13.4 Applying the Nursing Process to Eating Disorders
People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-client relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating.[1]
This section will apply the nursing process to anorexia and bulimia nervosa.
Assessment (Recognizing Cues)
When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques are required. Review signs and symptoms associated with various eating disorders in the “Basic Concepts” section.
A complete nursing assessment includes mental status examination, psychosocial assessment, and screening for risk of suicide or self-harm. Nutritional patterns, fluid intake, and daily exercise should also be assessed. If the client has a binging or purging pattern, the amount of food eaten and/or the frequency of these behaviors should be assessed.
Mental Status Examination
See Table 13.4a for common findings when assessing a client with an eating disorder. (See expected findings for these components of a mental status examination in the “Assessment” section in Chapter 4.) Critical findings that require immediate notification of the provider are bolded with an asterisk.
Table 13.4a Common Findings During Mental Status Examinations for Clients With Eating Disorders[2]
| Mental Status Examination Component | Common Findings in Eating Disorders
(*Indicates immediately notify provider) |
|---|---|
| Signs of Distress | May appear anxious, preoccupied with food, weight, or body image; may exhibit shame, denial, or resistance when discussing eating behaviors. Clients with bulimia may appear more outwardly distressed or dysregulated; those with anorexia may appear emotionally blunted. |
| Level of Consciousness and Orientation | Typically alert and oriented unless severely malnourished, in which case confusion, poor concentration, or delayed responses may occur. |
| Appearance and General Behavior | May appear underweight (anorexia), within normal weight range (bulimia), or overweight (binge eating disorder). Common findings: baggy clothing to hide body shape, pale or dry skin, lanugo (fine body hair), brittle hair/nails, signs of vomiting (e.g., Russell’s sign, dental erosion). Behavior may be avoidant or perfectionistic. |
| Speech | Generally normal in rate and volume, but may be guarded or evasive about food-related topics. Some clients may exhibit pressured speech if anxious; others may appear overly controlled. |
| Motor Activity | May be restless or hyperactive (common in anorexia), or sluggish due to malnutrition. Repetitive or ritualistic movements (e.g., fidgeting, checking body parts) may be observed. |
| Mood and Affect | Mood is often anxious, irritable, or depressed. Affect may be blunted or restricted, especially in anorexia. Clients may express low self-worth or describe feelings of shame, guilt, or emptiness. |
| Thought and Perception | Thought content often centers on body image distortion, weight obsession, and fear of gaining weight. Clients may express rigid thinking patterns or perfectionism.
*Suicidal ideation may be present in severe cases or with coexisting depression. |
| Attitude and Insight | Often demonstrate poor insight into the severity of the disorder. Clients may deny being underweight or minimize behaviors such as purging or restricting. May resist treatment, particularly if weight restoration is a goal. |
| Cognitive Abilities and Level of Judgment | Memory and attention typically intact unless severely malnourished. Clients may exhibit obsessive thoughts, poor concentration, and rigid cognitive patterns. Judgment and decision-making may be impaired by body image distortions. |
Psychosocial Assessment
As previously discussed in the “Application of the Nursing Process in Mental Health Care” chapter, a psychosocial assessment obtains additional subjective data that detects risks and identifies treatment opportunities and resources.[3],[4]:
- Reason for seeking health care (i.e., “chief complaint”)
- Thoughts of self-harm or suicide (both current and historical)
- Cultural assessment
- Spiritual assessment
- Family dynamics
- Current and past medical history
- Current medications
- History of previously diagnosed mental health disorders
- Previous hospitalizations
- Educational background
- Occupational background
- History of exposure to psychological trauma, violence, and domestic abuse
- Substance use (tobacco, alcohol, recreational drugs, misused prescription drugs)
- Family history of mental illness
- Coping mechanisms
- Functional ability/Activities of daily living
After identifying the reason the client is seeking health care, additional focused questions are used to obtain detailed information used to plan care. The mnemonic PQRSTU can be used to ask questions in an organized fashion. See Table 13.4b for a sample PQRST assessment for eating disorders and sample responses by a client.
