Clinical Care for Eating Disorders: Assessment, Treatment, and Impact on Family and Community

This article discusses the assessment, treatment, and impact of eating disorders on family and community. It covers clinical care for eating disorders, nursing interventions, and psychotherapeutic approaches. The article also highlights the importance of a comprehensive patient assessment and the role of healthcare professionals in monitoring eating patterns.

Running head: CLINICAL CARE 0
Clinical Care
Student’s name
Institution’s name

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Introduction
The current assignment focuses on the mental health issue of eating disorder
and the impact the same can have on the lifestyle, health, and surroundings of people.
Sometimes the effect is much more pronounced and effects the family members of the one
affected also. Eating disorder or binge eating often arises as an outcome of certain mental
health issues. Binge eating is mainly taken up by individuals when one is in a melancholic or
depressive state of mind. It is also a sign of the restless mind where an individual tries to
recover from their mental frustrations through indulging in food.
The eating disorder is mainly characterized by irregular eating patterns often
accompanied by large gaps which are primarily triggered by concern regarding individual
body and weight. Eating disorders are expressed equally within the male as well as in the
female. Apart from binge eating, the other types of the eating disorder include anorexia
nervosa and bulimia nervosa. The eating disorders can arise at any stage of life. However,
they are mainly are predominant during the teenage years and often co-exist with the mental
sickness issues which include depression, abuse of substance and anxiety. Most of the eating
disorders stem from a shame regarding body shape and image. The process of clinical
reasoning is used by medical professionals to aid in informed decision
making. Clinical expertise, previous knowledge and using evidence-based practice play an
important part in clinical reasoning to make the best use of patient's information in making a
judgment (Banning 2008, Lee, Lee, et al. 2016). Clinical reasoning is also helpful to care for
patients having unhealthy altered eating habits that progress to eating disorders. Eating
disorders are most commonly categorized into three, Binge eating disorder (BED), Anorexia
nervosa (AN) and Bulimia Nervosa (BN) and (Kupfer, Kuhl, et al. 2013, Maguen,
Hebenstreit, et al. 2018).

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Considering the patient’s situation is helpful when planning care for a patient having
an eating disorder. It is prevalent in younger age groups, especially in female population aged
15 -19-year-old (Smink, van Hoeken et al. 2012, Hoek 2016). Various factors including
genetic, neurobiological, psychological commonly body image dissatisfaction, personality
disorders, western cultural influence and childhood sex abuse contributes to eating disorders
occurrences (Rikani, Choudhry, et al. 2013). Patient history including family past occurences
of eating disorders and having a past or present diagnosis of mental illnesses including
obsessive-compulsive depression, disorder in mind, anxiety, etc. can also have a significant
impact on patient’s presentation of eating disorder (Cederlöf, Thornton et al. 2015).
Assessing a patient diagnosed with an eating disorder for the current issue, status on mental
health, developmental occurences, societal, medical history and current medical problems,
eating patterns and compensatory behaviors are essential for planning the care and treatment
plans (Wolfe and Gimby 2003). Current presentation like very low or high individual weight
in terms of age, physical health and sex, fearful of being overweight, being unable to sense
and control inappropriate eating habits. There is also consuming significant quantity of food
within a while, having settling behaviors to avoid weight gain are observed during eating
disorders (Harrington, Jimerson et al. 2015).
Malnutrition in anorexia nervosa can present as symptoms like brittle hair and nails,
hyperkeratosis, hypotension, amenorrhea, osteoporosis at young age. It can also progress to
more complications such as arrhythmia, bradycardia, edema etc. Due to electrolyte
imbalances and heart muscle wasting while in bulimia nervosa the clinical signs due to self-
induced vomiting include oral disease, calluses on fingers, parotid gland increase or scars,
weight fluctuations, electrolyte imbalances leading to edema, etc. (Harrington, Jimerson et al.
2015, Mehler and Brown 2015). Psychological conditions including disorder in mind,
anxiety, abuse of substance, personality, self-harm, committing suicide thoughts or

