interrupt the binge and purge cycle. He or she en-
courages clients to eat meals with their families or, if
they live alone, with friends. Clients always should
sit at a table in a designated eating area such as a
kitchen or dining room. It is easier for clients to fol-
low a nutritious eating plan if it is written in advance
and groceries are purchased for the planned menus.
Clients must avoid buying foods frequently con-
sumed during binges such as cookies, candy bars,
and potato chips. They should discard or move to the
kitchen food that was kept in desk drawers at work,
in the car, or in the bedroom.
IDENTIFYING EMOTIONS AND DEVELOPING
COPING STRATEGIES
Because clients with anorexia have problems with
self-awareness, they often have difficulty identify-
ing and expressing feelings (alexithymia). There-
fore, they often express these feelings in terms of
somatic complaints such as feeling fat or bloated.
The nurse can help clients begin to recognize emo-
tions such as anxiety or guilt by asking them to de-
scribehow they are feeling and allow adequate time
for response. The nurse should not ask, “Are you
sad?” or “Are you anxious?” because a client may
quickly agree rather than struggle for an answer.
The nurse encourages the client to describe her or his
feelings. This approach can eventually help clients to
recognize their emotions and to connect them to their
eating behaviors.
Self-monitoringis a cognitive-behavioral tech-
nique designed to help clients with bulimia. It may
help clients to identify behavior patterns and then
implement techniques to avoid or to replace them
(Wilson & Vitousek, 1999). Self-monitoring techniques
raise client awareness about behavior and help them
to regain a sense of control. The nurse encourages
clients to keep a diary of all food eaten throughout
the day including binges and to record moods, emo-
tions, thoughts, circumstances, and interactions sur-
rounding eating and binging or purging episodes. In
this way, clients begin to see connections between
emotions and situations and eating behaviors. The
nurse can then help to clients to develop ways to man-
age emotions such as anxiety by using relaxation
techniques or distraction with music or another activ-
ity. This is an important step toward helping clients
find ways to cope with people, emotions, or situations
that do not involve food.
DEALING WITH BODY IMAGE ISSUES
The nurse can help clients to accept a more normal
body image. This may involve clients agreeing to
weigh more than they would like, to be healthy, and
18 EATINGDISORDERS 447
to stay out of the hospital. When clients experience
relief from emotional distress, have increased self-
esteem, and are meeting emotional needs in healthy
ways, they are more likely to accept their weight and
body image.
The nurse also can help clients to view them-
selves in terms other than weight, size, shape, and
satisfaction with body image (Finelli, 2001). Helping
clients to identify areas of personal strength that are
not food-related broadens clients’ perceptions of them-
selves. This includes identifying talents, interests,
and positive aspects of character unrelated to body
shape or size.PROVIDING CLIENT AND FAMILY EDUCATION
One primary nursing role in caring for clients with
eating disorders is providing education to help them
take control of nutritional requirements indepen-
dently. This teaching can be done in the inpatient
setting during discharge planning or in the out-
patient setting. The nurse provides extensive teach-
ing about basic nutritional needs and the effects of
restrictive eating, dieting, and the binge and purgeKeeping a feeling diary.