Table 13.4b Sample PQRSTU Questions for Assessing Eating Disorders
| PQRSTU | Sample Questions | Sample Client Response |
|---|---|---|
| Provocation/Palliation
|
“What seems to trigger your eating behaviors or concerns about food or your body?” “What helps you cope or feel better?” |
“It usually starts when I feel stressed or out of control. Looking at myself in the mirror makes it worse. Skipping meals helps me feel like I’m in control again.” |
| Quality | “Can you describe the thoughts or feelings you have about food or your body?” | “I constantly think about calories and weight. Even when I eat something small, I feel guilty and disgusting. It feels like I’m never thin enough.” |
| Region | “Do you feel any physical effects from your eating behaviors—like pain, fatigue, or other sensations?” | “I’m always cold and tired. Sometimes I get dizzy when I stand up too fast. My stomach hurts, but I don’t really feel hungry anymore.” |
| Severity | “How much does this affect your daily life?” | I think about food and my body all day. It’s hard to focus on school or even talk to my friends.” |
| Timing/Treatment
|
“When did these behaviors or thoughts start? How often do they happen?”
|
“It started around two years ago, but got worse this past year. I am very careful about what I eat most days, but sometimes I binge and then purge at night.” |
| Understanding | “What do you believe is causing this? How do you understand what you’re going through?” | “When my life feels overwhelming, I focus on food and weight because it’s the one thing I can manage successfully.” |
Suicide and Self Injury Screening
Clients being evaluated or treated for eating disorders often have suicidal ideation, especially if they are also experiencing a depressive disorder. The Patient Safety Screener (PSS-3) is an example of a brief screening tool to detect suicide risk in all client presenting to acute care settings.[5]
Non-suicidal self-injury (NSSI) refers to intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Common forms of NSSI include behaviors such as cutting, burning, scratching, and self-hitting. It is considered a maladaptive coping strategy without the desire to die. NSSI is a common finding among adolescents and young adults in psychiatric inpatient settings.[6]
Review information about suicide screening, the Patient Safety Screener, and screening for non-suicidal self-injury (NSSI) in the “Assessment” section of the Applying the Nursing Process to Mental Health Care” chapter.
Cultural Assessment
Cultural Formulation Interview (CFI) questions help nurses understand a client’s cultural background and how it influences their experience of eating disorders.[7] Sample CFI questions focused specifically on understanding eating disorders within a cultural context include the following:
- Cultural Definition of the Problem
- “How would you describe the difficulties you’re having with eating, food, or your body?”
- “Are there any words or used in your community or family to describe what you’re going through?”
- Cultural Perceptions of Cause, Context, and Support
- “What do you think is causing these problems with eating or your body image?”
- “Are there cultural or family expectations around food, weight, or appearance that you think affect you?”
- “How do your family and friends view your eating habits? Do they express concerns about your weight?”
- “Do you feel any pressure from your friends to look or eat a certain way?”
- Cultural Factors Affecting Coping and Help-Seeking
- “What kinds of things have you done to cope with these feelings so far?”
- “Are there any traditional remedies, rituals, or religious practices you use to feel better?”
- “Have you tried to talk to anyone about these feelings, like family members, friends, religious leaders, or traditional healers?”
- “Do people in your community seek help for issues with food or body image? If so, from whom?”
- Cultural Features of the Nurse–Client Relationship
- ““Is there anything I should know about your background or beliefs that would help me better understand you?”
- “Do you have any concerns or hesitations you have about seeing a mental health professional?”
- “What kind of help do you think would work best for you?”
Findings from the cultural formulation interview are used to individualize a client’s plan of care to their preferences, values, beliefs, and goals.
Objective Assessment
Common objective assessment findings for individuals with anorexia nervosa and bulimia nervosa are compared in Table 13.4c. Note that clients with binge eating disorder may have obesity and gastrointestinal symptoms but do not typically have other associated abnormal assessment findings.