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depression are commonly comorbid with eating disorders; it is unclear whether these are
caused by or are a risk factor of an eating disorder (Herpertz-Dahlmann, Keski-Rahkonen and
Mustelin 2016).
For a patient diagnosed with this problem, it is important to consider the vast
possibilities of various medical and psychological co-morbidities, and hence a very
comprehensive patient assessment is essential to link the association of multiple diseases and
to formulate a treatment plan. Conventional diagnostic procedures for eating disorders
include SCOFF questionnaire, regular weight, height and body mass index measurements,
urinalysis to determine hydration status, ph. Level, kidney damage, routine blood pressure
measurements, electrocardiography, complete blood count, etc. (Harrington, Jimerson, et al.
2015). Deriving a pattern from the diagnosis and associated comorbidities a care plan can be
formulated by the treatment team. Attention is given to the severe medical conditions first
that may be life-threatening, for example, cardiac complications associated with the eating
disorder may require emergent hospitalization, after stabilizing those conditions focus can be
moved to improve the lifestyle and providing patient with psychological and medical support
to maintain that lifestyle.
Assessment of Eating Disorder
The occurrence of binge eating disorder within an individual could be
analyzed through comprehensive clinical assessment. As mentioned by Mehler & Andersen
(2017), the eating disorders are associated with the significant amount of health morbidities
as well as could also result in psychological distress. Some of the typical processes which
could be conducted by the attending physician to monitor the presence of eating disorder in
an individual are through routine laboratory tests, review of presenting symptoms, recording
vital health details of the patient and comparing them on each visit and conducting a

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psychometric assessment test. Some of the routine laboratory tests performed to monitor the
overall eating pattern of an individual are-liver function test, monitoring serum calcium,
magnesium and phosphorus, monitoring TSH, blood glucose. As commented by Clement et
al. (2015), the liver function tests are beneficial in determining any anomalies or
abnormalities in the metabolic process and digestion.
The health professional catering to the eating disorder concerns needs to review the
clinical symptoms expressed in the patient. Some of these could be health related or merely
psychological manifestations. The range of symptoms expressed in the patient are-fatigue,
frequent urination, heartburn, irritability, loss of menses, sleep disturbances, depression,
constipation, diarrhea, brittle hair, and nails. As supported by, self-monitoring of weight on a
regular basis can also help in regulation the obsessive eating disorder. Additionally, the
healthcare professionals could develop a range of questions to inquire regarding the eating
patterns of an individual.
Treatment and Nursing Interventions
Some nursing interventions and treatment methods could be suggested for
treatment of anorexia or eating disorder in people. The treatment or the intervention plans
have been designed concerning the overall health assessment of the patient. As mentioned by
Mehler & Andersen (2017), it is essential to consider the health co-morbidities before a
specific intervention plan could be met out to a patient. The healthcare or nursing
professionals could play a very effective role in monitoring the eating patterns of an
individual. As mentioned by Ágh et al. (2015), adequate nutrition and electrolyte balance
needs to be maintained as the lack of nutrient can lead to the development of some health
issues or disorders. Setting the time limits for each meal along with strictly monitoring
activities such as vomiting before and after eating can lead to a reduction in anxiety level

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related to eating. Additionally, monitoring the weight of the patients frequently can help in
preventing the incidents of binge eating. Integration of an individualized meal plan can also
help in restoration and stabilize normal eating (Chesney, Goodwin & Fazel, 2014). Some
psychotherapeutic approaches have been suggested for controlling the rate of binge eating in
an individual. Some of these are implemented through cognitive behavioral therapy which
helps an individual to change their perception regarding food and themselves.
The interpersonal psychotherapy focuses upon the interpersonal difficulties in a
person’s life which should be treated to bring the required changes in eating patterns. The
incorporation of a dialectical behavioral therapy helps people to figure out the emotional
distress faced by them. As commented by McElroy et al. (2015), lip-smacking food is often
seen as a way out from the melancholic and depressive mode of life. Thus, the process of the
mental based depression reduction therapy can also help in the reducing the dependence upon
food, which acts a source of stress buster.
Effect on Family And Community
An eating disorder is a severe problem in the modern world. It is a
psychological disorder which is characterized by disturbed or abnormal eating habit. For
example, nervosa is an eating disorder, where people stop eating because of the fear of
weight addition and hence, suffer from severe food restriction. The perceptions of a perfect
figure and resulting eating disorder have a profound implications on the individual, their
family and the community the individual is living in (Rohde, Stice & Marti, 2014).
Today, the mass media advertises the concept of beauty regarding youthful face and
slender figure of women, which leads to the idealization of a thin body by not gaining weight.
However, the ideal value is almost impossible to achieve, but women get panicked about their
weight and stop eating. Individuals can experience physical consequences, like malnutrition,

