Chapter 32: Eating Disorders in Psychiatric Care

Eating Disorders in Psychiatric Care begins by highlighting the significant increase in hospitalizations for these conditions, noting shifting demographics that now include younger children, older adults, and a rising number of men. The text details the DSM-5 diagnostic criteria for anorexia nervosa, emphasizing the core features of restricted energy intake leading to dangerously low body weight, an intense fear of weight gain, and a profound disturbance in body image. It distinguishes between the restricting type and the binge-eating or purging type, while outlining severe physiological consequences such as cardiac dysrhythmias, electrolyte imbalances, and potential bone density loss. In contrast, bulimia nervosa is defined by recurrent episodes of massive food consumption followed by inappropriate compensatory behaviors like self-induced vomiting, laxative abuse, or excessive exercise, often occurring in individuals who maintain a relatively normal weight. The etiology of these disorders is described as multifactorial, involving a complex interplay of biological factors like serotonin and dopamine dysregulation, sociocultural pressures favoring an unrealistic thinness ideal, and various psychological theories ranging from family enmeshment to cognitive distortions. Nursing management is presented as a critical, multidisciplinary effort that prioritizes medical stabilization and weight restoration, particularly for those in the life-threatening starvation phase of anorexia. Key nursing interventions include monitoring daily caloric intake, observing for purging behaviors, managing the milieu to prevent manipulation, and fostering a therapeutic alliance built on honesty and empathy. The chapter emphasizes the importance of recognizing refeeding syndrome, a dangerous condition caused by rapid nutritional replenishment. Treatment modalities discussed include Cognitive Behavior Therapy (CBT), which holds the strongest research support for bulimia, as well as family-based treatment for adolescents and the use of Selective Serotonin Reuptake Inhibitors (SSRIs) as pharmacological adjuncts. Furthermore, the text explores emerging interventions like virtual reality for body image normalization and deep brain stimulation for treatment-refractory cases. It concludes by addressing the unique presentation of eating disorders in men and the research-based criteria for binge-eating disorder, stressing that a comprehensive continuum of care is essential for long-term recovery and relapse prevention in these chronic conditions.