MS. RITIKA SONI ASS. PROF.

1. EATING DISORDERS:
PRESENTER: MS RITIKA SONI

2. EATING DISORDERS:
Look in the mirror. What do you see? Is it the real
you or just another "me"?

3. INTRODUCTION
 Nutrition is required to
sustain life, the most
individuals require
nutrients from eating
balanced food.
 The HYPOTHALAMUS
contains the appetite
regulation center with
in the brain. This
complex neural system
regulates the body’s
ability to recognize
when it is hungry and
when it has been stated.
 When it is disturbed,
lead to eating disorder.

4. WHAT IS AN EATING DISORDER?
 Eating disorders are
mental illnesses that
cause serious disturbances
in a person’s everyday
diet.
 It can manifest as eating
extremely small amounts
of food or severely
overeating.
 leading to severe changes.

5. TYPES OF EATING DISORDERS
 Anorexia Nervosa
 Bulimia Nervosa

6.  Obesity
 Binge Eating Disorder
 Psychogenic vomiting
 Not Otherwise Specified (NOS)

7. EPIDEMIOLOGICAL FACTOR
 The incidence of Anorexia Nervosa has increased in
the past 30 years both in the united states and in
western Europe. Studies indicate a prevalence rate
among young women in the united state of
approximately 1 percent . Anorexia nervosa occurs
predominantly in females 12-30 years.
 More prevalent in higher socio-economical groups.
 Bulimia nervosa is more prevalent than anorexia
nervosa, with estimates up to 4 percent of young
women.
 Onset occurs in late adolescent and early childhood.

8.  Obesity has been defined as a body mass index
(BMI= weight/height2) of 30 or greater. In the
united state, statistics indicate that, among
adults 20 years of age or older, 68 % are
overweight.

9. ANOREXIA NERVOSA: WHAT IS IT?

10. ANOREXIA NERVOSA
 Anorexia: Prolonged loss of appetite.
 Nervosa : Indicates that the loss is due to
emotional reason.
 Body image: a subjective concept of one’s
physical appearance based on the personal
perceptions of self and the reactions of others.

11. ANOREXIA NERVOSA:
 Anorexia nervosa
happens when one is
obsessed with
becoming thin that
they reach extreme
measures and this
leads to extreme
weight loss.

12.  Anorexia nervosa is characterized by a morbid
fear of being obese. This fear does not
decrease even if body becomes very thin and
underweight.
 The term anorexia was actually a misnomer.
 It was initially believed that anorexics didn't
experience sensation of hunger .
 However, research indicates that they do indeed
suffer from pangs of hunger, and it is only with
food intake of less than 200 calories per day
that hunger sensation actually ceases.

13.  Body – image disturbance
 Refusal to maintain body weight.
 Significant loss of weight occurs, usually more
than 25% of the original weight.
 No known medical illness, which can account for
the weight loss , is present.
 Absence of any other psychiatric disorder.

14.  Symptoms includes: gross distortion of body image
 preoccupation with food, and refusal to eat food.
 Weight loss due to less intake of food and extensive
exercising
 Poor sexual adjustment.( often conflict about being a
female and fear of pregnancy)
 Up to 50% of anorexics have bulimic episodes.
Characterized by rapid consumption of large amount
of food in a short period, when alone , called being
eating. Due to intense guilt attempt to remove eaten
food by:
 Self induced vomiting and abuse of laxative or
diuretics also may occur.

15.  Others like hypothermia,
edema, lanugo, and variety of
metabolic changes.
 Amenorrhea usually follows
weight loss.
 Obsessed with food . E.g.:
hoard or conceal food, talk
about food and recipes or
prepare food for others.
 Feeling of depression, anxiety .
 Death may occur due to
hypokalemia ( by self induced
vomiting), dehydration,
malnutrition, CCF.

