References:
- Psychiatric-Mental Health Nursing, 8th Edition, 978-1-975116-37-8, by Sheila L. Videbeck
- Course Module
- Lecturer
Eating Disorders are disorders characterized by alterations in eating patterns and disturbances in body image that interferes with relationships and occupational functioning. Both anorexia nervosa and bulimia nervosa are far more prevalent in industrialized societies, where food is abundant and beauty is linked with thinness. There are nine types of eating disorders described by the DSM-5:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Other Specified Feeding and Eating Disorder (OSFED)
- Pica
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Unspecified Feeding or Eating Disorder (UFED)
- Others: - Muscle Dysmorphia - Orthorexia Nervosa (ON)
Medical complications of eating disorders related to weight loss:
| Body System | Symptoms |
|---|---|
| Musculoskeletal | Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures |
| Metabolic | Hypothyroidism (lack of energy, weakness, cold intolerance, bradycardia), hypoglycemia, decreased insulin sensitivity |
| Cardiac | Bradycardia, hypotension, loss of cardiac muscle, small heart, arrhythmias (atrial/ventricular premature contractions, prolonged QT, ventricular tachycardia), sudden death |
| Gastrointestinal | Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea |
| Reproductive | Amenorrhea, low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels |
| Dermatologic | Dry, cracking skin (dehydration), lanugo (fine body hair), edema, acrocyanosis (blue hands/feet) |
| Hematologic | Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, hypercarotenemia |
| Neuropsychiatric | Abnormal taste sensation, apathetic depression, mild organic mental symptoms, sleep disturbances |
Medical complications of eating disorders related to purging (vomiting and laxative abuse):
| Body System | Symptoms |
|---|---|
| Metabolic | Electrolyte imbalances (hypokalemia, hypochloremic alkalosis, hypomagnesemia), elevated BUN |
| Gastrointestinal | Salivary gland/pancreas inflammation and enlargement (↑ serum amylase), esophageal/gastric erosion or rupture, dysfunctional bowel, superior mesenteric artery syndrome |
| Dental | Erosion of dental enamel (perimyolysis), especially of front teeth |
| Neuropsychiatric | Seizures (from fluid/electrolyte shifts), mild neuropathies, fatigue, weakness, mild organic mental symptoms |
Factors Influencing Eating Disorders
- Biologic Factors: - Genetic vulnerability from personality types’ - Lateral hypothalamus dysfunction resulting in anorexia, and Ventromedial dysfunction resulting in unsatiety and excessive eating
- Neurochemical Changes: - Decreased norepinephrine results in anorexia (AN, AFRID) - Increased serotonin results in decreased satiety (bulimia, BEDs) - Decreased monoamine oxidase, resulting in bulimia and purging disorders
- Developmental Factors: lack of autonomy, lack of identity, lack of role models, and familial dysfunctions (disorder as a result of conflict response; childhood adversity e.g. abuse, rejection, overprotectiveness, authoritarianism, etc.)
- Sociocultural Factors: advertisements, magazines, and movies with unrealistic body standards, peer pressure, etc.
Anorexia Nervosa
A life-threatening disorder with weight reduction ranging from 15% to 85% less than normal body weight.
- Restricting Subtype: weight loss results from fasting, dieting, and excessive exercise.
- Binge-Purging Subtype: weight loss results from purging (vomiting, laxatives, diuretics, enema)
Symptoms
- Amenorrhea for at least three cycles
- No organic explanations for weight loss
- Overtly thin, but a feeling of being fat
- Refusal to maintain body weight
- Emotional expression is restrained
- Social Withdrawal and Depression may be present
- Intense fear of gaining weight
- Preoccupied with food, e.g. in grocery shopping, collecting recipes, counting calories, formulating fat-free meals, and other unusual ritualistic food behaviors (not eating around others, cutting food into small pieces, not allowing food to touch the lips)
| System | Symptoms |
|---|---|
| Cardiac | Hypotension, Bradycardia, Cardiac arrythmias |
| Dermatology | Dry cracking skin, Lanugo, Acrocyanosis |
| Hematology | Leukopenia, Anemia, Thrombocytopenia |
| Metabolic | Hypoglycemia, Hypothyroidism, Cold Intolerance, Weakness |
| Musculoskeletal | Fat loss, Osteoporosis, Pathologic Fractures |
| Gastrointestinal | Constipation, Abdominal pain, Diarrhea |
| Reproduction | Amenorrhea |
| Neuropsychiatry | Depression, Insomnia |
| Others | Electrolyte imbalances, Elevated BUN, Salivary gland hypertrophy |
Bulimia Nervosa
An eating disorder characterized by recurrent episodes of binge eating at least twice a week for three months.
Symptoms
- Binge-Eating
- Under strict diets or vigorous exercise
- Lack of eating control
- Induced Vomiting
- Moth-eaten appearance of teeth
- Increased and persistent bodily concerns
- Abuse of diuretics and laxatives
| System | Symptoms |
|---|---|
| Dental | Perimyolysis (erosion of dental enamel) |
| Gastrointestinal | Salivary gland inflammation, parotid gland enlargement, pancreatitis, esophagitis |
| Metabolic | Electrolyte abnormalities, hypokalemia, metabolic alkalosis, hypochloremic alkalosis, hypomagnesemia, elevated BUN |
| Neuropsychiatric | Seizures, fatigue, weakness |
Summary
| Anorexia | Bulimia |
|---|---|
| Egosyntonic, i.e., perceived as natural to the individual. | Egodystonic, i.e., recognized as abnormal behavior. |
| Early Onset: 12 to 20 y.o. or less | Late Onset: >20 y.o. |
| Below normal body weight | Near normal or normal body weight |
| Does not recognize abnormal eating behavior | Recognizes altered eating pattern |
| Less worried about external opinions | Worried about external opinions |
| Starvation | Binge followed by purge |
| Amenorrhea | No amenorrhea |