Feeding and Eating Disorders

Overview

Feeding and eating disorders are complex conditions characterized by chronic disturbances in eating behavior, which impair food consumption and absorption, and significantly affect both physical and psychological health. These disorders are influenced by social, cultural, and psychological factors, and require a multidisciplinary approach for effective management.

• Food is essential to life and the body requires nutrients for optimal functioning.

• Eating disorders disrupt normal nutritional intake and can lead to serious health consequences.

Types of Eating Disorders

• Anorexia Nervosa (AN): Characterized by severe restriction of food intake, intense fear of gaining weight, and distorted body image.

• Bulimia Nervosa (BN): Involves episodes of binge eating followed by compensatory behaviors such as purging, excessive exercise, or fasting.

• Binge Eating Disorder (BED): Marked by recurrent episodes of rapid, excessive food consumption without regular compensatory behaviors.

Pathophysiology, Etiology, and Risk Factors

Pathophysiology

• Biologic: Dysregulation of feedback mechanisms that maintain energy homeostasis.

• Genetic: Family history increases risk.

• Hormone dysfunction: Abnormalities in hormones regulating appetite and metabolism.

Etiology

• Biological: Genetic predisposition, neurochemical imbalances.

• Cognitive-behavioral: Maladaptive thought patterns regarding food, weight, and self-image.

Risk Factors

• Sociocultural: Societal emphasis on thinness, media portrayal of ideal body types.

• Family systems: Family dynamics, history of obesity, and parental attitudes toward food and body image.

Sociocultural and Family Factors

Sociocultural Factors

• Cultural portrayal of 'ideal' body

• Obsession with thinness

• Negative body image, body dissatisfaction

• Girls, women are at higher risk

Family Factors

• Enabler, not cause: Family may facilitate but not directly cause the disorder.

• Possible abuse: History of abuse may increase risk.

• Impaired conflict resolution skills

• Emphasis on achievement, performance, fitness

• Enmeshment: Over-involvement in each other's lives.

Prevention

Prevention strategies focus on reducing negative risk factors and increasing protective factors through education.

• Universal: Broad-based education for all populations.

• Targeted: Focused interventions for at-risk groups.

• School-based: Programs implemented in educational settings.

Clinical Manifestations

All eating disorders include body image disturbance, anxiety, and ineffective coping skills.

• Distorted body image

• Anxiety

• Ineffective coping skills

Comparison: Dieting vs. Anorexia

Anorexia Nervosa (AN)

Characteristics

• Potentially life threatening

• Lose more weight than is healthy for age/height

• Intense fear of gaining weight even when underweight

• Dieting/exercise to point of dangerous malnutrition

• Typically begins in teen years, more common in Caucasian females

Diagnostic Criteria

• Intense fear of gaining weight

• Refusal to maintain healthy weight

• Distorted body image

• Amenorrhea is no longer a diagnostic criterion

Signs and Symptoms

• Rigid rules to control weight

• Limit food intake

• Excessive exercise

• Self-induced vomiting

• Cutting food into small pieces while pretending to eat

• Use of diuretics, laxatives, diet pills

• Refusal to eat in presence of others

Multisystem Effects

• Hair and nails become dry and brittle

• Skin becomes dry and yellow

• Lanugo on previously hairless parts of body

• Cold feet and hands

• BP and HR drop, dysrhythmias, anemia

• Brittle bones, fractures

• Impaired cognition

Anorexia nervosa has the highest mortality rate of any mental disorder. Many die from complications of starvation or suicide.

Severity and Hospitalization Criteria

• BMI as an indicator of severity:

• Other factors: acute medical complications, refusal to eat, risk of self-harm or suicide, failure to respond to outpatient treatment

Bulimia Nervosa (BN)

Characteristics

• Late adolescent to early adulthood, mostly females

• More common than anorexia

• Comorbid with other psychiatric disorders

• Incessant obsession with food, body weight

Diagnostic Criteria

• Binging on food or episodes of overeating

• After binging, purge food to avoid weight gain

• Can co-occur with Anorexia Nervosa

• Binge eating with unhealthy compensatory behaviors (purging, excessive exercise) at least once a week over a 3-month period

• Frequently underdiagnosed; individuals may be overweight or normal weight

Physical Signs and Physiologic Damage

• Physical signs: trash (junk food, hoarding food), menstrual irregularities, depressed mood, stomach pain, sore throat, damage to teeth, scarring on backs of fingers, swollen cheeks (self-gagging)

• Physiologic damage: injury to digestive tract, tooth decay, esophageal and stomach injury, acid reflux, dehydration, bloating, slowed peristalsis, dysrhythmias, electrolyte disturbances

Binge Eating Disorder (BED)

Characteristics

• Periods of rapid food consumption, inability to stop eating

• Continued eating long after satiety

• Initial sense of fulfillment, followed by disgust, guilt, worthlessness, depression, and embarrassment

Diagnostic Tests

Goals of Treatment

• Reestablish adequate nutrition

• Cessation of binge-purge behaviors

• Reduction of excessive exercise

• Restore healthy weight

• Treat underlying psychological issues

• Eliminate behaviors that lead to malnutrition and relapse

Treatment Approaches

Pharmacologic Therapy

• Anorexia nervosa: Antidepressants, mood stabilizers, antipsychotics

• Bulimia nervosa: Prozac (Fluoxetine) is the only FDA-approved medication for treating bulimia

• Binge-eating: Same as bulimia

Nonpharmacologic Therapy

• Anorexia nervosa: Individual, group, and family therapy; Maudsley Approach for adolescents (parents take responsibility for feeding)

• Bulimia nervosa and Binge-eating: Cognitive Behavioral Therapy (CBT), family therapy

• Combination of medical treatment and psychotherapy is most effective

Treatment Settings

Day Treatment Programs

• Continued educational, occupational, and social activities

• Active involvement of family

Inpatient Settings

• High acuity, structured environment

• Medical support

• Monitoring of refeeding syndrome

• Affiliated with day and outpatient programs

Inpatient Criteria

• <75% of ideal body weight

• Ongoing weight loss despite intensive management

• Rapid, persistent decline in weight

• Hemodynamic instability

• Cardiovascular risk

• Electrolyte imbalances

• Risk for self-harm

Complimentary Health Approaches

• Herbal dietary substances

• Acupuncture

• Yoga

• Meditation

• Mindfulness

• No conclusive evidence to support efficacy

Lifespan Considerations

• Children: Picky eating, parents with history of obesity increase risk

• Adolescents: Late adolescence is a common onset period

• Adults: May develop or persist into adulthood

• Pregnant women: Increased risk of BED

• Men: Focus on leanness and masculinity

• Older adults: Decreased appetite, physiological changes of aging

Nursing Process

• Assessment: Gather information about eating behaviors, physical and psychological health

• Diagnosis: Identify specific eating disorder and related health issues

• Planning (Goals): Set treatment objectives

• Interventions: Implement therapeutic strategies

• Evaluation: Monitor progress and adjust treatment as needed

Key Equations

• Body Mass Index (BMI):

Example

A patient with a height of 1.65 m and weight of 45 kg has a BMI of:

This BMI would be classified as moderate anorexia nervosa.

Additional info: Eating disorders are multifactorial and require a holistic approach for prevention, diagnosis, and treatment. Early intervention improves outcomes and reduces long-term complications.