Chapter 18: Eating & Feeding Disorders

Key conditions discussed include Anorexia Nervosa (AN), characterized by a significantly low Body Mass Index (BMI), an intense phobia of weight gain, and a disturbed body image, often maintained through restriction or compensatory behaviors like purging. Research highlights the neurobiological underpinnings of AN, noting genetic correlations, altered serotonin metabolism, and variations in brain structures like the insula, which interferes with interoceptive awareness and satiety signals. Nursing care for AN necessitates immediate medical stabilization for life-threatening issues, such as severe electrolyte imbalance and bradycardia, often involving structured refeeding to safely achieve 90% of ideal body weight while carefully avoiding refeeding syndrome. Bulimia Nervosa (BN) is defined by recurrent episodes of uncontrollable binge eating followed by inappropriate compensatory behaviors; these patients are typically at or near normal weight but struggle with impulse control, low self-esteem, and altered dopamine and serotonin signaling pathways related to reward processing. Cognitive Behavioral Therapy (CBT) is a first-line psychological treatment for BN, often supplemented by FDA-approved pharmacotherapy like Fluoxetine. Finally, Binge-Eating Disorder (BED) involves recurrent binging episodes that cause marked distress but lack compensatory behaviors, frequently leading to obesity and associated health risks. BED treatment focuses on binge abstinence and may utilize medications like Lisdexamfetamine dimesylate. The chapter concludes with an introduction to Feeding Disorders, which typically emerge in childhood but can persist, including Pica (ingesting non-nutritive substances), Rumination Disorder (regurgitation and rechewing), and Avoidant/Restrictive Food Intake Disorder (ARFID), where avoidance is based on sensory issues rather than body image concerns. Across all disorders, nursing management emphasizes patient-centered outcomes, milieu management, addressing cognitive distortions, and promoting improved coping skills and self-esteem.