Nurse’s Guide to Caring for Patients With Eating Disorders

Nurse’s Guide to Caring for Patients With Eating Disorders

Eating disorders are serious and potentially fatal conditions. Learn how nurses can identify signs and provide effective care to aid patients in their recovery. Eating disorders (EDs) don’t discriminate; they affect people of all ages, genders, ethnicities, and backgrounds. These disorders stem from distressing thoughts or emotions and can lead to severe health complications and even death if untreated. Early detection and proper treatment are essential for positive outcomes.

The Associate Dean of Regis College School of Nursing, Cassandra Godzik, emphasizes the crucial role of nurses in identifying patients with eating disorders. She points out that EDs are often kept secret, like in cases of binging/purging disorders due to the shame and guilt associated with the condition.

Godzik explains further, stating, “Patients might visit the doctor’s office, and it’s often nurses who ask about their overall health, including their appetite, sleep, and exercise habits.”

This guide offers a comprehensive look into eating disorders and the significant role nurses play in their care.

Key Facts About Eating Disorders

– Approximately 28.8 million Americans will experience an eating disorder during their lifetime.
– Between 2018 and 2019, around 10,200 deaths were linked to eating disorders.
– Less than 6% of people with an eating disorder are medically classified as “underweight.”

National Association of Anorexia Nervosa and Associated Disorders
Deloitte Access Economics: Social and Economic Cost of Eating Disorders in the United States of America

The Role of Nurses in Caring for Patients With Eating Disorders

Nurses are crucial in recognizing harmful eating patterns and offering comprehensive care to patients from detection to recovery. The goal is to adopt a holistic, multidisciplinary approach to caregiving.

Monitoring nutritional status, weight, electrolyte balance, and activity, as well as observing diuretic and laxative use, are vital aspects of a nurse’s role.

Patients also need emotional support as they navigate through deep pain and distressing thoughts. Nurses can build trust through active listening, empathy, and positive reinforcement. They can promote independence, educate patients and families, and set goals to encourage healthy coping strategies, positive body image, and self-worth.

Godzik outlines the nurse’s role in caring for patients with EDs, which includes:

– Active listening
– Being available and present
– Open and honest communication
– Allowing patients time to reflect on the best approach for recovery
– Embracing a multidisciplinary approach and advocating for patients
– Maintaining a nonjudgmental attitude

Identifying an Eating Disorder

Nurses often serve as the initial point of contact for patients, enabling them to identify EDs through routine assessments of vital signs, weight, and dietary patterns.

Both physical and emotional signs can serve as indicators of eating disorders. Physically, signs can include cardiac irregularities, high blood pressure, hair loss, weight changes, fainting, tooth decay, skin problems, and bruised knuckles.

Emotionally or behaviorally, indicators might encompass depression, impulsiveness, perfectionism, isolation, post-meal bathroom visits, hoarding food, excessive exercise, or hidden eating.

Individuals Prone to Developing an Eating Disorder

EDs are believed to result from a mix of biological, psychological, and sociocultural factors. The path to recovery starts with identifying the underlying causes and risk factors.

The National Eating Disorders Association and the National Alliance on Mental Illness have identified risk factors associated with ED development. Biological factors can include dieting, having a family member with an ED or mental disorder, and Type 1 diabetes. Adolescents, young adults, and females are often at higher risk.

Psychological factors might involve distorted body image, perfectionism, anxiety, obsessive-compulsiveness, or social phobia. Sociocultural factors include diet trends, societal body ideals, overprotective parenting, experiences of bullying, and involvement in activities like gymnastics or dance.

Modern Medicine: Evolution and Advancements

Despite identifiable risk factors, an ED can emerge regardless of age, race, socioeconomic status, body type, or gender. For instance, EDs aren’t always externally visible. Dispelling misconceptions is vital in preventing misdiagnosis.

Various Types of Eating Disorders

EDs aren’t just about unhealthy dietary choices; they’re harmful attempts to manage emotional struggles. Just as there are diverse risk factors contributing to the development of an eating disorder, there are various types of eating disorders.

