Psychiatric Mental Health Nursing by Videbeck

18 EATINGDISORDERS 449

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These limits will discourage previous binge be-

havior, which involves sneaking and gulping food,

hiding food, and so forth. You will help the client

to return to normal eating patterns. Eating three

meals a day will prevent starvation and subse-

quent overeating in the evening.

Eating with other people will discourage secrecy

about eating although initially the client’s anxiety

may be too high to join others at mealtime.

Verbal expression of feelings can help decrease

the client’s anxiety and the urge to engage in

purging behaviors.

The client’s safety is a priority. It is important to

remember that you will not give the client ideas

about suicide by addressing the issue directly.

A diary can help the client to examine the food in-

take and the feelings he or she experiences. Grad-

ually the client may be able to see relationships

among these feelings and behaviors. Initially the

client may be able to write about these feelings

and behaviors more easily than talk about them.

You can help the client begin to express feelings in

a nonthreatening environment. Being nonjudg-

mental gives the client permission to openly dis-

cuss feelings that may be negative or unacceptable

to him or her without fear of rejection or reprisal.

You may be able to help the client see how he or

she has used food to deal with feelings or to com-

fort himself or herself.

It is important to help the client separate emo-

tional issues from food and eating behaviors.

Set limits with the client about eating habits.
Food will be eaten in a dining room setting at
a table only at conventional mealtimes.

Encourage the client to eat with other clients,
when tolerated.

Encourage the client to express feelings such as
anxiety and guilt about having eaten.

Ask the client directly about thoughts of suicide
or self-harm.

Encourage the client to keep a diary in which to
write types and amounts of foods eaten and to
identify feelings that occur before, during, and
after eating, especially related to urges to engage
in binge or purge behavior.

Encourage the client to describe and discuss feel-
ings verbally. Begin to separate dealing with feel-
ings from eating or purging behaviors. Maintain a
nonjudgmental approach.

Discuss the types of foods that are soothing to the
client and that relieve anxiety.

Help the client to explore ways of relieving
anxiety and expressing feelings especially
anger, frustration, and anxiety, that are not
associated with eating. Help the client to iden-
tify ways to experience pleasure that are not
related to food or eating.

IMPLEMENTATION

Nursing Interventions *denotes collaborative interventions Rationale

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