127. CCA Study Notes: Feeding and Eating Disorders

The Big Picture

Feeding and eating disorders affect how people think about food, eating, and their bodies. A person may become extremely concerned about body weight or shape. This can lead to eating behaviours that seriously harm their health.

These disorders involve more than food. A person’s emotions, thoughts, and experiences can all play a part. Some people recover, while others continue to struggle. Eating disorders can also be life-threatening.

Three disorders you will learn about are anorexia nervosa, bulimia nervosa, and pica. Each involves different eating behaviours. As a Continuing Care Assistant (CCA), you can help by treating clients with patience, respect, and compassion.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Understanding Feeding and Eating Disorders

Feeding and eating disorders involve changes in how people see their bodies, along with disturbed eating behaviours and unusual concern about body weight and shape.

These disorders are influenced by three types of factors:

• Biological factors: Factors related to the body.
• Psychological factors: Factors involving thoughts, feelings, and behaviour.
• Sociocultural factors: Influences from society and culture, including ideas about the ideal body shape.

People may follow strict diets because they want to achieve an appearance they believe is ideal.

Feeding and eating disorders occur mainly in teenage girls and young women, although increasing numbers of men are also affected.

Certain groups may face greater risk because thinness is valued or expected in their work or activities. These groups include athletes, actors, dancers, models, and television personalities.

The two most common eating disorders are anorexia nervosa and bulimia nervosa.

Eating Disorders Compared With Anorexia in Long-Term Care

Feeding and eating disorders are different from the anorexia that some older clients experience in long-term care.

A younger person with a feeding or eating disorder may have a complex psychological struggle involving food, weight, and body image.

An older client may refuse food for other reasons, including:

• Fear of choking
• Feeling sick
• Depression
• Disliking the food’s taste or texture

Key difference: Refusing food does not automatically mean a person has anorexia nervosa or another feeding and eating disorder.

Anorexia Nervosa

Anorexia nervosa is a serious and often long-lasting eating disorder. It can become life-threatening.

It has three defining features:

1. Refusing to maintain a minimum body weight within 15% of the individual’s normal weight.
2. Having an intense fear of gaining weight.
3. Having a distorted body image, such as believing the person looks fat or ugly despite being extremely thin.

A person with anorexia nervosa may ignore hunger to maintain control over eating and body weight.

When Anorexia Nervosa Develops

Anorexia nervosa often begins around puberty. It can also develop during another major life change.

It affects mainly adolescent girls and young women, but men and older women can also develop the disorder.

Some people with anorexia nervosa share certain personality traits or experiences, including:

• Low self-esteem ⓘ
• Perfectionism ⓘ
• Social isolation ⓘ, which often develops after anorexia-related behaviours begin
• High achievement in school or athletics

For some people, controlling food and body weight becomes a way to focus attention away from painful or difficult personal issues.

The feeling of control over eating and weight can become especially important when other parts of life feel emotionally difficult.

Behaviours Associated With Anorexia Nervosa

People with anorexia nervosa may develop unusual behaviours involving food.

For example, a person may:

• Ignore feelings of hunger.
• Cut food into extremely small pieces.
• Refuse to eat around other people.
• Cook elaborate meals for others without eating the food.
• Hide food in personal spaces.
• Exercise obsessively while restricting food intake.
• Misuse laxatives or enemas to remove food from the body.
• Misuse diuretics in an attempt to lose weight.

Diuretics are medications that make the kidneys produce larger amounts of urine. This removes extra fluid from the body and can cause weight loss.

Obsessive exercising can make a person appear active and healthy even while they are starving themselves.

Physical and Emotional Signs of Anorexia Nervosa

Anorexia nervosa can affect physical appearance, body functions, and emotional health.

Signs and symptoms include:

• Extreme concern about food and weight
• Refusal to maintain a minimum normal body weight
• Believing the body looks fat despite being extremely thin
• Brittle hair and nails
• Dry, yellow skin
• Frequent complaints of feeling cold because body temperature drops
• Lanugo, which is fine hair usually found on newborns, appearing on the body
• Depression
• Stoppage of menstrual periods

Some people with female genitalia develop amenorrhea. This means at least three consecutive menstrual periods that would normally be expected do not occur.

Causes and Risk Factors of Anorexia Nervosa

Feeding and eating disorders tend to occur within families.

A girl whose sibling has anorexia nervosa has a 10 to 20 times greater risk of developing the disorder.

