436 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Eating is part of everyday life. It is necessary for
survival, but it is also a social activity and part of
many happy occasions. People go out for dinner, invite
friends and family for meals in their homes, and cel-
ebrate special events such as marriages, holidays,
and birthdays with food. Yet for some people, eating
is a source of worry and anxiety. Are they eating too
much? Do they look fat? Is some new weight-loss pro-
motion going to be the answer?
Obesity has been identified as a major health
problem in the United States; some call it an epidemic.
The number of obesity-related illnesses among children
has increased dramatically (Wang & Dietz, 2002). At
the same time, millions of women are either starving
themselves or engaging in chaotic eating patterns that
can lead to death.
This chapter focuses on anorexia nervosa and
bulimia nervosa, the two most common eating dis-
orders found in the mental health setting. It discusses
strategies for early identification and prevention of
these disorders.
OVERVIEW OF EATING DISORDERS
Although many think that eating disorders are rel-
atively new, documentation from the Middle Ages
indicates willful dieting leading to self-starvation in
female saints who fasted to achieve purity. In the
late 1800s, doctors in England and France described
young women who apparently used self-starvation to
avoid obesity. It was not until the 1960s, however,
that anorexia nervosa was established as a mental
disorder. Bulimia nervosa was first described as a
distinct syndrome in 1979 (Halmi, 2000).
Eating disorders can be viewed on a continuum
with clients with anorexia eating too little or starving
themselves, clients with bulimia eating chaotically,
and clients with obesity eating too much. There is
much overlap among the eating disorders: 30% to 35%
of normal-weight people with bulimia have a history
of anorexia nervosa and low body weight and about
50% of people with anorexia nervosa exhibit bulimic
behavior (Kaye, Klump, Frank, & Strober, 2000). The
distinguishing features of anorexia include an earlier
age of onset and below-normal body weight; the per-
son fails to recognize the eating behavior as a problem.
Clients with bulimia have a later age of onset and
near-normalbody weight. They usually are ashamed
and embarrassed by the eating behavior.
More than 90% of cases of anorexia nervosa
and bulimia occur in females (American Psychiatric
Association [APA], 2000). Although fewer men than
women suffer from eating disorders, the number of
men with anorexia or bulimia may be much higher
than previously believed (Woodside et al., 2002). Men,
however, are less likely to seek treatment. The preva-
lence of both eating disorders is estimated to be 1%
to 3% of the general population in the United States
(Halmi, 2000).Anorexia Nervosa
Anorexia nervosais a life-threatening eating dis-
order characterized by the client’s refusal or in-
ability to maintain a minimally normal body weight,
intense fear of gaining weight or becoming fat, sig-
nificantly disturbed perception of the shape or size
of the body, and steadfast inability or refusal to ac-
knowledge the seriousness of the problem or even that
one exists (APA, 2000). Clients with anorexia have a
body weight that is 85% less than expected for their
age and height, have experienced amenorrhea for at
least three consecutive cycles, and have a preoccupa-
tion with food and food-related activities.
Clients with anorexia nervosa can be classified
into two subgroups depending on how they control◗ SYMPTOMS OFANOREXIANERVOSA
Fear of gaining weight or becoming fat even when
severely underweight
Body image disturbance
Amenorrhea
Depressive symptoms such as depressed mood,
social withdrawal, irritability, and insomnia
Preoccupation with thoughts of food
Feelings of ineffectiveness
Inflexible thinking
Strong need to control environment
Limited spontaneity and overly restrained emo-
tional expressionComplaints of constipation and abdominal pain
Cold intolerance
Lethargy
Emaciation
Hypotension, hypothermia, and bradycardia
Hypertrophy of salivary glands
Elevated BUN (blood urea nitrogen)
Electrolyte imbalances
Leukopenia and mild anemia
Elevated liver function studies