The document provides an overview of eating disorders such as anorexia nervosa and bulimia nervosa. It discusses their history, symptoms, subtypes, contributing factors, medical management, and treatment approaches. Anorexia is characterized by self-starvation and intense fear of gaining weight. Bulimia involves binge eating followed by purging. Both disorders involve distorted body image and are influenced by biological, developmental, family, and sociocultural factors. Treatment includes medical stabilization, psychotherapy, medication, establishing healthy eating patterns, and education.

1. EATING DISORDERS

3. OVERVIEW
• MIDDLE AGES DOCUMENTATION INDICATES WILLFUL DIETING LEADING TO SELF-STARVATION IN FEMALE
SAINTS WHO FASTED TO ACHIEVE PURITY.
• IN THE LATE 1800S, DOCTORS IN ENGLAND AND FRANCE DESCRIBED YOUNG WOMEN WHO APPARENTLY
USED SELF-STARVATION TO AVOID OBESITY.
• IT WAS NOT UNTIL THE 1960S, HOWEVER, THAT ANOREXIA NERVOSA WAS ESTABLISHED AS A MENTAL
DISORDER.
• BULIMIA NERVOSA WAS FIRST DESCRIBED AS A DISTINCT SYNDROME IN 1979 (ANDERSON & YAGER,
2005)

4. • ANOREXIA AND BULIMIA ARE BOTH CHARACTERIZED BY PERFECTIONISM, OBSESSIVE–COMPULSIVENESS,
NEUROTICISM, NEGATIVE EMOTIONALITY, HARM AVOIDANCE, LOW SELF-DIRECTEDNESS, LOW
COOPERATIVENESS, AND TRAITS ASSOCIATED WITH AVOIDANT PERSONALITY DISORDER.
• IN ADDITION, CLIENTS WITH BULIMIA MAY ALSO EXHIBIT HIGH IMPULSIVITY, SENSATION SEEKING, NOVELTY
SEEKING, AND TRAITS ASSOCIATED WITH BORDERLINE PERSONALITY DISORDER (THOMPSON, 2009).
• EATING DISORDERS OFTEN ARE LINKED TO A HISTORY OF SEXUAL ABUSE, ESPECIALLY IF THE ABUSE OCCURRED
BEFORE PUBERTY .
• SUCH A HISTORY MAY BE A FACTOR CONTRIBUTING TO PROBLEMS WITH INTIMACY, SEXUAL ATTRACTIVENESS,
AND LOW INTEREST IN SEXUAL ACTIVITY. CLIENTS WITH EATING DISORDERS AND A HISTORY OF SEXUAL ABUSE
ALSO HAVE HIGHER LEVELS OF DEPRESSION AND ANXIETY, LOWER SELF-ESTEEM, MORE INTERPERSONAL
PROBLEMS, AND MORE SEVERE OBSESSIVE–COMPULSIVE SYMPTOMS (CARTER ET AL., 2006).

5. ANOREXIA NERVOSA

6. •A LIFE-THREATENING EATING DISORDER CHARACTERIZED BY THE CLIENT’S REFUSAL OR
INABILITY TO MAINTAIN A MINIMALLY NORMAL BODY WEIGHT,
•INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT,
•SIGNIFICANTLY DISTURBED PERCEPTION OF THE SHAPE OR SIZE OF THE BODY, AND
STEADFAST INABILITY OR REFUSAL TO ACKNOWLEDGE THE SERIOUSNESS OF THE
PROBLEM OR EVEN THAT ONE EXISTS

7. •CLIENTS WITH ANOREXIA HAVE A BODY
WEIGHT THAT IS 85% OR LESS OF THAT
EXPECTED FOR THEIR AGE AND HEIGHT,
•HAVE EXPERIENCED AMENORRHEA FOR AT
LEAST THREE CONSECUTIVE CYCLES

8. • THESE CLIENTS DO NOT LOSE THEIR APPETITES.
• THEY STILL EXPERIENCE HUNGER BUT IGNORE IT AND SIGNS OF PHYSICAL WEAKNESS
AND FATIGUE;
• THEY OFTEN BELIEVE THAT IF THEY EAT ANYTHING, THEY WILL NOT BE ABLE TO STOP
EATING AND WILL BECOME FAT.
• CLIENTS WITH ANOREXIA OFTEN ARE PREOCCUPIED WITH FOOD-RELATED ACTIVITIES
SUCH AS GROCERY SHOPPING, COLLECTING RECIPES OR COOKBOOKS, COUNTING
CALORIES, CREATING FAT-FREE MEALS, AND COOKING FAMILY MEALS.