Table 13.4c Comparison of Assessment Findings in Anorexia Nervosa and Bulimia Nervosa[8]
| Anorexia Nervosa | Bulimia Nervosa |
|---|---|
| Low weight | Normal to slightly low weight |
| Muscle weakening (from starvation and electrolyte imbalance) | Muscle weakening (from electrolyte imbalance) |
| Peripheral edema (from hypoalbuminemia) | Peripheral edema (from rebound fluids if diuretics are used) |
| Cardiovascular abnormalities (hypotension, bradycardia, heart failure from starvation, and dehydration) | Cardiovascular abnormalities (cardiomyopathy and cardiac dysrhythmias from electrolyte imbalances) |
| Abnormal lab results (hypokalemia and anemia from starvation) | Electrolyte imbalances (hypokalemia and hyponatremia from diuretics, laxatives, or vomiting) |
| Other signs:
Amenorrhea (lack of menstruation) Lanugo (growth of fine hair all over the body) Cold extremities Constipation Impaired renal function Decreased bone density Wearing many layers of clothing due to feeling cold and also to hide body frame. |
Other signs:
Tooth erosion or dental caries (from vomiting reflux over enamel) Parotid swelling (due to increased serum amylase levels) Calluses or scars on hand (from self-induced vomiting) Seizures (purging via self-induced vomiting lowers seizure threshold) |
Diagnostic and Lab Work
Laboratory and diagnostic testing are typically performed to rule out thyroid imbalances and to evaluate for potential physiological complications resulting from starvation, dehydration, and electrolyte imbalances. Laboratory testing may include the following[9]:
- Complete blood count
- Electrolyte levels
- Glucose level
- Thyroid function tests
- Erythrocyte sedimentation rate (ESR)
- Creatine phosphokinase (CPK)
Diagnostic testing may include these tests:
- Electrocardiogram (ECG)
- Dual energy X-ray absorptiometry (DEXA) to measure bone density
Lifespan Considerations
Life span considerations influence how the client is assessed, as well as the selection of appropriate nursing interventions. It is important to individualize all interventions to the age and developmental level of the client. Review developmental stages in the “Application of the Nursing Process in Mental Health Care” chapter.
Children and Adolescents
Eating disorders (EDs) are often underdiagnosed and many adolescents go untreated, do not recover, or only reach partial recovery. Denial of symptoms is common. Higher rates of EDs are being seen in younger children, boys, and in minority groups. EDs are also being increasingly recognized in clients with obesity. Family influence must be considered. Individual treatment including cognitive behavioral therapy and family-based treatment focused on weight restoration and reducing blame can be effective.[10]
Older Adults
Older adults may present with unintentional weight loss, disinterest in food, or somatic complaints. Their focus may be on control rather than weight or body image. Symptoms may be misattributed to aging, other medical conditions, dementia, or side effects of medications. Perceived stigma may prevent older adults from discussing eating habits, body image concerns, or feelings. Grief, isolation, depression, and anxiety may increase risk for eating disorders.[11]
Diagnosis (Analyzing Cues)
Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses[12]:
- Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: More Than Body Requirements
- Risk for Electrolyte Imbalance
- Risk for Imbalanced Fluid Volume
- Impaired Body Image
- Ineffective Coping
- Interrupted Family Processes
- Chronic Low Self-Esteem
- Powerlessness
- Risk for Spiritual Distress
Outcome Identification (Generate Solutions)
Outcomes are individualized to client’s situation and diagnosis and symptoms and should address the acute nursing diagnosis with prioritization on safety. These are the typical overall treatment goals for individuals with eating disorders[13]:
- Restoring adequate nutrition
- Bringing weight to a healthy level
- Reducing excessive exercise
- Stopping binge-purge and binge eating behaviors
SMART expected outcomes are individualized for each client based on their established nursing diagnoses and current status. (SMART is an acronym for Specific, Measurable, Attainable/Actionable, Relevant, and Timely.) Examples of SMART outcomes for an individual hospitalized with anorexia nervosa who is experiencing electrolyte imbalances are:
- The client will maintain a normal sinus heart rhythm with a regular rate during their hospitalization.