16. ANOREXIA NERVOSA: WARNING
SIGNS
 Dramatic weight loss
 Refusal to eat certain foods or food categories.
 Consistent excuses to avoid situations involving food
 Excessive and rigid exercise routine
 Withdrawal from usual friends/relatives

17. HEALTH RISKS WITH ANOREXIA
 Heart failure
 Kidney failure
 Low protein stores
 Digestive problems

18. BULIMIA NERVOSA: WHAT IS IT?

19. BULIMIA NERVOSA
 Bulimia : excessive, insatiable appetite (Hunger)
 Nervosa: Indicates that due to emotional reason.

20. BULIMIA NERVOSA
 Bulimia Nervosa is an episodic,
uncontrolled , compulsive, rapid
ingestion of large amount of
food over a short period of
time (bingeing), followed by
inappropriate compensatory
behavior to rid the body of
the excess calorie(purging)

21.  Early teens or adolescents
 Intense fear of being obese. There may be history of
anorexia nervosa.
 Body image disturbance
 Persistent preoccupation with eating, and an
irresistible craving for food.
 Episode of binge eating
 No known medical illness
 Absence of psychiatric disorder.

22.  Recurrent episodes of
being eating. An
episode of binge eating
is characterized by
both of the following:
 A) eating in a discrete
period of time
 B) a sense of lack of
control over eating
during the episode.

23.  Attempt to ‘counteract’ the effects by inappropriate
compensatory behavior in order to prevent weight
gain, self induced vomiting ;misuse of laxatives,
diuretics, enemas, fasting, or excessive exercise.
 The binge eating and inappropriate compensatory
behavior occurs, at least twice a week for 3 months.
 Specific types:
 Purging type: during the current episode of bulimia
nervosa, the person has regularly engaged in self-
induced vomiting or the misuse of laxative, diuretics,
or enemas.
 Nonpurging type: during the current episode of
bulimia nervosa, the person has used other
inappropriate compensatory behaviors, such as
fasting, or excessive exercise.

24. BULIMIA NERVOSA: WARNING SIGNS
 Wrappers/containers indicating consumption of large
amounts of food
 Frequent trips to bathroom after meals
 Signs of vomiting e.g. staining of teeth, calluses on hands
 Excessive and rigid exercise routinely.
 Withdrawal from usual friends/relatives

25. HEALTH RISKS WITH BULIMIA
 Dehydration and
electrolyte
imbalance
 Dental problems
 Stomach rupture
 Menstruation
irregularities
 Mood disorder,
anxiety disorder,
substance abuse etc.

26. BINGE EATING DISORDER: WHAT
IS IT?

27. BINGE EATING DISORDER
 Binge eating is
disorder in which
someone eats a
lot amount of
food at a time but
they don't vomit.

28. BINGE EATING DISORDER:
WARNING SIGNS
 Wrappers/containers indicating consumption of
large amounts of food
 MAY be overweight
 MAY eat throughout the day with no planned
mealtimes

29. HEALTH RISKS WITH
BINGE EATING DISORDER
 High blood pressure
 High cholesterol
 Gall bladder disease
 Diabetes
 Heart disease
 Certain types of cancer

30. PREDISPOSING FACTOR
 Biological influences:
 Genetics- on the basis of family history
 Chromosome abnormality: 1,2,13
• Neuroendocrine abnormalities :
- primary hypothalamic dysfunction in anorexia nervosa
- Elevated cerebrospinal fluid cortical levels
(proteolysis)( released in response to stress or low
blood-glucose concentration).
- Impairment of dopaminergic regulation(brain
dopamine receptors –known for controlling movement,
also for weight and feeding behavior)
• Neurochemical influences:
- Neurotransmitter serotonin and nor epinephrine
- High level of endogenous opioids in the spinal fluids.

31.  Psychological influences:
- Perfectionist and overachievers
 Low self-esteem
 Feelings of inadequacy or failure
 Feeling out of control
 Response to change (puberty)
 Response to stress
 Personal illness
 breakup.

