIMIA NERVOSA?

It is quite common than anorexia nervosa. It Bulimia is a repeated and persistent episode of
eating a large quantity of food than a normal people eat (binge eating) followed by feeling of
strong guilty and purging behaviour (induced
vomiting). Usually bulimic behaviour are performed
secretly.

10.4 WHAT CAUSES EATING DISORDERS?

In both anorexia and bulimia the cause is unknown.

However genetic, psychological &imbalances of the
neurotransmitters play a significant role.
 C
Genetic, Family history of Female, early adolescent
R
eating disorders. (anorexia), late adolescent
A
(bulimia), young women
I
U Psychological: Ex: childhood Obesity& dieting at early
S
S abuse (physical &mental) age, family conflicts, upper
K class family
E Neurotransmitters
dysfunction: Ex: serotonin Athletes, cultural &media
S
emphases on beauty, and
thinness.

10.5 HOW CAN YOU IDENTIFY INDIVIDUALS SUFFERING FROM

ANOREXIA/BULIMIA NERVOSA?

ANOREXIA NERVOSA BULIMIA NERVOSA

1. Marked weight loss ( 85% BMI) 1.Normal weight/overweight/under weight

2. Preoccupation with food & weight but 2. Frequent periods of binge eating (eating
avoids food intake. Perception of being large amount of food than a normal person)
overweight(even if emaciated) usually within 2 hours’ time.
3. Binge eating (eating large amount of 3.Compensatory behavior such as self-induced
food), purging behavior (Inducing vomiting(purging behavior)
vomiting) & performing excessive
exercise.
4. Severe distortion of body image, 4. Misuse of laxatives, diuretics, enema and
loss/control of hunger excessive exercise
5. Presents of psychiatric illness ex: 5. Presents of psychiatric illness ex:depressive
depression, obsessive compulsive and anxiety symptoms.
disorder.
6. Possible substance use 6.Possible substance use
7. Amenorrhea (at least three consecutive 7.Menstrual irregularities
cycles), thin and brittle hair &nails.
 8. Medical complications such as 8.Metabolic acidosis and alkalosis, Loss of
osteoporosis, hypothyroidism dental enamel/Increased dental caries,
Hypotension, bradycardia, edema and Esophageal tears
seizure etc.
9. Fatigue, Constipation, abdominal pain, 9.Fluid and electrolyte abnormalities
fluid &electrolyte imbalances
10. Changes in electrolytes, Blood Urea 10.Mild elevated levels of amylase
Nitrogen(BUN),liver function

10.6 WHAT ARE THE TYPES OF ANOREXIA/BULIMIA NERVOSA?

Mild Anorexia: Body Mass Index (BMI) > 17 kg/m, Moderate: BMI 16-16.99 kg/m2, Severe:
BMI 15-15.99 kg/m2, Extreme: BMI < 15 kg/m2. They are grouped in to two types depending
on how they suppress their body mass.

Anorexia & Bulimia nervosa

Restricting type Binge eating &purging type

Performing excessive dieting, exercising Abnormally over eating (binging), followed
and fasting by induced vomiting (purging) by abusing
laxatives, diuretics and enemas

As per ICD 10 criteria, Eating disorders (anorexia &bulimia) comes under Chapter 5,
Behavioral syndromes associated with physiological disturbances and physical factors
(F50-F59). As per DSM V criteria, eating and feeding disorders described in 307.7
Screening tool such as Eating Attitude Scale is useful in screening patient with eating
disorders.

10.7 HOW IS ANOREXIA AND BULIMIA NERVOSA MANAGED?

Treating patients with anorexia &bulimia nervosa is very challenging. Life threatening
conditions such as severe fluid& electrolyte deficit, cardiovascular problems and severe and risk
for suicide, require intensive care treatment. Management mainly includes correcting fluid &
electrolyte imbalance, managing nutritional imbalances, weight restoration, and prevention of
suicide, medications and psychosocial treatment.

Medications

Most of the patients have associated comorbid psychiatric illness such as anxiety, depression and
OCD, which will need treatment with antidepressants.

Nutritional rehabilitation

1. Severely undernourished patients may need total parenteral nutrition and tube feedings
2. Gradually increase the calorie intake (initially 1200-1500)
3. Provide adequate protein, amino acids and fatty acid supplement depending on their level
of activity, weight and growth needs.
Psychosocial Intervention

Role of the nurse:

-Identify the nutrition needs of the patient -Explain about actual measurement of patient’s
body with the patients perceived observation
-Introduce behavioral modification plans -set limit on eating habit
-Monitor intake and output and maintain -Teach the patient to maintain self-monitoring
diary on their feelings, thoughts and behaviour
food diary
-Remain with the patient during meals and -Assist patient in identifying his feeling and
teach adaptive coping strategies
one hour after
-Plan for promising exercise program for -Teach breathing exercise and distractions
bulimia.
 KEY POINTS
 Eating disorders significantly causes serious physical and mental health problem.
 Anorexia nervosa and Bulimia nervosa are two commonest eating disorders.
 It is fairly common with adolescent (girls) & young women
 In both the illness mal adaptive eating pattern & body image issues are apparent.
 patient
-Teach the Focusing on reality
about healthybetween
eating pattern
food & coping abilities
-Directly enquirewill
thesooner recover
patients theplan for
about
disease. suicide
and body image
-Assist to identify his strength and weakness -Help the patient to view herself normally

10.8 CONCLUSION

The rate of eating disorders in adolescents and young women are progressing. Eating disorders
can lead serious of psychiatric and physiological complications. A comprehensive treatment plan
which includes medical, psychiatric management is crucial to treat patients.

10.9 RED FLAGS FOR REFERRAL

 Sudden loss of bodyweight

 strange in eating habits
 constantly talks about dieting &exercise
 Spends lots of time alone, feeling tired, and withdrawn.

10.10 FREQUENTLY ASKED QUESTIONS?

Do persons with bulimia always look fat?
Persons with bulimia may look normal or obese
Do eating disorders lead to a serious problem?
Not all the disorders are mild. Anorexia nervosa is one of the life threatening disorder which
require intensive care.