Presentation on eating disorders for second semester Mental Health project at Sonoma State University

1. Eating Disorders
Paige Abrams, Megan Hofer, Chris Zimmerman

2. Prevalence:
National Statistics
In the United States, “20 million women and 10 million men” suffer from a clinically
significant eating disorder at some time in their life.
Lifetime incidence of:
Anorexia Nervosa (0.9% for females and 0.3% for males)
Bulimia Nervosa (1.5% for females and 0.5% for males)
Binge Eating Disorder (3.5% for females and 2% for males)
It is difficult to determine specific number of people affected with eating disorders since
fewer than half seek health care for their illness (Halter, 2014).
By age 6, girls start to express concerns about their weight or shape. 40-60% of elementary
school girls (ages 6-12) are concerned about their weight or about becoming too fat.

3. Our Class Stats…
34% currently have or have in the past suffered
from an eating disorder
24% have purged in order to control their weight
90% of our class knows someone who has or
currently is suffering from an eating disorder
40% believe that they are “fat”
70% have been called fat by someone else
95% compare their bodies to models/celebrities
in the mediahttps://www.youtube.com/watch?v=F0pwXRQxSYE&index=12&list=PLuW2vBvU29jEmo7DoAkQK_fyoHYLfBvQS

5. Influences from media?
● Studies have shown that culture influences the development of self-concept
and satisfaction with body size. The Western cultural ideal equates feminine
beauty to tall, thin models and has received much attention in the media as
an etiology for the eating disorders.
● Numerous correlational and experimental studies have linked exposure to
the thin ideal in mass media to body dissatisfaction, internalization of the
thin ideal, and disordered eating among women.
● The effect of media on women’s body dissatisfaction, thin ideal
internalization, and disordered eating appears to be stronger among young
adults than children and adolescents. This may suggest that long-term
exposure during childhood and adolescence lays the foundation for the
negative effects of media during early adulthood.

6. Etiology: ● TRAUMA: Childhood trauma and sexual abuse have been
reported in 20% to 50% of patients with eating disorders,
and those patients with reported abuse have poorer
outcomes from treatment than those who do not. Physical
neglect, emotional abuse, and sexual abuse have been
found to be significant predictors for eating disorders
● GENETIC: There is a strong genetic link for eating
disorders. Heritability of anorexia nervosa is 60%.
● NEUROBIOLOGICAL: Research demonstrates that altered
brain serotonin function contributes to dysregulation of
appetite, mood, and impulse control in the eating
disorders.
● PSYCHOLOGICAL: Currently, cognitive-behavioral
theorists suggest that eating disorders are based on learned
behavior that has positive reinforcement.
● CULTURAL: culture influences the development of self-
concept and satisfaction with body size.

7. 3 Categories of Eating Disorders

8. Refuse to maintain a minimally normal weight
for height and express an intense fear of
gaining weight.
<75% of ideal
body weight
Some restrict their intake, others engage in
binge eating and purging.
Anorexia Nervosa

9. Signs & Symptoms
Extremely low body weight
Severe food restriction
Intense fear of gaining weight
Distorted body image and self-esteem
Lack of menstruation among girls and
women.
Other symptoms and medical complications may
develop over time, including:
Osteopenia or osteoporosis
Brittle hair and nails
Dry and yellowish skin
Growth of fine hair all over the body (lanugo)
Mild anemia, muscle wasting, and weakness
Severe constipation
Low blood pressure
Damage to structure and function of heart

10. Personality Traits
Perfectionism
Obsessive thoughts and actions relating to
food
Intense feelings of shame
People pleasing
The need for complete control
Self-destructive behaviors
13 to 18 years of age - associated with
oppositional defiant disorder
Personality disorders occur more often in the
eating disordered population than the
general population. In particular,
obsessive-compulsive personality
disorder represents only 8% of the
general population but accounts for 22%

11. Bulimia Nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating
unusually large amounts of food and feel a lack of control over these episodes.
● Followed by behavior that compensates for the overeating. (Purging, laxatives, etc.)
● Accompanied by feelings of disgust, depression, embarrassment or shame.