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together with other chronic diseases, for example, high blood pressure, diabetes, heart
disease, dental issues, heart attack, inflamed esophagus, weak bones, and sometimes even
death (Blodgett Salafia et al., 2015). The physical impact of the eating disorder shows the
implications gradually on the body system. The effects are long-term, which cast their impact
in the adulthood. If an individual suffers from this disorder and its resultant health effects,
then it is an another cost to the family of the person affected and the whole community. The
society is then burdened to provide long-term treatment to these individuals. Yu, Damhorst &
Russell (2011) state that in the future, when these young people grow up with many chronic
diseases, the community has to provide proper medical treatment at large, regarding hospital
facilities, drug counseling, and many more. The working capacity of that individual will also
be affected due to ill health, which in turn will change the work culture as well as the
productivity of the community.
The individuals with severe eating disorder suffer from isolation and substance abuse.
These can have repercussions for their families. The academic performance, social
interaction, participation in school and college programs, all get affected due to health issues
of the individuals (Moessner & Bauer, 2017). The parents want to cope up with such
problems, also get isolated from the society, which is again a major problem for the
community. As the problem of an eating disorder is more mental and less physical, it brings
extreme pressure on the individual and their families although from different perspectives.
The behavior coming from this disorder puts an emotional toll on the affected individual and
his family and friends. They start lagging behind in confidence, which gets reflected in their
regular activities of daily life and the family faces financial consequences (Gale et al., 2014).
The medical cost for such nervous problem is quite high, and the families and the society gets
affected by the cost of treatment.

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It can be said that the self-perception of an individual, influenced by the media, can
result in a disastrous effect on the individual regarding somatic and mental health and the
families and the community get affected through high medical cost and social isolation.

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Conclusion
The current assignment focuses on the aspect of eating disorder in individuals.
The eating disorder stems from psychological stress, negative self-image and failure to lose
weight. There is broad scale opinion that weight is genetically controlled and once someone
is fat they can hardly do anything about it. Therefore, failure leads to more disappointment
and as a result of which an individual has often been seen to stop making an effort altogether.
The higher the frustration, the more is the level of indulgence in binge eating. The binge
eating can result in a tremendous amount of health complications such as gastrointestinal
disorders along with obesity, which can trigger further complications. One of the most critical
methods in the control of eating disorders is through implementing useful counseling
sessions. As mentioned by Ágh et al. (2015), the counseling sessions help in changing the
view possessed by an individual regarding self and eating habits. As suggested by Clement
et al. (2015), acceptance of self in the true form can help in reducing the fidgety behavior
regarding food. However, effective nursing intervention methods are crucial in the
assessment of the obesity patterns of an individual. Some of the intervention approaches
could be delivered in the form of psychotherapy sessions. The psychotherapeutic approaches
can further help in removing the individual biases regarding self and food.

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References
Clinical reasoning
Banning, M. (2008). "Clinical reasoning and its application to nursing: Concepts and
research studies." Nurse Education in Practice 8(3): 177-183.
Cederlöf, M., et al. (2015). "Etiological overlap between obsessive‐compulsive
disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin
study." World Psychiatry 14(3): 333-338.
Obsessive‐compulsive disorder (OCD) often co‐occurs with anorexia
nervosa (AN), a comorbid profile that complicates the clinical management of both
conditions. This population‐based study aimed to examine patterns of comorbidity,
longitudinal risks, shared familial risks and shared genetic factors between OCD and
AN at the population level. Participants were individuals with a diagnosis of OCD
(N=19,814) or AN (N=8,462) in the Swedish National Patient Register between
January 1992 and December 2009; their first‐, second‐ and third‐degree relatives; and
population‐matched (1:10 ratio) unaffected comparison individuals and their relatives.
Female twins from the population‐based Swedish Twin Register (N=8,550) were also
included. Females with OCD had a 16‐fold increased risk of having a comorbid
diagnosis of AN, whereas males with OCD had a 37‐fold increased risk. Longitudinal
analyses showed that individuals first diagnosed with OCD had an increased risk for a
later diagnosis of AN (risk ratio, RR=3.6), whereas individuals first diagnosed with
AN had an even higher chance for a later diagnosis of OCD (RR=9.6). These
longitudinal risks were about twice as high for males than for females. First‐ and
second‐degree relatives of probands with OCD had an increased risk for AN, and the

