What Every Nurse Needs to Know About Eating Disorders

JanineKelbach, RN

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), each year, more than 30 million people of all ages have an eating disorder. Eating disorders are considered a mental illness, and one of the most deadly. Many nurses don't know about eating disorders, or how to effectively care for the patient.

Types of Eating Disorders

There are six different types of eating disorders. They include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Pica, Avoidant/Restrictive Food Intake Disorder, and night eating syndrome. Even though you are a nurse and have probably heard about most or all of these disorders, this article will help break them down a little further.

Anorexia Nervosa

Anorexia Nervosa or what many refer to as anorexia is a disorder in which the caloric intake is not enough for what the body needs. Losing weight is a visible sign of anorexia, but it goes into more than that. When the body doesn't get enough calories, muscle wasting and other health problems will evolve. The mental illness involvement with this disorder includes the person viewing of himself as being too fat, no matter how skinny they are.

Bulimia Nervosa

Bulimia Nervosa or as many refer to as bulimia is characterized by an episode of binge eating (eating an extremely large amount of food, following by self-induced vomiting. They also exercise to the extreme and/or abuse laxatives. The mental illness involvement with this disorder is that the person cannot control or stop eating, and also cannot stop themselves from inducing vomiting because they feel bad about what they have eaten.

Binge Eating Disorder

A binge eating disorder is recurrent episodes of binge eating. These meals are larger than what most can eat within a two hour period. The mental problem associated with it is the lack of control in stopping the behavior. They eat fast, feel uncomfortably full, eat alone, and feel disgusted with themselves.

Pica

Pica is a disorder in which the person eats substances that are not food. These food have no nutritional value, and they eat it for at least one month. Some examples include cotton, clay, or chalk. This type of disorder could be linked to a deficit in nutrition, and often pregnancy brings it on.

Avoidant/Restrictive Food Intake Disorder

Avoidant/Restrictive Food Intake Disorder, or ARFID, is a disorder in which the person is unable to meet their nutritional or energy needs. Nutritional deficiencies, dependency on dietary supplements, not gaining weight is associated with these disorders.

Night Eating Syndrome

This diagnosis is made to those who consume 25% of their calories after their nighttime meal. The classic sign of this disorder is waking up to eat, after going to bed.

How to care for eating disorder patients

Even though we are nurses, we are human and tend to have judgemental thoughts. Many of us cannot understand why someone won't eat, why someone makes themselves vomit, or why someone wants to eat chalk. It's not our job to figure out the why, but understand the mental illness side of the disorder. As a nurse, it is our job is to help them and care for them. Finding them help is critical.

As the nurse for any of these patients, you have to monitor their food intake. If they are not taking in enough nutrition, they are at a danger of other health conditions, like muscle wasting and cardiac problems. You may have to supervise the bulimic patients after eating to make sure they do not make themselves vomit. To help with bulimia, setting time restrictions on meals may help. The most difficult part of caring for these patients is often the mental part.

Psychological care for eating disorder patients

The nurse has a hard job. The most difficult part of the job is to stay non-judgmental and open to the patient. You want to be open to be able to be there when the patient is ready to tell you her concerns. The nurses are with the patients the most, that means, you may get the most "out" of the patient through conversations.

We also have to be there for the family and help them to become more open to the patient. Depending on the situation, sometimes the patient is ashamed, and sometimes they are suicidal.

What else can you do clinically as a nurse? Watch for skin breakdown, help with anxiety by setting time limits on food intake. And monitoring them for excessive activity.

The Journal of the Clinical Nursing wrote an article titled, "Effective Nursing Care of Adolescents Diagnosed with Anorexia Nervosa: A Patient's Perspective." In that article, it described nurses as three role models for patients suffering eating disorders.

Nurses as decision makers - nurses provide a highly structured environment, eliminating excessive eating and exercise
Nurses as role models - nurses normalize eating behaviors by showing the patient normal eating behaviors
Nurses as support systems - nurses help support patients and bring back normalcy to eating and exercise patterns
Along with the help of psychology, the nurse can help these patients start their road to recovery.

Resources

Did you know there's a helpline to help patients who may:

Have feelings that could be affecting their eating
Help to get through a meal
Encouragement
Help stop a binge of purge
Family members who are concerned about their loved one

That number is 630-577-1330 - For now, this number is Monday through Friday 9am-5pm, a goal is to have that line 24/7 in the future.

Screen for eating disorders: Get Screened | nedawareness.org

Are you a nurse who works with this type of population? What are your insights?