Eating Disorders

Whispera, MSN, RN · Oct 2, 2009

When I first graduated from nursing school, I worked in a general hospital, on a psych unit where one of our specialties was caring for patients with eating disorders. We quit caring for eating disordered patients, though, when insurance companies quit paying for their treatment.

It was very interesting. The patients were there for 28 days, and worked to increase their diet to a healthy one, bit by painful bit, and to gain weight. They had all sorts of groups and individual therapy on learning a realistic body image of themselves, and learning what to do. Most of our patients were young women in their early twenties, but we had some older women and also some young men as patients. All were highly intelligent and motivated to be successful in life. They could also be very manipulative and sneaky. They found ways to hide food I never would have dreamed of doing. They would find ways of exercising that boggled my mind. They could vomit with what seemed to me like barely any thought at all! I have lots of stories, but wouldn't want to type them here, since I'd consider it a violation of confidentiality. If you can get into this line of work, it will be never a dull moment, you'll love the patients, they'll drive you almost over the edge, and you'll be joyous when you see some of them get better.

ceamaifrumoasafata23 · Oct 6, 2009

I dont think if you are telling stories with no names or pictures ,is a violation of confidentiality. we would love to hear some stories .I always share stories from my experience but I never mention names or room # or anything specific to the patient .Thanks :)

Orca, ADN, ASN, RN · Oct 6, 2009

We used to get quite a few bulimics. Since we weren't a treatment center for eating disorders, these patients (usually young women) were normally referred for more intensive treatment elsewhere.

We also dealt with a lot of active duty military personnel, and some were battling mental health issues that made it difficult for them to meet weight requirements. This sometimes created some strange adaptations. One woman developed a total aversion to any food or drink. She wouldn't take her prescribed medication because she said that the water we gave her to swallow her pills with would make her gain weight.

Whispera, MSN, RN · Oct 6, 2009

When I said I thought it would be a violation of confidentiality to tell my stories here, I didn't mean in the legal sense, but more in a moral sense. I think telling stories about patients can violate their trust in the nurse, if they're told in a way that could be seen as in any way entertaining. I think it's hard to draw a line on what's ok to tell and what's not. I know I would never want to say or type anything that a person could read and know it's about him or her, and I don't want to have my past patients be the source of caregivers' chuckles.

You never know who's reading this. This became personal to me when my mom was a psychiatric patient where I worked, and I arrived one day and heard the staff talking about the bizarre little old lady who had been brought in the night before. I wasn't working on the unit where my mom was hospitalized but my unit shared a nursing station with the nurses who cared for Mom. They didn't know I was her daughter, and they were telling each other a whole lot of things that were quite humourous, but to me, as the daughter of an extremely ill mom, they weren't funny at the time. You never know who's nearby, overhearing, or reading what you write here. I believe we must use much caution and care in all we post here.

wonderbee, BSN, RN · Oct 7, 2009

This summer I began signing up for shifts on the eating disorders unit. It is quite different from any other unit I've worked on. Everything revolves around refeeding. It's all hands on deck during meals and snacks. The kitchen is stocked to the brim. I tend to over eat so this is not the best environment for me since I'm a foodaholic. Love food and love to eat it. I was surprised to learn the calories are restricted and food groups are adhered to. The body can go into shock if refeeding is done to quickly.

These patients are high functioning, intelligent, often controlling and manipulative. Usually women in their 20's though young adolescent and preadolescent males (as young as 8, male and female) do get admitted. They love to entertain and are eager to please. I have also noticed a high degree of borderline behaviors. They have a lot of personal grooming items from home and for the most part, contraband restrictions are more relaxed. Some have sad stories with a general theme of abandonment or fear thereof; others seem to come from cookie cutter families that dote on them. Activities are highly structured and there is often competition for the spotlight during group. Most are there for at least a month and it's interesting to watch them bond and watch out for each other.

Because they come in as low as 50% of the minimum standard body weight, general health problems are common. Bradycardia is pretty standard. Also they are always cold because they lack insulation.

