Episode Details

Core Disorders & Distinctions Anorexia Nervosa (AN): Characterized by severe restriction of nutritional intake, extreme fear of weight gain, and severely distorted body image. Clients fail to recognize the illness, have an early onset (ages 14-18), and are significantly underweight. Subtypes include restricting (fasting/exercising) and binge-eating/purging. Bulimia Nervosa (BN): Involves recurrent, secretive binging followed by compensatory behaviors like purging, extreme exercise, or laxative use. Onset is later (ages 18-19), and clients are typically at a normal weight. Unlike AN, clients with BN recognize the pathology and experience immense shame and guilt.

High-Yield Medical Complications

• AN: Amenorrhea, cold sensitivity/lanugo, bradycardia, osteoporosis, and severe electrolyte imbalances (e.g., hypokalemia, hyponatremia).
• BN: Dental enamel erosion, hypokalemia, hypochloremic alkalosis, and esophageal/gastric erosion.

Priority Nursing Assessments & Interventions

• Safety First: Assess directly for suicidal ideation and self-mutilation, as risk is highly elevated.
• Milieu & Meal Management: Sit with clients during meals and enforce program limits (e.g., liquid protein for uneaten food). Critically, observe clients for 1 to 2 hours after meals to prevent covert purging.
• Daily Weights: Weigh clients daily upon awakening after voiding, wearing minimal clothing (hospital gown) to prevent them from hiding objects to artificially inflate weight.
• Therapeutic Communication: Clients often lack emotional self-awareness (alexithymia) and express emotions somatically. Encourage them to describe feelings using a journal. Never discuss food or deep emotional issues during mealtimes; separate emotions from food. Avoid labeling clients or foods as "good" or "bad".

Treatment Modalities & Psychopharmacology

• AN: The immediate priority is medical stabilization (weight restoration, correcting electrolytes) before psychiatric treatment can begin. Family therapy is highly beneficial for clients under 18. Medications have limited success, though Olanzapine can help with weight gain and bizarre body image distortions.
• BN: Cognitive-Behavioral Therapy (CBT) is the most effective outpatient treatment. Antidepressants, specifically SSRIs like fluoxetine, are effective in reducing binge eating and improving mood.

The "Exam Logic" 20% Focus

• Priority Action: Address life-threatening medical issues (bradycardia, hypokalemia) and suicide risk first.
• Milieu Safety: Supervise meals and restrict unsupervised bathroom access to stop the purging cycle.
• Best Therapeutic Response: Remain empathetic but nonjudgmental; set limits on eating behaviors and focus interactions on strengths unrelated to body size.