12. Signs & Symptoms
Chronically inflamed and sore throat
Swollen salivary glands in the neck and jaw
area (aka parotid glands)
Worn tooth enamel and decaying teeth
Acid reflux disorder and other
gastrointestinal problems
Intestinal distress and irritation from severe
dehydration
Electrolyte imbalances

13. Personality Traits
Sensitive to perceptions of others
Feelings of significant shame and
totally out of control
Major depression
Substance abuse
13 to 18 years of age - strongly
associated with mood and anxiety
disorders
Borderline personality disorder occurs
in 6% of the general population but
represents 28% of bulimia nervosa
patients

14. Binge Eating D/O
People with binge-eating disorder show marked
loss of control over their eating.
not followed by compensatory behaviors like
purging, excessive exercise, or fasting.
often are overweight or obese
also experience guilt, shame, and distress
about their binge eating, which can lead to
more binge eatingOver dilation of stomach causes heartburn,
dysphagia, bloating, and abdominal pain

15. Personality Traits
Overeating is frequently noted as a
symptom of an affective disorder, such as
atypical depression.
Higher rates of affective and
personality disorders are found
among binge eaters.
Binge eaters report a history of major
depression and anxiety disorders
significantly more often than non–binge
eaters.
https://www.youtube.com/watch?v=ljyExHVsZFg

17. Case Study
Stephanie is a 17 year old female who presents to the ED after her parents found
her lethargic and severely confused. Her parents tell the nurse that she has been
isolating herself, is stressed with college applications, and seems to be eating more
than usual. They also report that they found laxatives in her room. Upon initial
assessment, patient complains of leg cramps, feeling dizzy, and being tired/weak.
Her teeth are visibly eroded and her parotid glands are swollen. You take her vital
signs and they show: BP 115/78 sitting, 91/60 standing, pulse 70 beats/min
sitting, 97 beats/min standing. Her weight is within 95% of her ideal weight,
potassium level 2.8 mmol/L. EKG came back abnormal, consistent with
hypokalemia.

18. Case Study
What signs and symptoms might indicate that Stephanie has an eating disorder?
Overeating, use of laxatives, tooth erosion, enlarged parotid gland and low potassium contributing to low
blood pressure, confusion, lethargy, abnormal EKG, muscle weakness, dizzy and tired
What are some possible nursing diagnoses?
Risk for injury r/t low potassium and other physical changes secondary to binge eating and purging
Powerlessness related to inability to control binging and vomiting cycles
Decreased cardiac output/disturbed body image/ineffective coping/chronic low self esteem/social
isolation
Imbalanced nutrition/ risk for imbalanced fluid volume
Goals? Outcomes?
K+ will be WNL throughout hospitalization and afterwards will identify S+S of low K+
Stephanie will recognize need for treatment
Demonstrates effective coping, reports decrease in stress, uses personal support systems, uses effective
coping strategies
Stephanie will report congruence between body reality, ideal and presentation and satisfaction with body
appearance

19. Case Study
Interventions?
Establish therapeutic relationship
Educate Stephanie regarding the ill effects of self induced vomiting, laxative use, low K+ level and dental erosion
Educate about binge-purging cycle and its self-perpetuating nature
Explore ideas about trigger foods and challenge irrational thoughts and beliefs about “forbidden foods”
Teach patient the importance to plan and eat regularly scheduled balanced meals
Help Stephanie with use of relaxation techniques and develop better coping skills
Medication? SSRIs and Tricyclic antidepressants might help reduce cycle
What are our plans for Stephanie following discharge? How might this differ for a
patient with Anorexia or binge eating disorder?
Admit to partial hospitalization program designed for patients with eating disorders.
3-4 days a week and participates in individual and group therapy.
Examine underlying conflicts and body dissatisfaction that sustain the illness
CBT is best for psychological treatment and significantly reduces relapse risk

20. Other Nursing Considerations?
An assessment of eating disorder symptoms will assist the clinician in identifying target symptoms and behaviors
that will be addressed in the treatment plan as well as in determining the diagnosis of eating disorder.
Assess a detailed report of food intake during a single day in the patient’s life. Challenge to assess obese patients
with binge eating disorder?
Obtain a family history regarding eating disorders and other psychiatric disorders, alcohol and other substance
use disorders, obesity, family interactions in relation to the patient’s disorder,
Assess family attitudes toward eating, exercise, and appearance.
Promote caloric consumption for anorexic patients
Assess for suicidal ideation
Provide ongoing support to the patient and their family

21. Recovery?
https://www.youtube.com/watch?v=iErtF9IfI6M

22. 1.1. sdf

23. References
Chakraborty, K., & Basu, D. (2010). Management of anorexia and bulimia nervosa: An evidence-based review.
Indian Journal of Psychiatry, 52(2), 174–186. http://doi.org/10.4103/0019-5545.64596
Eating Disorders. Retrieved April 24, 2016, from
http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
Halter, M. J., & Varcarolis, E. M. (2014). Varcarolis' foundations of psychiatric mental health nursing: A
clinical approach. St. Louis, MO: Elsevier.
National Eating Disorders Association. Retrieved April 24, 2016, from
http://www.nationaleatingdisorders.org/