9. • THEY ALSO MAY ENGAGE IN UNUSUAL OR RITUALISTIC FOOD BEHAVIORS SUCH AS
REFUSING TO EAT AROUND OTHERS, CUTTING FOOD INTO MINUTE PIECES, OR NOT
ALLOWING THE FOOD THEY EAT TO TOUCH THEIR LIPS.
• EXCESSIVE EXERCISE IS COMMON AND MAY OCCUPY SEVERAL HOURS A DAY.
• ANOREXIA NERVOSA HAS THE HIGHEST MORTALITY RATE OF ANY MENTAL DISORDER.
WHILE MANY PEOPLE WITH THIS DISORDER DIE FROM COMPLICATIONS ASSOCIATED
WITH STARVATION, OTHERS DIE OF SUICIDE.

10. SYMPTOMS INCLUDE:
• EXTREMELY RESTRICTED EATING
• EXTREME THINNESS (EMACIATION)
• A RELENTLESS PURSUIT OF THINNESS AND UNWILLINGNESS TO MAINTAIN A NORMAL OR HEALTHY WEIGHT
• INTENSE FEAR OF GAINING WEIGHT
• DISTORTED BODY IMAGE, A SELF-ESTEEM THAT IS HEAVILY INFLUENCED BY PERCEPTIONS OF BODY WEIGHT AND
SHAPE, OR A DENIAL OF THE SERIOUSNESS OF LOW BODY WEIGHT

11. OTHER SYMPTOMS MAY DEVELOP OVER TIME, INCLUDING:
• Thinning of the bones (osteopenia or
osteoporosis)
• Mild anemia and muscle wasting and
weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body
(lanugo)
• Severe constipation
• Low blood pressure slowed breathing
and pulse
• Damage to the structure and
function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature,
causing a person to feel cold all
the time
• Lethargy, sluggishness, or feeling
tired all the time
• Infertility

12. CLIENTS WITH ANOREXIA NERVOSA CAN BE CLASSIFIED INTO TWO
SUBGROUPS DEPENDING ON HOW THEY CONTROL THEIR WEIGHT:
• CLIENTS WITH THE RESTRICTING SUBTYPE LOSE
WEIGHT PRIMARILY THROUGH DIETING, FASTING,
OR EXCESSIVE EXERCISING
• THOSE WITH THE BINGE EATING AND PURGING
SUBTYPE ENGAGE REGULARLY IN BINGE EATING
FOLLOWED BY PURGING
BINGE EATING means consuming a large amount of food (far greater than most people eat at
one time) in a discrete period of usually 2 hours or less.
PURGING involves compensatory behaviors designed to eliminate food by means of self-
induced vomiting or misuse of laxatives, enemas, and diuretics.

13. BULIMIA NERVOSA

14. • BULIMIA NERVOSA, OFTEN SIMPLY CALLED BULIMIA, IS AN EATING DISORDER CHARACTERIZED BY
RECURRENT EPISODES (AT LEAST TWICE A WEEK FOR 3 MONTHS) OF BINGE EATING FOLLOWED BY
INAPPROPRIATE COMPENSATORY BEHAVIORS TO AVOID WEIGHT GAIN, SUCH AS PURGING, FASTING, OR
EXCESSIVELY EXERCISING .
• THE CLIENT OFTEN ENGAGES IN BINGE EATING SECRETLY. BETWEEN BINGES, THE CLIENT MAY EAT LOW-
CALORIE FOODS OR FAST. BINGING OR PURGING EPISODES ARE OFTEN PRECIPITATED BY STRONG
EMOTIONS AND FOLLOWED BY GUILT, REMORSE, SHAME, OR SELF-CONTEMPT.

15. SYMPTOMS:
• THE WEIGHT OF CLIENTS WITH BULIMIA USUALLY IS IN THE NORMAL
RANGE, ALTHOUGH SOME CLIENTS ARE OVERWEIGHT OR
UNDERWEIGHT. RECURRENT VOMITING DESTROYS TOOTH ENAMEL,
• RECURRENT VOMITING, DESTROYS TOOTH ENAMEL
• INCIDENCE OF DENTAL CARIES AND RAGGED OR CHIPPED TEETH
• INCREASES IN THESE CLIENTS., DENTISTS ARE OFTEN THE FIRST
HEALTH

16. • CHRONICALLY INFLAMED AND SORE THROAT
• SWOLLEN SALIVARY GLANDS IN THE NECK AND JAW AREA
• WORN TOOTH ENAMEL AND INCREASINGLY SENSITIVE AND DECAYING
TEETH AS A RESULT OF EXPOSURE TO STOMACH ACID
• ACID REFLUX DISORDER AND OTHER GASTROINTESTINAL PROBLEMS
• INTESTINAL DISTRESS AND IRRITATION FROM LAXATIVE ABUSE
• SEVERE DEHYDRATION FROM PURGING OF FLUIDS
• ELECTROLYTE IMBALANCE (TOO LOW OR TOO HIGH LEVELS OF
SODIUM, CALCIUM, POTASSIUM, AND OTHER MINERALS) WHICH CAN
LEAD TO STROKE OR HEART ATTACK

