eating disorders Flashcards


altered serotonin pathway
early adolescence

Anorexia- restricting type

restricted intake.
NOT REGULARLY binge eating or purging or laxatives/diuretics

Anorexia- binge eating/purging type

restricted intake AND
regularly engages in above compensatory behaviors.

Characteristics of anorexia-

Cardinal symptom- dangerously low body weight in relation to age/gender.
Denial of low weight and hunger.
Irrational believes about shape and weight
Self-starvation or excessive exercise
Can co-morbidity with anxiety, depression, social phobia & OCD

Personality traits of anorexia

controls eating, risk aversion(dislike), rituals regarding food.
INTENSE fear of gaining weight and distorted body image.
Family dynamics focuses on control, emphasized perfection,
achievement and compliance

Physical characteristics of anorexia

BMI below 17, 15 severe.
Females often experience amenorrhea(abnormal menstruation)
Delay interest in opp sex
Cachexia/cachectic (severe underweight with muscle wasting)
Lanugo (fine downy hair on face& back)
Mottles, cool skin on extremities (cold feeling)
Acrocyanosis (end of extremity)
Low BP, pulse, and temp

Medical Complications of anorexia

Cardiac: bradycardia, orthostatic hypotension and hyptotension.
Cardiac arrest (electrolyte disturbances), murmur, dysthymias
LAB VALUES- electrolyte imbalance (hypokalemic alkalosis, elevated
serum bicarbonate, hypochloremia) elevated cholesterol, serum enzyme
hematuria and proteinuria. Leukopenia and lympthocytosis.
ABNORMAL Thyroid functioning= HYPOTHYROIDISIM, Osteoporosis.

With binge/purge anorexia physical characteristics

enlarged parotid glands,
electrolyte imbalance,
Physically ill enough (extreme electrolyte imbalance (hypokalemia))
body weight less than 75% needs immediate stabilization & require
intensive inpatient care.

Anorexia- risk of refeeding syndrome

for severely malnourished (15% below ideal body weight). Life
threatening complication in early phase of treating the severely malnourished.
Asses for edema, CHF, hypophosphatemia, electrolyte imbalance.
CHF- DEMANDS replenished circulatory system overwhelms the capacity
of nutritionally depleted cardiac muscle resulting in cardiovascular collapse.

PREVENTION of COMPLICATION of re-feeding syndrome

slow re-feeding and careful monitoring of F&E & vital signs �
weight gain of 3 lbs/week =safe.

Treatment for anorexia by nurses

immediate- weight restoration program to achieve 90% of ideal weight
(women can menstruate) through weight gain and normalized eating patterns.
LONG term goal- normalize distorted body image.
SHORT term goal- comply with going to group, accept being monitored.
Weight gain is focus of treatment but opp of pts wants.
Be supportive by acknowledging the difficulty of the situation and
life changes for pt.

Milieu therapy for anorexic patients

Monitor for suicidal or self harm risk and risk for medical
complications (especially cardiac & F&E disturbances)
Provide structure and routine- regularly scheduled weighing and
monitoring b4 and after meals.
Review daily journal regarding feelings and food intake.
Self care activities = improve social, coping and problem solving skills
Encourage therapy ( cognitive behavioral therapy or dialectical
therapy) improve self esteem, reduces cognitive distortions and
increases coping skills.

Medication for anorexia

olanzapine (Zyprexa) � affect weight gain & improve cognition and
body image. Treat symptoms
less effective who smoke
AE- Tardive dyskinesia


Altered serotonin receptors and transporters
More common than anorexia
Late adolescence

Characteristics of Bulimia

repeated episodes of binge eating followed by compensatory
behaviors = self induced vomiting, laxatives, diuretics or
other, fasting (binge eating may follow dieting) excessive exercise.

Personality traits of bulimia

problems with relationships, self-concept and impulsive behaviors.
Eating motivated by feelings of emptiness

Controls/ undoes weight gain
after binging eating
(binge often follows period of dieting)
recognizes behavior- feels guilt or shame and tries to hide both
binging and compensatory behaviors from others.

Family dynamic of bulimic patient

chaotic, emotionally expressive (negativity) & lack of nurturing.

Physical characteristics of bulimia

Maybe be normal or slightly above or below ideal weight for age and sex.
Teeth- severe attrition and erosions of teeth producing sensitivity
and exposing pulp of teeth. Loss of dental arch, diminished chewing
ability (because of vomiting)
Parotid gland enlargement
Russell�s sign (callus on knuckles)
[Ask about eating when see these assessments.]

