Rebecca Sposato MS, RN
Eating Disorders A collection of psychiatric conditions that manifest psychological illness through abnormal eating habits and body image
Includes anorexia nervosa, bulimia nervosa, binge eating, orthorexia nervosa, pica and selective eating disorder
(www.nationaleating disorder.org, 2011)
http://vimeo.com/user638254/videos/sort:date
StatisticsEating disorders are grossly under diagnosed due
to the surrounding secretive and resistant habits90% of cases are female: U.S. prevalence 10
million women and 1 million men40% of new diagnoses occur in females 15-19
years oldOnly 1/3 of people with anorexia nervosa and 6%
of people with bulimia receive mental health services
(www.nationaleating disorder.org, 2011)
Eating Disorders Comorbid DiagnosesBorderline Personality DisorderObsessive Compulsive Disorder and
Obsessive Personality DisorderDepressionAnxietyBody Dysmorphic DisorderNarcissistic Personality DisorderAddiction and Substance abuseVictim of Abuse or trauma
Methods of Eating DisordersPersons with eating disorders may utilize
different methods as their illness evolvesCalorie reductionExcessive exerciseInduced vomiting (mechanical or chemical)Misuse of laxatives, dieting pills, enemas,
diuretics Insulin misuse
What does 300 calories look like?
Anorexia NervosaSeek to maintain a BMI <18, most often with
calorie reductionRitualistic /analytical eating habitsPreoccupation with weight/size and anxiety
with weight gainLifetime prevalence of 1% in women, 90% of
cases are female Anorexia nervosa has a mortality rate of 20%,
giving it the highest mortality rate of all psychiatric disorders10% die within 10 years of diagnosis35% fully recover
(www.state.sc.us/dmh/anorexia/statistics.htm, 2011)
Body Mass index
Bulimia NervosaEngage in compulsory consumption of high
calorie foods during binge episodes often followed by purgingCyclic pattern of calorie restraint, excessive intake
and purgingBinge on high calorie, high sugar and high fat foodsBinge-purge twice/week x 3 months per DSM 4Episodes occur in private, beyond volitional control
Usually have a BMI >18Episodes are often triggered by stressful events
and changes (www.womenshealth.gov/faq/bulimia-nervosa.cfm#a, 2011)
Pro-Ana, Pro-Mia and Pro-EdA n eating disorder community who
collectively deny the pathology of their habits, defend their condition as a lifestyle choice and maintain extreme thinness as a form of beauty
Thinspiration pictures
http://www.bukisa.com/articles/381852_45-pro-ana-tips-and-tricks
AssessmentWhat would you include in your assessment?
Questions?Measurements?Labs?Diagnostics?
Medical TreatmentsStandard:
History: height/weight, eating/dieting habits , body image, menstrual habits, stressors/coping
Labs: CBC, chem panel, thyroid levels, estrogen, albumin/prealbumin, urinanalysis, ABG
Diagnostics: VS, EKG
>20% below BMI: chest x-ray, 24hr creatinine clearance, bone density scan, echocardiogram (mitral valve prolapse) EEG, brain imaging
(www.nationaleatingdisorders.org/uploads/file/Screening%20for%20Eating%20Disorders%20by%20Primary%20Care%20Physicians-2.pdf, 2011)
Recovery TeamMedical MD, psychiatrist Clinical psychologist/therapist, expressive therapist
Social worker, case managerNurse Dietician Teachers/School Liaison
Recovery EnvironmentsHospital Inpatient: Acute physical problemsMental Health Inpatient Facility: unstable
psychiatric problems, suicidalResidential Facility: structured living
environmentIntensive Outpatient: several hours on most
weekdaysOutpatient: weekly sessionsTelehealth: technology and telephone
resources (www.eatingdisorderrecovery.com. 2011)
Recovery InterventionsTube Feeding – with consentTreat the compounding psychiatric
conditionIndividual counseling, psychotherapyGroup TherapyFamily TherapySupport GroupsArt/Expression Therapy,
Culinary/Nutrition Sessions (www.eatingdisorderrecovery.com. 2011)
ReferencesEating Disorder Recovery (2011). Retrieved
from www.eatingdisorderrecovery.com.
National Eating Disorders Association (2011). Retrieved from www.nationaleating disorder.org
Women’s Health Information Center (2011) Retrieved from www.womenshealth.gov