- “The client will achieve and maintain normal electrolyte levels (potassium, sodium, magnesium, and phosphorus) within the reference range, as measured by daily blood tests, for at least 7 consecutive days before discharge, through adherence to the prescribed nutritional plan and medical interventions.”
Planning (Generate Solutions)
Safety
Safety receives top priority when planning and implementing interventions for clients with eating disorders who are at risk of suicide. If the client is exhibiting risk for suicide, a safety plan should be immediately implemented. Review nursing care for clients with risk for suicide in the “Application of the Nursing Process in Mental Health Care” chapter.
Planning other interventions depends on the acuity of the client’s clinical status and their established expected outcomes. As previously discussed, clients are hospitalized for stabilization. Common criteria for hospitalization include extreme electrolyte imbalance, weight below 75% of healthy body weight, arrhythmias, hypotension, temperature less than 98 degrees Fahrenheit, or risk for suicide.[14] After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling. Review the “Treatment for Eating Disorders” section for more details.
Implementation (Take Action)
Inpatient Care
Severely malnourished clients may require therapeutic enteral nutrition. Any client with negligible food intake for more than five days is at risk of developing a potentially fatal complication called refeeding syndrome. The hallmark feature of refeeding syndrome is hypophosphatemia but may also involve serious sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia. To avoid this syndrome, a thorough nutritional assessment must be performed followed by the slow reintroduction of nutrients and fluids according to evidence-based guidelines.[15]
After resolving acute symptoms, clients with anorexia nervosa begin a weight restoration program for incremental weight gain with a treatment goal set for 90% of ideal body weight. Specially trained dieticians assist in developing daily meal plans and caloric intake, and clients are generally weighed two or three times a week to gauge progress.[16]
Nurses should be aware that clients with bulimia nervosa typically establish a therapeutic nurse-client relationship more quickly than clients with anorexia nervosa. As previously discussed in this chapter, clients with anorexia nervosa often do not view their condition as a disorder and value their obsessive-compulsive behaviors with eating as a way to feel safe and secure and avoid negative feelings. Conversely, clients with bulimia nervosa view their behaviors as problematic and desire help.[17]
Outpatient Care
Outpatient partial hospitalization is an option for clients who have been medically stabilized. In this setting, clients are in a clinical setting during the day and then go home to practice skills in the afternoon. Outpatient treatment continues if the client maintains a contracted weight, vital signs are within a normal range, and there is an absence of disordered eating behaviors.[18]
A significant part of the recovery process includes rebuilding relationships with family. Family members or significant others often feel frustrated, powerless, and hopeless. Family members may feel overwhelmed and exhausted at the level of care and monitoring required to support the client with an eating disorder into recovery because the strategies they previously attempted, such as forcing the client to eat or begging the client to eat, were not successful. The nurse helps with this recovery process by providing education to the client and their loved ones about the illness, treatment, and meal planning. Adaptive coping skills to address disordered thoughts should be reinforced.[19] Review information about coping strategies in the “Stress, Coping, and Crisis Intervention” chapter.
Nursing Interventions for Eating Disorders Based on Categories of the APNA Implementation Standard
Nurses individualize interventions based on the client’s current clinical status and their phase of treatment. Interventions can be categorized based on the American Psychiatric Nursing Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy; and Therapeutic Relationship and Counseling. (Review information about these subcategories in the “Application of the Nursing Process in Mental Health Care” chapter.) Read nursing interventions for clients with eating disorders categorized by APNA categories in Table 13.4d.
Table 13.4d Examples of Nursing Interventions for Clients with Eating Disorders by APNA Subcategories[20],[21]
| Subcategory of the APNA Standard of Implementation | The nurse will … | Rationale |
|---|---|---|
| Coordination of Care | -Communicate client trends with interprofessional team members, such as risk for suicide and target weight. A target weight and daily caloric intake are set in collaboration with the dietician and the provider.