32.  Psychodynamic influences:
Early and profound disturbances in mother –
infant interactions may results in retarded ego
development in child.
 Troubled family and personal relationships
 Difficulty expressing emotions and feelings
 History of being teased or ridiculed based on
size or weight
 History of physical or sexual abuse

33. • Family and social pressure:
- Participation in any activity: Gymnastic , modeling
 Cultural pressures that glorify thinness and
place value on obtaining the perfect body
 Narrow definitions of beauty that include only
women and men of specific body weights and
shapes.
 Cultural norms that value people on the basis of
physical appearance and not inner qualities and
strengths.

34. OBESITY
 Obesity has been defined as a body mass index
(BMI= weight/height2) of 30 or greater.
 The following formula is used to determine extent of
obesity in individual:
 BMI=Weight (kg)
Height (m)2
 BMI range for normal weight is 18.5-24.9
 Overweight= BMI of 25.0-29.9
 Obesity= BMI of 30.0 or greater
 American average women has BMI= 26
 Fashion models=18
 Anorexia nervosa=17.5

35. RISKS:
 Hyperlipidemia
 Diabetes mellitus
 Workload on heart and lungs is increased

36. PREDISPOSING FACTORS TO OBESITY
 Biological influences:
-Genetics:
- Physiological factors: lesions in the appetite and
satiety centers in the hypothalamus may
contribute to overeating and obesity.
-hypothyroidism( thyroid helps in metabolism of
calories).
- Lifestyle factors: sedentary life style, ingestion
of greater no. of caloric food.
- Psychosocial influences: obese individual have
unresolved dependency needs and are fixed in
the oral stage of psychosexual development.

37. TREATMENT MODALITIES:
 Behavior modifications along with cognitive therapies helps
the patient to confront irrational thinking and strands to
modify distorted and maladaptive cognitions about body
image and eating behaviors. Providing positive
reinforcement.
 Individual therapy
 Family therapy
 Psychopharmacology: fluoxetine, clomipramine,
chlorpromazine, olanzapine ( antipsychotic), other
antidepressants: imipramine, desipramine, amitriptyline
etc.
 Hospitalization: with adequate nursing care for food intake
and weight gain.

38. GENERAL MANAGEMENT
 Identification of psychosocial stressors.
 Environmental manipulation to deal with stress.
 Teaching coping skills.
 Psychotherapy

39. NURSING INTERVENTION
 For anorexia nervosa:
 Imbalanced nutrition/deficient fluid volume less
than body requirements related to refusal to
eat/ drink, self-induced vomiting , abuse of
laxatives as evidenced by loss of weight, poor
muscle tone, dry mucous membrane.
 Interventions:
1. Dietitian will determine number of calories
required to provide adequate nutrition.
2. Weight patient daily. Keep strict record of
intake and output.

40.  Stay with patient during established time for
meal(usually 30 min) and for at least 1 hours following
meals.
 If excessive weight loss occurs due to deterioration
in nutritional status, tube feedings will be initiated.
 Encourage the patient to explore and identify the
true feelings and fears that contribute to
maladaptive eating behavior.
 FOR BULIMIA NERVOSA:
2. Imbalanced nutrition more than body requirements :
1. Encourage the patient to keep a diary of food
intake.
2. Discuss feelings and emotions associated with
eating. Formulate an eating plan that includes food
from the required food groups with low-fat intake.

41.  Plan a progressive exercise program tailored to
individual goals and choice. Exercise may enhance
weight loss by burning calories, reducing
appetite, increasing energies etc.

42.  With input from the client, formulate an eating
plan with emphasis on low intake food.
 Provide instruction about medications to assist
with weight loss. Appetite suppressant drugs:
phentermine and other that have weight loss as a
side effect e.g. : fluoxetine, topiramate.

43. FOR THE PATIENT WITH OBESITY
 Assess the patient’s feeling and attitude about being
obese. Obesity and compulsive eating behavior may have
deep rooted psychological implications such as
compensation for lack of love or nurturing.
 Determine the patient’s motivation for weight loss and set
goals. The individual may harbor repressed feelings of
hostility, which may be expressed inwardly on the self.
 Help the patient identify positive self-attributes. Focus on
strengths and past accomplishment unrelated to physical
appearance.
 Group therapy : support groups – increase motivation