Medical complications of bulimia

CARDIAC � electrolyte disturbances causing sudden cardiac arrest.
EKG changes- cardiac dysrhythmias, sinus bradycardia
Orthostatic hyptenstion and/or decreased heart rate
Cardiac murmur; mitral valve prolapse
Cardiomyopathy from ipecac intoxication (med emergency can cause death)

Lab changes of bulimic patients

electrolyte imbalances:
Hypokalemia (first thing to check)- vomiting
Hypochloremia (abnormal low chloride) 97-107 normal.
Elevated serum bicarbonate levels, low serum bicarbonate (metabolic acidosis)
Esophageal tears from self-induced vomiting
Severe abdominal pain indicative of gastric dilation.

nursing care for bulimic patient

Assess for thoughts of suicide or self harm- emotional dysregulation
(mood disorders) is at the core of bulimic behaviors.
NURSES accepting, non-judgmental approach is important to building self-esteem.
Be aware that pt may be feeling ashamed and out of control and
sensitive to the perception of others.
Encourage use of journal to monitor feelings and related eating behaviors.

Milieu therapy for bulimic pts

Provide structure and routine to establish new eating behaviors
Monitor during meals/visitation (binging) & after meals &
when using bathroom for compensatory behaviors & to interrupt
binge/compensatory behavior cycle.
Nutritional consult- healthy eating patterns
Promote appropriate amount of exercise and relaxation techniques
Encourage participation in group therapy (Cognitive behavioral therapy)
Maintain journaling feelings, thoughts and related eating patterns.
Teach � health implications of compensatory behaviors and
significant risks.

medication for bulimia

Fluoxetine (Prozac) �gold standard- decreases binge eating and
purging behaviors- watch for suicide risk in early treatment.

Discharge planning for bulimia

refer to outpt treatment, family counseling (family involvement imp)
and support groups

short term outcomes of bulimia

�discontinue self purging activities while hospitalized�
�Accept the fact of being monitored�

Physical characteristics of EATING DISORDERS

weight loss of 30% OVER 6 MONTHS
Severe hypothermia- loss of subcut tissue or dehydration
Heart rate less than 40 bpm
Systolic less than 70
Hypokalemia less than 3 or other electrolytes- not correlated by
oral suppls= Sufficient for bulimic pts bc of vomiting/ diarrhea
EKG changes

Psychiatric characteristics of EATING DISORDERS

Suicidal or Thoughts of suicide, self-mutilating(self harm on body)
behaviors or sever depression, psychosis.
Use of laxatives, emetics, diuretics, street drugs
Fail to comply w/ treatment
Family dysfunction/crisis

Nurses dealing with ED pts

do not appear authoritarian, Coercive (threat) or act parental. DO
NOT be controlling with caring for pt with ED.

Personality traits with ED

issues of control, manipulation, deception, and perfectionism are
difficult to work with

Binge eating Disorder (BED)

Recurrent episodes of binge eating and then experiences significant
distress (feeling guilty or shameful)
Differs from bulimia= NO regular compensatory behaviors (purging,
exercise, medication)

personality traits of BED

usually coexists with a psychiatric disorder (bipolar, depression,
anxiety, personality, substance use)
Report binge eating is soothing and helps regulate moods of anxiety
and/or depression= impulsive behavior.
50%= no attempt to restrict food intake


Altered serotonin receptors and transporters (motivation for eating
and enjoying life)
More common than anorexia
Late adolescence

Medication for BED

antidepressant meds to address mood disorder and anti obesity meds.

When I started this research last January I came across a
website set up by a girl who was disgusted with herself because she
had put on a few pounds at Christmas. She planned to fast for
three days and regain control. "In under
two hours, she had 36 followers saying things like 'You're wonderful,
you're an inspiration to me, I'm only fasting because of you'.

Laurance, Jeremy. "Hundreds of Websites Urging Girls to 'Starve
for Perfection'." The Independent. 28 Nov. 2012: 16.
SIRS Issues Researcher. Web. 01 Jun. 2016

Social pressure to be
as slender as a catwalk model, as sylph-like as a Hollywood star, is
said to be what drives anorexia, the so-called slimmer's
disease. An estimated one million people in Britain suffer from
the disorder, which has the highest death rate--from suicide or
starvation--of any mental health condition.

Laurance, Jeremy. "Born to Be Thin?." The
Independent. 07 Oct. 2014: 34. SIRS Issues Researcher.
Web. 01 Jun. 2016.

They tell people how
to stay thin, promoting diets of 400-500 calories a day
(compared with a recommended 2,000 for women and 2,500 for men),
backed by coffee, cigarettes and diet pills.