18. BIOLOGIC FACTORS
• STUDIES OF ANOREXIA NERVOSA AND BULIMIA NERVOSA HAVE SHOWN THAT THESE
DISORDERS TEND TO RUN IN FAMILIES. GENETIC VULNERABILITY ALSO MIGHT RESULT FROM A
PARTICULAR PERSONALITY TYPE OR A GENERAL SUSCEPTIBILITY TO PSYCHIATRIC DISORDERS.
OR IT MAY DIRECTLY INVOLVE A DYSFUNCTION OF THE HYPOTHALAMUS. A FAMILY HISTORY OF
MOOD OR ANXIETY DISORDERS (E.G., OBSESSIVE–COMPULSIVE DISORDER) PLACES A PERSON
AT RISK FOR AN EATING DISORDER (ANDERSON & YAGER, 2005)

19. DEVELOPMENTAL FACTORS
• SELF-PERCEPTIONS OF THE BODY CAN INFLUENCE THE DEVELOPMENT OF IDENTITY IN
ADOLESCENCE GREATLY AND OFTEN PERSIST INTO ADULTHOOD.
• ADOLESCENT GIRLS WHO EXPRESS BODY DISSATISFACTION ARE MOST LIKELY TO EXPERIENCE
ADVERSE OUTCOMES, SUCH AS EMOTIONAL EATING, BINGE EATING, ABNORMAL ATTITUDES
ABOUT EATING AND WEIGHT, LOW SELF-ESTEEM, STRESS, AND DEPRESSION.
• THE NEED TO DEVELOP A UNIQUE IDENTITY, OR A SENSE OF WHO ONE IS AS A PERSON, IS
ANOTHER ESSENTIAL TASK AND COINCIDES WITH THE ONSET OF PUBERTY.
• ADVERTISEMENTS, MAGAZINES, AND MOVIES THAT FEATURE THIN MODELS REINFORCE THE
CULTURAL BELIEF THAT SLIMNESS IS ATTRACTIVE.

20. FAMILY INFLUENCES
• GIRLS GROWING UP AMID FAMILY PROBLEMS AND ABUSE ARE AT HIGHER RISK FOR BOTH
ANOREXIA AND BULIMIA.
• DISORDERED EATING IS A COMMON RESPONSE TO FAMILY DISCORD.
• TEENS GROWING UP IN FAMILIES WITHOUT EMOTIONAL SUPPORT OFTEN TRY TO ESCAPE THEIR
NEGATIVE EMOTIONS AND PLACE AN INTENSE FOCUS OUTWARD ON SOMETHING CONCRETE:
PHYSICAL APPEARANCE. DISORDERED EATING BECOMES A DISTRACTION FROM EMOTIONS.

21. SOCIOCULTURAL FACTORS
• THE MEDIA FUELS THE IMAGE OF THE “IDEAL WOMAN” AS THIN.
• THE CULTURE EQUATES BEAUTY, DESIRABILITY, AND, ULTIMATELY, HAPPINESS WITH BEING VERY
THIN, PERFECTLY TONED, AND PHYSICALLY FIT.
• THE CULTURE CONSIDERS BEING OVERWEIGHT A SIGN OF LAZINESS, LACK OF SELF-CONTROL,
OR INDIFFERENCE; IT EQUATES PURSUIT OF THE “PERFECT” BODY WITH BEAUTY, DESIRABILITY,
SUCCESS, AND WILL POWER.
• PRESSURE FROM COACHES, PARENTS, AND PEERS AND THE EMPHASIS PLACED ON BODY FORM
IN SPORTS SUCH AS GYMNASTICS, BALLET, AND WRESTLING CAN PROMOTE EATING DISORDERS
IN ATHLETES.

23. MEDICAL MANAGEMENT - ANOREXIA
• FOCUSES ON WEIGHT RESTORATION, NUTRITIONAL REHABILITATION, REHYDRATION, AND CORRECTION OF
ELECTROLYTE IMBALANCES.
• SEVERELY MALNOURISHED CLIENTS MAY REQUIRE TOTAL PARENTERAL NUTRITION, TUBE FEEDINGS, OR
HYPERALIMENTATION TO RECEIVE ADEQUATE NUTRITIONAL INTAKE.