Anorexia Nervosa

The National Institute of Mental Health (NIMH) defines AN as “characterized by significant and persistent reduction in food intake, leading to extremely low body weight for age, sex, and physical health; an unrelenting pursuit of thinness; a distorted body image and intense fear of weight gain; and extremely disturbed eating behavior.”

AN carries a heightened risk of morbidity and mortality due to medical complications associated with self-imposed starvation or suicide.

AN can emerge at any age, but it’s more common among adolescent females, with an average onset age of 18. Other risk factors include life transitions, traumatic experiences, dieting, genetics, and cultural influences. AN might coexist with an extreme desire for perfectionism or obsessive-compulsive disorder.

Symptoms of AN can manifest as physical signs of malnourishment or behavioral shifts. Common indicators include severe caloric restriction, emaciation, an overwhelming fear of weight gain, wearing loose clothing, and distorted body image.

Bulimia Nervosa

According to the NIMH, BN is characterized by “episodes of binge eating (consuming large quantities of food within a short period and experiencing a loss of control), followed by behaviors intended to compensate for the binge, such as purging (vomiting, excessive use of laxatives, or diuretics), fasting, or excessive exercise.”

BN usually begins in late adolescence or early adulthood, and it is more prevalent among females. The average onset age is 18. Genetic predisposition, family history, previous traumatic experiences, distorted body image, and psychological factors like depression and anger contribute to its development.

Symptoms of BN may include calloused or bruised knuckles, weight fluctuations, irregular menstruation, and dental problems. Isolation, fainting, dry skin, hoarding food, or excessive exercise can also serve as warning signs.

Binge-Eating Disorder

According to the NIMH, BED is the primary eating disorder in the United States. It involves “recurrent binge-eating episodes characterized by a loss of control and intense distress over eating. Unlike bulimia nervosa, binge-eating episodes are not followed by purging, excessive exercise, or fasting. Consequently, individuals with binge-eating disorder often experience overweight or obesity.”

BED is more prevalent among females, particularly in the age groups 45-59 and 19-29, with an average onset age of 21.

Other risk factors include genetic predisposition, family history, psychological issues such as depression or anger, substance misuse, distorted body image, and past traumatic experiences. Dieting and boredom are additional factors contributing to BED. Symptoms may encompass eating even when full, secretive eating, consuming large amounts of food, frequent dieting, and feelings of shame, depression, disgust, and guilt.

Other Varieties of Eating Disorders

Avoidant-restrictive food intake disorder involves limiting food intake without the distorted body image or fear of weight gain typical of AN. Unspecified feeding or eating disorders and specified feeding or eating disorders are additional categories

Other specified feeding or eating disorders (OSFED) include purging behaviors without bingeing. Night-eating syndrome involves waking up during the night to consume a significant amount of food. Pica disorder involves consuming non-food items. Rumination disorder entails regularly regurgitating food, which may be re-chewed, re-swallowed, or expelled.

Acute Care Nursing: Providing Immediate Medical Care

Nurse’s Best Practices in Caring for Patients With Eating Disorders

The nurse’s role is a cyclical process, involving detection, recovery, and ongoing monitoring. Godzik stresses that “Nurses working with ED patients should recognize that patients can indeed achieve recovery from an ED. However, this is something that nurses should continually monitor.”

The best practices for nurses include:

1. Mindful Communication

Nurses need to communicate with sensitivity when interacting with ED patients. They should avoid commenting on weight, appearance, or food consumption.

Godzik emphasizes the significance of asking patients if they want to know their weight. “Healthcare providers, including nurses, should avoid commenting on their patients’ weight changes (‘You’ve lost so much weight. You look fantastic!’ … or ‘I see you’ve gained weight. What’s happening in your life?’).” Such comments can be distressing for patients who have dealt with ED behaviors before.

Promoting positive self-talk might involve complimenting patients on qualities unrelated to appearance or highlighting aspects they appreciate about themselves.

