Psych / Mental Health · Eating Disorders
Eating Disorders
open a plain-language definition. Tap or click them, or press Enter on the keyboard.
On this page
Prepared for Pass the Shift (owner: Kristina, RN). Always follow your facility’s protocols, provider orders, and current references.
If you or someone you know is in crisis: call or text 988 (Suicide & Crisis Lifeline, U.S.) or call 911 for immediate danger. This guide is for exam study, not for diagnosing or treating anyone.
1. Overview
Eating disorders are serious mental illnesses with the highest mortality of psychiatric disorders (from medical complications and suicide). They affect all genders, body sizes, and backgrounds; onset is often adolescence.
| Anorexia nervosa | Bulimia nervosa | Binge-eating disorder | |
|---|---|---|---|
| Core | Restriction → significantly low body weight, intense fear of weight gain, distorted body image | Recurrent binges + compensatory behavior (vomiting, laxatives, diuretics, fasting, excess exercise) | Recurrent binges with loss of control and distress, no regular compensation |
| Weight | Low | Often normal | Often higher weight |
| Insight | Often denies illness | Usually ashamed, secretive; more insight | Shame, guilt |
Also: ARFID (avoidant/restrictive food intake, not driven by body image). Contributors: genetics, perfectionism, anxiety, trauma, cultural pressures, sports emphasizing weight.
2. Signs & Complications
Anorexia (starvation): bradycardia, hypotension/orthostasis, hypothermia, cold intolerance, , dry skin, brittle hair, amenorrhea, constipation, osteoporosis, anemia/leukopenia, hypoglycemia, arrhythmias (QT prolongation).
Bulimia (purging): hypokalemia (arrhythmias — most dangerous), from vomiting, dental erosion, parotid (salivary) gland swelling, , esophagitis/tears, dehydration; laxative abuse → metabolic acidosis, dependence.
3. Priority Nursing Actions
- Physiologic stability first: vitals including orthostatics, cardiac monitoring, electrolytes (K, Mg, phosphate), glucose, weight
- Refeeding safely: start nutrition and advance per dietitian/provider; watch for — low phosphorus, K, Mg; fluid overload, edema, heart failure, arrhythmias (highest risk first ~1–2 weeks)
- Supervise meals (set time limit, e.g., 30 min) and observe 1–2 hours after meals (bathroom access supervised) to prevent purging
- Weigh consistently: same time (usually morning after voiding), same scale, gown only, back to the scale if per protocol; check for hidden weights/water loading
- Monitor I&O, exercise (limit excessive activity), and bowel patterns
- Focus on feelings, not food: don’t bargain or argue about food; use a behavioral contract with privileges tied to progress
- Assess for suicide risk, self-harm, depression, and anxiety
4. Treatment & Medications
- Nutritional rehabilitation with a dietitian; multidisciplinary team
- Therapy: family-based treatment (Maudsley) for adolescents with anorexia; CBT/CBT-E for bulimia and binge eating; DBT
- Fluoxetine is FDA-approved for bulimia (often at higher doses)
- Lisdexamfetamine is FDA-approved for moderate–severe binge-eating disorder
- Bupropion is contraindicated in bulimia and anorexia (seizure risk with electrolyte abnormalities)
- Electrolyte replacement as ordered (K, phosphate, Mg)
5. Emergencies
- Severe bradycardia (often < 40–50/min), hypotension, syncope, hypokalemia, arrhythmias → hospitalization criteria
- Refeeding syndrome (see above)
- Esophageal rupture (severe chest pain after vomiting)
6. Patient & Family Education
- Recovery is possible; relapse can occur — continue outpatient care
- Family: avoid comments on weight/appearance; model balanced eating
- Dental care; avoid brushing immediately after vomiting (rinse with water/baking soda)
- Resources: NIMH, national eating disorder organizations, 988 for crisis
7. Memory Aids
- Anorexia = “Everything goes LOW” (HR, BP, temp, weight, glucose)
- Bulimia = “Potassium Plunges”
- Refeeding = “Phos Falls First”
8. NCLEX-Style Practice Questions
1. A 16-year-old with anorexia has HR 38/min, BP 82/50, and K 3.0 mEq/L. Which is the priority?
A. Body image counseling
B. Cardiac monitoring and electrolyte replacement per orders
C. Family therapy referral
D. Teaching about food groups
Answer: B. Physiologic instability takes priority.
2. On day 3 of nutritional rehab, a patient develops edema, weakness, and a phosphorus of 1.5 mg/dL. The nurse recognizes:
A. Expected weight gain
B. Refeeding syndrome
C. Lithium toxicity
D. Hyperthyroidism
Answer: B. Hypophosphatemia with fluid shifts early in refeeding.
3. Which finding suggests self-induced vomiting?
A. Lanugo
B. Calluses on the knuckles and swollen parotid glands
C. Hypothermia
D. Bradycardia only
Answer: B. Russell sign and parotid enlargement are classic for purging.
4. Which intervention helps prevent purging after meals?
A. Allow private bathroom use immediately after eating
B. Observe the patient for 1–2 hours after meals
C. Let the patient eat alone in their room
D. Provide laxatives as needed
Answer: B.
5. A provider considers bupropion for a patient with bulimia. The nurse is concerned because:
A. It causes weight gain
B. It increases seizure risk in patients who purge
C. It interacts with tyramine
D. It causes agranulocytosis
Answer: B. Bupropion is contraindicated in eating disorders due to seizure risk.
References
Moore, C. A., & Bokor, B. R. (2023). Anorexia nervosa. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459148/
National Institute of Mental Health. (n.d.). Eating disorders. Retrieved October 15, 2026, from https://www.nimh.nih.gov/health/topics/eating-disorders
National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/test-plans.page