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magnitude of this risk tended to grow with the degree of genetic relatedness. Bivariate
twin models revealed a moderate but significant degree of genetic overlap between
self‐reported OCD and AN diagnoses (ra=0.52, 95% CI: 0.26‐0.81), but most of the
genetic variance was disorder‐specific. The moderately high genetic correlation
supports the idea that this frequently observed comorbid pattern is in part due to
shared genetic factors. However, disorder‐specific factors are more important. These
results have implications for current gene‐searching efforts and clinical practice.
Harrington, B. C., et al. (2015). "Initial evaluation, diagnosis, and treatment of
anorexia nervosa and bulimia nervosa." Am Fam Physician 91(1): 46-52.
Eating disorders are life-threatening conditions that are challenging to
address; however, the primary care setting provides an important opportunity for
critical medical and psychosocial intervention. The recently published Diagnostic and
Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria
for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for
bulimia nervosa (e.g., the criterion for the frequency of binge episodes decreased to an
average of once per week). In addition to the role of environmental triggers and
societal expectations of body size and shape, research has suggested that genes and
discrete biochemical signals contribute to the development of eating disorders.
Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are
often accompanied by depression and other comorbid psychiatric disorders. For low-
weight patients with anorexia nervosa, virtually all physiologic systems are affected,
ranging from hypotension and osteopenia to life-threatening arrhythmias, often
requiring new assessment and hospitalization for metabolic stabilization. In patients
with frequent purging or laxative abuse, the presence of electrolyte abnormalities

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requires prompt intervention. Family-based treatment is helpful for adolescents with
anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior
therapy, is adequate for most patients with bulimia nervosa. The use of psychotropic
medications is limited for anorexia nervosa, whereas treatment studies have shown a
benefit of antidepressant medications for patients with bulimia nervosa. Treatment is
most effective when it includes a multidisciplinary, team-based approach.
Herpertz-Dahlmann, B. "Adolescent Eating Disorders." Child and Adolescent
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Hoek, H. W. (2016). "Review of the worldwide epidemiology of eating disorders."
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Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors." Current
Opinion in Psychiatry 29(6): 340-345.
Purpose of review Eating disorders – anorexia nervosa, bulimia
nervosa, and binge eating disorder – affect numerous Europeans. This narrative
review summarizes European studies on their prevalence, incidence, comorbidity,
course, consequences, and risk factors published in 2015 and the first half of 2016.
Recent findings Anorexia nervosa is reported by <1–4%, bulimia nervosa <1–2%,
binge eating disorder <1–4%, and subthreshold eating disorders by 2–3% of women
in Europe. Of men, 0.3–0.7% report eating disorders. Incidences of anorexia appear
stable, whereas bulimia may be declining. Although the numbers of individuals
receiving treatment have increased, only about one-third is detected by healthcare.

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Over 70% of individuals with eating disorders report comorbid disorders: anxiety
disorders (>50%), mood disorders (>40%), self-harm (>20%), and substance use
(>10%) are common. The long-term course of anorexia nervosa is favorable for most,
but a substantial minority of eating disorder patients experience longstanding
symptoms and physical problems. The risk of suicide is elevated. Parental psychiatric
disorders, prenatal maternal stress, various family factors, childhood overweight, and
body dissatisfaction in adolescence increase the risk of eating disorders. Summary
Eating disorders are relatively common disorders that are often overlooked, although
they are associated with high comorbidity and severe health consequences.
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The next revision of psychiatry's Diagnostic and Statistical Manual of
Mental Disorders (DSM-5)1 will be published in May 2013 and is the first revision of
this psychiatric nomenclature in almost two decades. DSM-5 involved an
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vast amounts of their time throughout this 6-year official process, as well as many
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Mehler, P. S. and C. Brown (2015). "Anorexia nervosa – medical complications."
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In contrast to other mental health disorders, eating disorders have a
high prevalence of concomitant medical complications. Specifically, patients
suffering from anorexia nervosa (AN) have a litany of medical complications which
are commonly present as part of their eating disorders. Almost everybody system can
be adverse, affected by this state of progressive malnutrition. Moreover, some of the
complications can have permanent adverse effects even after there is a thriving
program of nutritional rehabilitation and weight restoration. Within this article, we
will review all body systems affected by AN. There is also salient information about
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Rikani, A. A., et al. (2013). "A critique of the literature on etiology of eating
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The development of eating disorders including anorexia nervosa,
bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many
young women and even men in the productive period of their lives is complex and
varied. While numbers of presumed risk factors contributing to the development of
eating disorders are increasing, previous evidence for biological, psychological,
developmental, and sociocultural effects on the development of eating disorders have
not been conclusive. Despite the fact that a considerable body of research has
carefully examined the possible risk factors associated with the eating disorders, they

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have failed not only to uncover the exact etiology of eating disorders but also to
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of two factors. In this review, some risk factors including biological, psychological,
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