2. Identifying Possible Triggers

Setbacks can happen during a patient’s recovery journey. Recognizing triggers can help minimize the risk of relapse. Patients can create a plan to prevent relapse by identifying triggers and getting rid of their scales while establishing a healthier eating plan.

During each appointment, nurses should regularly ask about patients’ appetite and closely observe changes in vital signs, height, and weight. “Life stressors can trigger emotions that might lead to relapse,” warns Godzik.

However, she emphasizes that “nurses should remember that patients in recovery from EDs can be sensitive to discussions about weight. Nurses should be aware that not all patients want to receive information about their weight, as it can trigger rumination about their eating behaviors.”

3. Collaborative Care Plan

Nurse case or care managers empower patients to take control by guiding them to actively participate in managing their ED. By offering guidance, nurses can help patients create a care plan that includes meals (e.g., frequent small meals with snacks), physical and social activities, and an overall healthier lifestyle.

4. Offering Support and Resources

Nurses establish a safe space through active listening, empathetic communication, and an open attitude. As advocates, t, multidisciplinary team approach. They can provide patients and their families with referrals, sharing information about support groups and other resources related to eating disorders.

Common Treatments and Therapies for Eating Disorders

Individuals diagnosed with EDs experience intense emotional turmoil due to traumatic thoughts or experiences. As patients address their trauma, the risk of ED behaviors can escalate. Patients are also at a heightened risk for suicide, mental health disorders, physical ailments, and substance misuse. A comprehensive approach to treating eating disorder symptoms yields the best results.

Standard treatments for EDs include nutritional counseling and psychotherapies. Psychotherapy may involve group sessions, family therapy, and individual psychotherapy like cognitive-behavioral therapy (CBT). Medications such as antidepressants, antipsychotics, or mood stabilizers can also be part of the treatment.

“The treatment goals for a patient with an eating disorder should be patient-centered, meaning that the patient and the nurse collaboratively formulate recovery goals.”
– Cassandra Godzik

Godzik emphasizes, “Treatment goals for patients with eating disorders should be patient-centered, meaning that the patient and the nurse collaboratively formulate recovery goals. Goals and outcomes are determined jointly with the patient, rather than being imposed on them.”

Godzik highlights that treatment may involve incorporating family members or a patient’s friends to offer support. “It’s a collective effort.”

“Some potential goals during ED treatment,” says Godzik, “might include (1) refraining from engaging in ED behaviors (calorie restriction, bingeing, and purging) during the upcoming week; (2) restoring weight to a healthy body mass index range; and (3) participating in group or individual therapy twice a week.”

Looking Beyond Food

Given the diverse risk factors, detecting EDs can be challenging. Nurses play a crucial role in recognizing risks and clinical presentations of EDs, guiding patients through recovery.

Continuing education empowers nurses to stay up-to-date on EDs. By applying knowledge and nursing strategies in the care of ED patients, nurses greatly contribute to positive patient outcomes.

Helpful Resources for Nurses Dealing With Eating Disorders

MedlinePlus.gov – Eating Disorders

MedlinePlus.gov provides information about different types of eating disorders, including their causes, risk factors, symptoms, and clinical presentation. The website also outlines diagnostic tests and treatment options.

National Association of Anorexia Nervosa and Associated Disorders

ANAD is a leading nonprofit organization that offers free peer support services for individuals dealing with disordered eating and body image struggles. Volunteers share insights from personal experiences and recovery from EDs.

Cleveland Clinic – Eating Disorders

Cleveland Clinic offers eating disorder treatments involving psychotherapy (such as CBT, family-based treatment, and the Maudsley approach), medication, and nutritional counseling. A comprehensive approach combining multiple treatments is recommended.

The SCOFF Questionnaire

Healthcare professionals designed the SCOFF questionnaire as a screening tool to assess patients with potential EDs. The questions are:

– Do you induce vomiting due to feeling uncomfortably full?
– Do you worry about your loss of control over how much you eat?
– Have you lost more than one stone (14 lbs.) within a three-month period?
– Do you view yourself as fat even when others consider you thin?
– Does food dominate your thoughts?