-Collaborate with interdisciplinary team (physician, dietitian, therapist, social worker) to create a personalized care plan. -Refer to community resources and outpatient treatment. |
Eating disorders require multidisciplinary management to address medical, psychological, and nutritional needs. Involving the family supports continuity and adherence.
|
| Health Teaching and Health Promotion | -Provide education about the physical and psychological effects of eating disorders. Teach about nutrition, body image, and coping strategies using age-appropriate language. Address myths about weight, food, and health.-Promote health by teaching adaptive coping strategies such as journaling. Support basic skills such as learning how to create meal plans, shopping at the grocery store, and navigating family or social eating situations. |
Education increases insight, empowers recovery, and reduces maladaptive beliefs. Promoting healthy lifestyle choices supports long-term change. Nurses encourage resilience by promoting healthy coping strategies, communication, and problem-solving skills. |
| Pharmacological, Biological, and Integrative Therapies | -Deliver client education about antidepressants or other prescribed medications with expected time frames for improvement.
-Monitor for side effects and signs of malnutrition (e.g., bradycardia, electrolyte imbalance). -Incorporate mindfulness, journaling, or guided imagery to reduce anxiety. |
Medications may help with comorbid anxiety or depression. Integrative therapies enhance self-regulation and reduce relapse risk. Medical monitoring ensures safety during nutritional rehabilitation. |
| Milieu Therapy | -Create a structured, nonjudgmental environment with consistent meal and weigh-in routines. -Establish therapeutic norms for group therapy and communal eating. -Monitor for food hoarding, purging, or excessive exercise.-Provide a pleasant, calm atmosphere at mealtimes. Emphasize the social nature of eating. Encourage conversations during mealtimes that do not involve the topics of eating or exercise.-Observe clients during meals to prevent hiding or throwing away food and at least one hour after eating to prevent purging.-Encourage the client to make their own menu choices as they approach their goal weight. |
A therapeutic milieu provides predictability and safety, reduces secrecy, and supports behavioral stabilization. It also models healthy social interactions. The milieu of an eating disorder specialty unit is purposefully organized to assist the client in establishing healthy eating patterns and normalization of eating. The highly structured environment provides precise mealtimes, adherence to the meal plan, close observation of bathroom trips, and monitoring potential access to laxatives or diuretics. Mealtimes can cause episodes of high anxiety. The client should feel accepted and safe from judgmental evaluations in the milieu with a focus on eating behaviors and underlying feelings of anxiety, dysphoria, low self-esteem, and a lack of control. |
| Therapeutic Relationship and Counseling | -Provide 1:1 therapeutic communication to encourage the client to develop adaptive coping strategies, use stress management techniques, develop supportive relationships, and seek spiritual resources.
-Acknowledge the emotional and physical difficulty the client is experiencing. -Use motivational interviewing and contract with the client to increase their ownership of treatment goals. -Weigh the client daily in their underwear for the first week and then three times a week. Do not allow oral intake before the morning weigh-in. It is permissible for the client to not view the scale during the weigh-in. -Administer liquid supplements as prescribed. -Be empathetic with the client’s struggle to give up control of their eating and weight as they are expected to regain weight. Encourage the clients to verbalize or use a journal to record their feelings surrounding eating disorder behaviors. Confront irrational thoughts and beliefs to promote healthy eating behaviors. -Monitor physical activity and individualize the client’s plans for exercise. -Focus on the client’s strengths, including their work on normalizing weight and eating behaviors. Reinforce the knowledge and skills gained from individual, family, and group therapy sessions. |
Effective therapeutic techniques for clients with depression can promote hope and positive self-esteem. Clients with eating disorders often struggle with control and perfectionism; a supportive approach fosters motivation for recovery.
