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20.1 Psychological, Social, and Physiological Factors

Eating disorders are a growing concern in nursing that can affect individuals of all ages and backgrounds. Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, pica, and rumination are all eating disorders influenced by many psychological, behavioral, genetic, social, and environmental factors. Clients with eating disorders can have severe complications, and nurses are essential members of the health-care team when managing these clients. A collaborative approach that will include several disciplines in the plan of care and medication management is required in assessing and treating eating disorders.

20.2 Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by extreme restriction of food intake below the daily requirements, causing very low body weight that can be fatal. Anorexia is divided into two categories—restricting type and binge eating/purging type—and can involve cognitive distortions like thought-shape fusion. Clients with anorexia nervosa often have other comorbid mental health conditions, such as anxiety and depression. Beneficial interventions include medications, mentoring, self-help, and therapy. Clients with anorexia nervosa are at high risk for suicide, so nurse care planning should include suicide assessment, providing a safe environment, and maintenance of the therapeutic relationship.

20.3 Avoidant/Restrictive Food Intake Disorder

ARFID is an eating disorder characterized as a disturbance with eating or feeding resulting in an individual continuously not meeting their nutritional or energy needs (SAMHSA, 2016). It can be caused by sensory sensitivity, low appetite/interest in foods, or avoidance due to trauma, and it can lead to a severe reduction in nutrients. ARFID differs from anorexia because it is often seen in infancy and early childhood and does not involve issues with body image. Other mental disorders, such as autism and anxiety, can be psychological drivers for ARFID along with a history of trauma related to eating. Treatment of ARFID requires a collaborative approach that focuses on restoring nutritional balance, stabilizing weight, and modifying disrupted eating behaviors. Family-based care is essential to treatment, along with therapies that focus on behavior modification, cognitive thought processes, and nutritional skills building.

20.4 Bulimia Nervosa

Bulimia nervosa is an eating disorder where there are recurrent episodes of binge eating that are followed by behaviors to prevent weight gain like extreme exercise, fasting, or purging. It affects females more than males and there are several biological, psychological, environmental, and temperamental factors associated with it. Bulima is categorized as purging and nonpurging type and can cause significant medical complications that can require hospitalization. Severe life-threatening complications can also occur with bulimia, such as suicide, esophageal rupture, and cardiac arrhythmias. Nurse care planning includes interventions to stabilize nutritional status, interrupt maladaptive behaviors, and manage complications. Treatment includes behavioral therapy, medications, and client self-help. It is also important to provide a safe environment for clients with bulimia due to their increased suicide risk.

20.5 Binge-Eating Disorder

Binge eating disorder (BED) is the most common eating disorder, is characterized by repeated episodes of excessive eating in short amounts of time, and is accompanied by the inability to control eating. Loss of control over eating can cause feelings of shame or guilt. BED differs from bulimia in that there are no repeated purging behaviors that occur in BED and clients with BED tend to be overweight. There are several medical complications associated with BED that may require nursing care. Treatment of BED requires a collaborative approach that includes medications, psychotherapy, behavioral therapies, and surgical interventions. The goals of treating BED include weight loss and changing disordered eating patterns, which a therapeutic relationship with the client can help facilitate.

20.6 Pica

Pica is an eating disorder where people consume nonfood items repeatedly. Medical complications can occur with pica that require immediate medical intervention. Consumption of nonfood items may not be considered pica if it is a culturally accepted practice or occurs in children under the age of two. The cause of pica is unknown, but there are several suspected etiologies and behavioral factors that are associated with pica, such as iron deficiency anemia. Pica can occur in pregnancy and, if severe, can cause harm to the mother and unborn child. Nutritional deficiencies and mental health comorbidities are also common in individuals with pica. Treatment includes restoring deficient minerals and nutrients, behavioral interventions, and prevention strategies. Nurses play an essential role in managing pica and can empower families to be active in the client’s plan of care.

20.7 Rumination Disorder

Rumination syndrome is an eating disorder where food is repeatedly regurgitated and rechewed or spat out after being ingested. It affects all ages, but the age of onset for infants is typically between three and twelve months. It can mimic gastrointestinal conditions, so it is important to rule out gastrointestinal causes when assessing for rumination syndrome. Medical complications can occur with rumination disorders, such as dental erosions, choking, and nutritional deficiencies. The most effective treatments for rumination syndrome are behavioral therapies such as diaphragmatic breathing. Other treatment options include medication, cognitive behavioral therapy, and family therapy. Client education, family support, and empowerment are essential to treating individuals with rumination disorder.


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