ered successful if the client maintains a body weight
within 5% to 10% of normal with no medical compli-
cations from starvation or purging.
COMMUNITY-BASED CARE
Treatment for clients with eating disorders usually
occurs in community settings. Hospital admission
is indicated only for medical necessity such as for
clients with dangerously low weight, electrolyte im-
balances, or renal, cardiac, or hepatic complications.
Clients who cannot control the cycle of binge eating
and purging may be treated briefly in an inpatient
setting. Other treatment settings include partial hos-
pitalization or day treatment programs, individual or
group outpatient therapy, and self-help groups.
MENTAL HEALTH PROMOTION
Nurses can educate parents, children, and young
people about strategies to prevent eating disorders.
Important aspects include realizing that the “ideal”
figures portrayed in advertisements and magazines
are unrealistic, developing realistic ideas about body
size and shape, resisting peer pressure to diet, im-
proving self-esteem, and learning coping strategies
for dealing with emotions and life issues.
The Atlanta Center for Eating Disorders (2002)
offers the following advice:
- Read the research about fad diets: they don’t
work. “No fat” diets are unhealthy, and
claims about special combinations food diets
are unfounded. - Send the right message to children about
food and body image issues. Parents who are
constantly worrying about or talking about
weight or are always “on a diet” powerfully
influence their children. Give up dieting and
eat well-balanced meals. - Listen to your conversation. Weight, dieting,
and appearance are among the most common
topics for women. Make a pact with friends
to stop talking about your bodies negatively. - Focus on the positive aspects of yourself and
others that have nothing to do with physical
appearance. - Encourage healthy expression of emotions.
Learn positive ways to communicate. - Give up “wanting to be thin” before doing
anything, and get on with enjoying your life. - Increase physical activity by focusing on
the enjoyment of movement not how many
calories you’ll burn.
School nurses, student health nurses at colleges
and universities, and nurses in clinics and doctors’
452 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
offices may encounter clients in various settings who
are at risk for developing or who already have an
eating disorder. In these settings, early identifica-
tion and appropriate referral are primary responsi-
bilities of the nurse. Anstine and Grinenko (2000)
suggest routine screening of young women for eating
disorders (Box 18-1). Such early identification could
result in early intervention and prevention of a full-
blown eating disorder.SELF-AWARENESS ISSUES
An emaciated, starving client with ano-
rexia can be a shocking sight, and the nurse may
want to “take care of this child” and nurse her back
to health. When the client rejects this help and re-
sists the nurse’s caring actions, the nurse can become
angry and frustrated and feel incompetent to handle
the situation.
The client initially may view the nurse, who is
responsible for “making the client eat,” as the enemy.
The client may hide or throw away food or become
overtly hostile as anxiety about eating increases. The
nurse must remember that the client’s behavior is a
symptom of anxiety and fear about gaining weight
and not personally directed toward the nurse. Taking
the client’s behavior personally may cause the nurse
to feel angry and behave in a rejecting manner.
Because eating is such a basic part of everyday
life, the nurse may wonder why the client cannot just
eat “like everyone else.” The nurse also may find it dif-
ficult to understand how a 75-pound client sees her-
self as fat when she looks in the mirror. Likewise
when working with a client who binges and purges,
the nurse may wonder why the client cannot exert theBox 18-1
➤ DISORDEREDEATINGSCREENINGQUESTIONS
- How many diets have you been on in the past
year? - How often does your weight affect how you feel
about yourself? - How often do you feel you should be dieting?
- How often do you feel dissatisfied with your
body size?
Reprinted with permission from Elsevier Science form Rapid
screening for disordered eating in college-aged females in
the primary care setting by Anstine, D., & Grinenko, D.
Anstine, D., & Grinenko, D. Journal of Adolescent Health,
26(5), 338–342. © 2000 by the Society for Adolescent
Medicine.