The first priority is to establish a therapeutic relationship. A client’s feelings of fatigue can be used to engage cooperation in the treatment plan. Motivational interviewing is a collaborative, goal-oriented style of communication. It is designed to strengthen personal motivation and commitment to specific goals by eliciting and exploring the person’s reasons for change within an atmosphere of acceptance and compassion.[22] Accurate weight taking and monitoring are vital. The client may try to control and sabotage the weight monitoring. The client is typically expected to gain 0.5 pound on a specific schedule. However, weight gain of more than five pounds in one week can cause pulmonary edema. The particulars of how clients should be weighed (i.e., open vs. blind weighed) is a point of debate in the field. Because viewing the scale can cause anxiety, blind weighing is typically used during the acute stage of treatment, whereas open weighing may be suitable at later stages of recovery.[23] Oral or enteral supplements may be prescribed based on the client’s status. However, be alert for refeeding syndrome in severely malnourished clients. External control is required initially to promote good nutrition and a healthy weight. Cognitive and behavioral changes will occur gradually. The client often experiences a strong drive to exercise. Nurses can assist in planning a reasonable amount of exercise. Acknowledge milestones and encourage other sources of gratification other than eating. |
Nursing Interventions for Physiological Signs of Eating Disorders
Nursing interventions also target common physiological signs of eating disorders as summarized in Table 13.4e.
Table 13.4e Nursing Interventions Targeting Physiological Signs of Eating Disorders[24]
| Problem/Intervention | Rationale |
|---|---|
Nutrition
|
Clients with eating disorders often experience malnutrition, electrolyte imbalances, and risk of refeeding syndrome. Structured support ensures gradual, safe nutritional rehabilitation. Electrolyte disturbances (especially hypokalemia) are life-threatening and common with vomiting, laxative use, and restriction. Malnutrition, purging, and starvation can lead to life-threatening cardiac changes, especially in anorexia. Early detection is critical to prevent sudden cardiac arrest. Close monitoring prevents cardiac and renal complications. |
Sleep/Fatigue
|
Anxiety, hyperactivity, and malnutrition often disrupt sleep. Adequate rest supports mood stabilization, cognition, and healing. |
Elimination
|
Disordered eating and purging can cause gastrointestinal dysfunction. Laxative abuse and food avoidance alter elimination patterns and must be managed to prevent long-term complications. |
Activity and Exercise
|
Excessive exercise is a common compensatory behavior in eating disorders and may worsen malnutrition and cardiac risk. Structured limits ensure safety during stabilization. |
Self-Care Deficits
|
Severe malnutrition and depressive symptoms may lead to poor hygiene and low motivation. Encouraging self-care promotes dignity and recovery of function. |
Communication Tips for Clients with Eating Disorders
Helpful communication techniques for building therapeutic rapport, fostering trust, and supporting recovery in individuals with eating disorders are described in the following box.
Communication Tips for Clients with Eating Disorders[25]
- Use nonjudgmental, empathetic language.
- Rationale: Clients with eating disorders often experience intense shame, guilt, or secrecy. An empathetic tone reduces defensiveness and encourages honesty and openness in discussing symptoms.
- Avoid focusing on weight or appearance.
- Rationale: Commenting on weight, even positively, can reinforce disordered thinking. Instead, focus on behaviors, emotions, and health (e.g., “I noticed you seemed more energized today.”).
- Validate emotional experiences, not just behaviors.
- Rationale: Acknowledge feelings behind behaviors (e.g., “It sounds like you were feeling overwhelmed when that happened.”). This builds trust and shifts focus from control to coping.
- Be consistent and set clear, supportive boundaries.
- Rationale: Clients may test boundaries due to anxiety or control struggles. Consistent expectations and compassionate firmness help them feel safe and contained.
- Normalize discussion of food and body image struggles.
- Rationale: Statements like “Many people in recovery have similar fears” reduce isolation and stigma, encouraging clients to share more freely.
- Collaborate in goal setting.
- Rationale: Involve clients in creating achievable recovery goals. This enhances autonomy and reduces resistance, especially in those who fear loss of control.
- Frame meal plans and interventions as health-supportive, not punitive. Use open-ended questions (such as, “What makes meals difficult for you?”) instead of coercion.
- Rationale: Clients with eating disorders often experience intense fear, shame, and anxiety around food, eating, and body image. Their relationship with food is not merely about nutrition but is often deeply tied to control, self-worth, identity, or coping with distress. When meal plans and interventions are presented in a rigid or authoritative manner, clients may perceive them as punitive or threatening, which can lead to increased resistance or noncompliance.
