Eating disorders: Nursing process (ADPIE)

Lily Truitt is a 22-year-old female client with a history of anorexia nervosa who is admitted to the medical psychiatric unit following signs of malnourishment at an outpatient clinic appointment.

Over the last two weeks, Lily has expressed increasing concern about the way she looks. She feels that she is overweight and has been anxious about being seen in class and at social events.

She discloses that she has been restricting her intake and that she hasn’t eaten anything in 2 days.

Eating disorders are mental health disorders characterized by abnormal eating behaviors that can negatively impact a client’s physical and mental health.

They are quite common, especially among young females, usually between 12-25 years of age. However, they can affect anybody, regardless of their sex, age, and social background.

The most common eating disorders include anorexia nervosa and bulimia nervosa.

Now, the exact cause of eating disorders is not well known, but they seem to be tied to both biological and environmental risk factors.

Biological risk factors include genetics and family history for an eating disorder, as well as associated mental health disorders like anxiety or obsessive compulsive disorder.

In addition, anorexia nervosa is thought to be associated with dysfunction in neural systems implicated in regulatory self-control and reward, which seems to be caused by a deficiency in neurotransmitters like serotonin and dopamine.

On the other hand, environmental risk factors include the psychosocial pressure to have a socially-defined “ideal body,” and having careers that promote weight loss, like modeling or sports, as well as experiencing childhood trauma, bullying, and loneliness, as well as stress and big life transitions or changes.

Symptoms vary according to the specific eating disorder. Anorexia nervosa is characterized by a constant fear of gaining weight, associated with a distorted body image, with individuals often believing that they are overweight, while actually being underweight, with a Body Mass Index or BMI lower than 18.5.

To avoid gaining weight, clients with anorexia may engage in two main compensatory behaviors. One is the restricting type, where clients reduce the amount of food they eat or over-exercise in order to lose weight without any purging.

The other is the binge-eating and purging type, where clients eat large amounts of food in one sitting and then purge that food through self-induced vomiting or by taking laxatives or diuretics, and this occurs recurrently for at least 3 months.