Laurance, Jeremy. "Hundreds of Websites Urging Girls to 'Starve
for Perfection'." The Independent. 28 Nov. 2012: 16.
SIRS Issues Researcher. Web. 01 Jun. 2016

I suffered from anorexia from around 12 or 13, and then from bulimia
from the age of 17. But I began looking at pro-ana sites at the age of
about 11. They offer
'thinspiration' pictures and message boards to discuss how much
weight you've lost that day. It can turn into a competition.
I learned how to hide food from my family and make excuses. At the
time, you think the websites are great, but now I see they're really
warped, damaged communities and they should be closed down. One recommended to
sleep with the windows open as shivering burns calories.

Laurance, Jeremy. "Hundreds of Websites Urging Girls to 'Starve
for Perfection'." The Independent. 28 Nov. 2012: 16.
SIRS Issues Researcher. Web. 01 Jun. 2016

On these blogs, the lines quickly blur between images of presumably
healthy, bikini-clad models to starkly lean, skeletal--sometimes
emaciated--women, with hash tags such as #thinspo, #depressed,
#anorexic, #pale, #hip bones, #thigh gap and #sexy. The
images are accompanied by such statements as "Nothing tastes as
good as skinny feels," "Ribcage is the new black" and
"Don't eat anything today that you'll regret
tomorrow." One image shows a person staring down at her
thighs; printed atop the image is the message "Look at your
thighs. Now put the food down." Authors of these blogs
boast about how many pounds they have lost or how little they have
eaten, and implore followers to exercise frequently and excessively.

Mascarelli, Amanda. "Fueled by Social Media, 'Thigh Gap' Focus
Can Lure Young Women..." Washington Post. 02 Jul. 2014:
n.p. SIRS Issues Researcher. Web. 01 Jun. 2016.

Within three years of television being introduced to the region, the
amount of girls who induced vomiting to control their weight increased
by 11 percent and the amount of girls scoring highly on a test for
eating disorder risks increased by 16 percent.
Additionally, girls who watched TV three or more nights a week were 50
percent more likely to describe themselves as being "too fat.

Mulliniks, Kayla. "Studies Say Social Media Prompts Body Image
Discussion." University Wire. 25 Feb. 2014: n.p.
SIRS Issues Researcher. Web 01 Jun. 2016.

High school boys in
Los Angeles are twice as likely to induce vomiting or use laxatives
to control their weight as the national average, with 5.2% of those
surveyed saying they had recently done so, according to the
most recent survey data gathered by the Centers for Disease Control
and Prevention and the Los Angeles Unified School District. They are
also more likely to have used diet pills, powders or liquids than boys nationwide

Alpert, Emily. "A Guy Thing Too." Los Angeles
Times. 14 Jun. 2013: A.1. SIRS Issues Researcher. Web.
01 Jun. 2016

"With young males
facing more pressure over body image, disorders such as bulimia and
anorexia aren't limited to girls.

Alpert, Emily. "A Guy Thing Too." Los Angeles
Times. 14 Jun. 2013: A.1. SIRS Issues Researcher. Web.
01 Jun. 2016

Other "devil body challenges" include showing your legs are
no wider than an iPhone6 at the knees or balancing five coins on your
collar bone to show it protrudes. The name "devil body
challenge" comes from Chinese mythology about evil spirits who
change into beautiful sirens to entrap mortal men.

Gardner, Hannah. "Too Skinny? In China, Beauty Can Be Measured
in...iPhones." USA TODAY. 07 Apr. 2016: A.3. SIRS
Issues Researcher. Web. 01 Jun. 2016.

These abnormal standards could trigger depression or even
eating disorders in women. These are
not the correct values to be spreading," said Su Shu, lifestyle
editor of Cosmopolitan in China.

Gardner, Hannah. "Too Skinny? In China, Beauty Can Be Measured
in...iPhones." USA TODAY. 07 Apr. 2016: A.3. SIRS
Issues Researcher. Web. 01 Jun. 2016.

As pressure to compete at elite levels increases among young
athletes, a growing number are suffering from eating
disorders spawned from their rigorous training
regimens, said Heather Gallivan, PsyD LP, clinical director at Melrose
Center, an eating disorder treatment program based in
St. Louis Park.

Steiner, Andy. "Focus on Elite Performance Makes Eating
Disorders Common Among..." 02 Mar. 2016:
n.p. SIRS Issues Researcher.Web. 01 Jun. 2016.

Other sites had advice on how best to make yourself vomit and how to
use laxatives to induce diarrhoea and dehydration. In the
microscopically calibrated world of the anorexic, women are encouraged
not only to drink nothing but water, but ice-cold water, because the
body expends a teeny bit more energy when the digestive system warms
it up.

Penberthy, David. "Websites That Make You Want to Vomit."
Sunday Telegraph (Surry Hills). 04 Sep. 2011: 44. SIRS
Issues Researcher. Web. 01 Jun. 2016.