I encourage you to work on an eating disorders unit if you get the opportunity. It's a refreshing change from mood and psychotic disorders.

ceamaifrumoasafata23 · Oct 7, 2009

Thank you so much for sharing ur experience with us ! I would love to get on eating disorders unit.

Whispera sorry about ur experience with your mom.That sounds tough!!!!

jojom · Oct 17, 2009

Any experiences from Canada to share! No insurance problems, thats for sure....but the frustrations, the challenges and the rewards are the same. Would love to hear everything. we really do need to share on all the hiding stuff so that we can all be aware, nothing to do with confidentiality at all. Lets share so we can be better nurses in this department and be on top of it all.

Here is mine..... Asking to put milk in the fridge because they like it cold, but dumping it and then taking an empty carton to the table,

When weighing in the morning, check the sleeves of the gown, found weights taped around the upper arms.

Whispera, MSN, RN · Oct 17, 2009

food hiding: under the plate, under the metal thing that goes under the plate but over the bottom of the container that is supposed to maintain heat in the whole thing, in a plant, in the trash, in a napkin (between the metal thing and the bottom of the container), in the milk carton or coffee cup (with lid put back on).

staff must be in the room during meals

bathrooms may not be used for 1/2 hour after meals, nor during meals

patients must stay in the eating room for 1/2 hour after meals

patients should be told these are the rules before they are admitted too

it's common for patients to drink lots of water before being weighed, so it looks as if they have gained weight

rachelgeorgina · Oct 19, 2009

^ I've heard of a pediatrician who used to bladder scan all her patients before weighing them to check for water loading. Like, an actual bladder scan! She also took her own orthostatic BPs because she didn't trust the nursing staff...

As for hiding food? Using butter as a glue to stick bread underneath the table, the chair, on another patient, butter/peanut butter/jam/honey in hair, breasts of chicken down other patient's tops, diet coke inside a chocolate flavoured Fortisip... It gets very creative, no?

jojom · Oct 20, 2009

Thanks for the replies...

We also sit with the group for meals. Just before they sit, the bottom metal dishes and lids are taken away and set back on the cart. I find a good one also is getting butter or peanut butter all over their fingers, then excessively using a napkin to wipe. When this happens, we take the napkin away. One other we have instituted for some, if we need to, is putting the spreads on ourselves. That way there is less temptation to get it all over your fingers.

We disallow bathroom for 1 hour after meals. If they have to go, we go with them.

We have two staff with a group of 6 patients, for all meals. ( We only have 6 beds. ) After meals we check all cartons and if anything is found, it must be replaced with liquid nutrition.

We weigh in the a.m. and someone stands outside of the room to ensure the water has not been turned on so they cannot drink. The bladder scanner is a great idea but we don't have the time with only 1 nurse trying to get all the weights done at 6:30 a.m.

palemoon · May 10, 2010

I know I'm late on this topic, but I as an ED patient (now in recovery after 4 long years) turned nursing student, a few things I would have liked the nursing staff to know on the psych unit I was hospitalized on multiple times:

1. As stated by other posters, I am a very intelligent person whose illness forces me to manipulate you to prevent me from eating. I don't enjoy this any more than you do, but still, NEVER let your guard down around me.

2. In a secret part of me I may never tell you about, I am grateful someone has taken over my life which, though I may swear otherwise, is completely out of control.

3. You may not understand my complex need to not eat. That's totally fine. What goes a long way is attempting to understand, with active listening. Being ignored and hushing up my feelings contributed greatly to me getting sick in the first place. When my symptoms flare up, I am trying to communicate what I can't say in words. Don't ask me, "Why won't you eat?" Instead, ask, "What do you want to say to me right now?"

4. Again, you may not see it right away. But being in the hospital may be the first real support I've gotten in a long, long time. People finally "get" me, and I don't have to constantly keep up this facade of being fine while my mental, physical, social, and spiritual health slowly but surely degrade. It was, and still is, the best thing that could have been done for me, though I appeared to fight and kick the whole time.

Thanks to the psych nurses who cared for me until I could get well enough to help others like me :).