24. PSYCHOPHARMACOLOGY - ANOREXIA
• AMITRIPTYLINE (ELAVIL) AND THE ANTIHISTAMINE CYPROHEPTADINE (PERIACTIN) IN HIGH DOSES (UP TO
28 MG/DAY) CAN PROMOTE WEIGHT GAIN IN INPATIENTS WITH ANOREXIA NERVOSA.
• OLANZAPINE (ZYPREXA) HAS BEEN USED WITH SUCCESS BECAUSE OF ITS ANTIPSYCHOTIC EFFECT (ON
BIZARRE BODY IMAGE DISTORTIONS) AND ASSOCIATED WEIGHT GAIN.
• FLUOXETINE (PROZAC) HAS SOME EFFECTIVENESS IN PREVENTING RELAPSE IN CLIENTS WHOSE WEIGHT
HAS BEEN PARTIALLY OR COMPLETELY RESTORED (ANDREASEN & BLACK, 2006)

25. COGNITIVE - BEHAVIORAL THERAPY
BULIMIA
• CBT HAS BEEN FOUND TO BE THE MOST EFFECTIVE TREATMENT FOR
BULIMIA.
• THIS OUTPATIENT APPROACH OFTEN REQUIRES A DETAILED MANUAL
TO GUIDE TREATMENT.
• STRATEGIES DESIGNED TO CHANGE THE CLIENT’S THINKING
(COGNITION) AND ACTIONS (BEHAVIOR) ABOUT FOOD FOCUS ON
INTERRUPTING THE CYCLE OF DIETING, BINGING, AND PURGING AND
ALTERING DYSFUNCTIONAL THOUGHTS AND BELIEFS ABOUT FOOD,
WEIGHT, BODY IMAGE, AND OVERALL SELF-CONCEPT.

26. PSYCHOPHARMACOLOGY - BULIMIA
• DRUGS, SUCH AS DESIPRAMINE (NORPRAMIN), IMIPRAMINE (TOFRANIL), AMITRIPTYLINE (ELAVIL),
NORTRIPTYLINE (PAMELOR), PHENELZINE (NARDIL), AND FLUOXETINE (PROZAC) WERE PRESCRIBED IN THE
SAME DOSAGES USED TO TREAT DEPRESSION.
• ANTIDEPRESSANTS WERE MORE EFFECTIVE THAN WERE THE PLACEBOS IN REDUCING BINGE EATING. THEY
ALSO IMPROVED MOOD AND REDUCED PREOCCUPATION WITH SHAPE AND WEIGHT

28. ESTABLISHING NUTRITIONAL EATING PATTERNS
•PRIMARY NURSING ROLES ARE TO IMPLEMENT AND TO SUPERVISE THE REGIMEN FOR
NUTRITIONAL REHABILITATION.
•TOTAL PARENTERAL NUTRITION OR ENTERAL FEEDINGS MAY BE PRESCRIBED INITIALLY
WHEN A CLIENT’S HEALTH STATUS IS SEVERELY COMPROMISED.
•THE NURSE IS RESPONSIBLE FOR MONITORING MEALS AND SNACKS AND OFTEN
INITIALLY WILL SIT WITH A CLIENT DURING EATING AT A TABLE AWAY FROM OTHER
CLIENTS.
•AFTER EACH MEAL OR SNACK, CLIENTS MAY BE REQUIRED TO REMAIN IN VIEW OF STAFF
FOR 1 TO 2 HOURS TO ENSURE THEY DO NOT EMPTY THE STOMACH BY VOMITING.

29. IDENTIFYING EMOTIONS AND DEVELOPING COPING
STRATEGIES
•THE NURSE ENCOURAGES THE CLIENT TO DESCRIBE HER OR HIS FEELINGS. THIS
APPROACH CAN EVENTUALLY HELP CLIENTS TO RECOGNIZE THEIR EMOTIONS AND TO
CONNECT THEM TO THEIR EATING BEHAVIORS.
•IT MAY HELP CLIENTS TO IDENTIFY BEHAVIOR PATTERNS AND THEN IMPLEMENT
TECHNIQUES TO AVOID OR TO REPLACE THEM .
•THE NURSE CAN THEN HELP CLIENTS TO DEVELOP WAYS TO MANAGE EMOTIONS SUCH
AS ANXIETY BY USING RELAXATION TECHNIQUES OR DISTRACTION WITH MUSIC OR
ANOTHER ACTIVITY.

30. CLIENT/FAMILY EDUCATION
•CLIENT BASIC NUTRITIONAL NEEDS
•HARMFUL EFFECTS OF RESTRICTIVE EATING, DIETING, AND PURGING
•REALISTIC GOALS FOR EATING
•ACCEPTANCE OF HEALTHY BODY IMAGE