Referral to Resources
Nurses refer clients and their loved ones to community resources. Examples of community resources are described in the following box.
Examples of Resources for Individuals With Eating Disorders
- National Eating Disorders Association (NEDA): Support, resources, and treatment options
- Eating Disorders Resource Group: Resources including treatment apps
- ANAD: Eating disorder peer support groups
Evaluation (Evaluate Outcomes)
Evaluation is a continuous process of reviewing a client’s progress towards their individualized goals and SMART outcomes. Interventions are continually evaluated and modified based on their success in meeting these short-term goals.
Recovery is a long and difficult process. It is common for individuals to relapse. Attention should be paid to identifying triggers and warning signs of disordered eating before a relapse occurs. Ongoing support is critical to long term recovery. Potential long term medical consequences of eating disorders are neurological disease, cardiac damage, blood pressure complications and early onset osteoporosis.
General questions to include when evaluating a client’s plan of care include the following:
- Has the patient’s weight stabilized or moved closer to a healthy range?
- Are vital signs (e.g., heart rate, blood pressure, temperature) within normal limits?
- Have laboratory values (e.g., electrolytes, liver function) improved or normalized?
- Has the patient’s menstrual cycle returned (if applicable)?
- Are physical symptoms (e.g., dizziness, fatigue, hair loss) improving?
- Is the patient adhering to a structured meal plan?
- Has the frequency of restrictive eating, binge eating, or purging behaviors decreased?
- Is the patient complying with treatment recommendations (e.g., attending therapy, following medical advice)?
- Are harmful behaviors (e.g., self-induced vomiting, laxative misuse, excessive exercise) being reduced or eliminated?
- Are the patient’s relationships with family, friends, or peers improving?
- Is the patient participating in social activities, hobbies, or responsibilities they had previously avoided?
- Has the patient’s overall quality of life and ability to function in daily life improved?
- Has the patient’s preoccupation with food, weight, or body image decreased?
- Are there improvements in mood, anxiety, or emotional stability?
- Does the patient demonstrate increased insight into their illness and motivation for recovery?
- Is the patient developing healthier coping mechanisms to manage stress and emotions?
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. (2017, July). What is cognitive behavioral treatment? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Suicide Prevention Resource Center. (n.d.). The patient safety screener: A brief tool to detect suicide risk. https://sprc.org/micro-learning/patientsafetyscreener ↵
- Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01946/full ↵
- DeSilva, R., Aggarwall, N. K., & Lewis-Fernandez, R. (2015). The DSM-5 cultural formulation interview and the evolution of cultural assessment in psychiatry. Psychiatric Times, 32(6). https://www.psychiatrictimes.com/view/dsm-5-cultural-formulation-interview-and-evolution-cultural-assessment-psychiatry ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Campbell, K., & Peebles, R. (2014). Eating disorders in children and adolescents: State of the art review. Pediatrics, 134(3), 582–592. https://doi.org/10.1542/peds.2014-0194 ↵
- Lapid, M.I,., Prom, M.C., Burton, M.C., et al. (2010). Eating disorders in the elderly. International Psychogeriatrics, 22(4): 523-536, https://doi.org/10.1017/S1041610210000104 ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- National Institute of Mental Health. (2024). Eating disorders. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/eating-disorders ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: What it is, and how to prevent and treat it. BMJ, 336, 1495–1498. https://doi.org/10.1136/bmj.a301 ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- American Nurses Association, American Psychiatric Nurses Association, and International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2nd ed.). ↵
- Miller, W. R., & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd ed.). Guilford Press. ↵
- Froreich, F. V., Ratcliffe, S. E., & Vartanian, L. R. (2020). Blind versus open weighing from an eating disorder patient perspective. Journal of Eating Disorders 8, 39. https://doi.org/10.1186/s40337-020-00316-1 ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
- Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
A syndrome in which individuals exhibit hypophosphatemia, sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia.