Other influences that may increase the risk include:

• Behavioural factors
• Environmental factors
• Stressful life events

Depression and obsessive-compulsive disorder may occur alongside anorexia nervosa.

Some people with anorexia nervosa also experience repeated episodes of binge eating and purging.

Effects of Anorexia Nervosa on the Body

Severe food restriction and starvation can cause serious medical complications.

These include:

• Damage to vital organs, including the heart and brain
• Irregular heart rhythms
• Heart failure
• Loss of calcium from bones, making them brittle and more likely to break

The most serious possible outcome is death from starvation or related complications.

Anorexia nervosa is described as having the highest mortality rate ⓘ among psychiatric conditions, at 6%.

Fortunately, most complications associated with anorexia nervosa can be reversed when normal body weight is restored.

Bulimia Nervosa

Bulimia nervosa is a psychological feeding and eating disorder involving episodes of uncontrolled overeating followed by inappropriate attempts to control body weight.

These attempts are called purging.

Purging behaviours may include vomiting or misusing laxatives or diuretics.

Understanding Binge Eating and Purging

Binge eating occurs when someone eats a much larger amount of food than most people would eat in a similar situation.

The person experiences a loss of control over eating.

A binge-eating episode may involve consuming up to 20,000 calories at one time.

Binge eating is described as a compulsion, meaning an uncontrollable urge to perform an action.

It is generally not caused by intense hunger. Instead, it often occurs in response to:

• Depression
• Stress
• Low self-esteem

During a binge, the person experiences a loss of control. This may be followed by a brief feeling of calm and then feelings of self-loathing ⓘ.

Binge eating and purging can become an obsession, meaning a thought or desire that persists.

The cycle is often repeated.

Some individuals binge as often as twice a day or several times daily.

Foods commonly eaten during binges include sweet, high-calorie foods or soft, smooth foods, such as ice cream, cake, and pastries.

Why Bulimia Nervosa Can Be Difficult to Recognize

A person with bulimia nervosa may appear to have a normal body weight.

Many people with the disorder have a normal weight, while some are overweight.

This means a person’s appearance may not reveal that they have bulimia nervosa.

The condition can also be difficult to recognize because:

• Bingeing and purging often happen secretly.
• Individuals may deny having the disorder.
• Some affected women are high achievers.

Key fact: A person does not need to look extremely thin to have a serious eating disorder.

Signs and Symptoms of Bulimia Nervosa

Bulimia nervosa can involve changes in eating, weight-control behaviours, physical health, and emotions.

Eating and weight-control behaviours include:

• Uncontrolled eating
• Purging
• Strict dieting
• Fasting ⓘ
• Vigorous or compulsive exercising
• Vomiting or misusing laxatives and diuretics to lose weight
• Frequent bathroom use after meals

Emotional and body-image signs include:

• Depression
• Mood swings
• Feeling out of control
• Excessive concern about body shape and weight

Physical signs and symptoms include:

• Vomiting blood
• Swollen glands in the neck and face
• Heartburn
• Bloating
• Indigestion
• Constipation
• Irregular menstrual periods
• Poor dental health
• Sore throat
• Weakness and exhaustion
• Bloodshot eyes

Some signs involve digestion, while others affect the mouth, teeth, or general physical health.

Effects of Bulimia Nervosa on the Body

Repeated bingeing and purging can cause serious health problems.

Damage to the mouth, teeth, and throat:

• Repeated vomiting exposes teeth to acidic stomach contents.
• This can wear away tooth enamel.
• Dental cavities and sensitivity to hot or cold foods can develop.
• Salivary glands may become swollen and sore.
• The throat and esophagus may suffer damage.

Damage to digestive functions:

• Stomach ulcers
• Rupture of the stomach or esophagus
• Disruption of normal bowel release function

Other complications:

• Electrolyte imbalance
• Dehydration
• Irregular heartbeat
• Increased risk of suicidal behaviour
• Decreased libido, meaning reduced sex drive

Some damage caused by bulimia nervosa can be permanent.

Damage to the teeth, throat, and esophagus is especially concerning because of repeated exposure to acidic stomach contents.

Important care point: Proper oral and dental care must be emphasized for clients with bulimia nervosa.

Causes of Bulimia Nervosa

The exact causes of bulimia nervosa are not definitively known.

Its possible triggers are generally believed to be similar to those associated with anorexia nervosa.

Pica

Pica is a feeding and eating disorder in which a person persistently eats substances that have no nutritional value.

For the behaviour to meet the stated definition of pica, it must continue for at least one month.

A person with pica may put nonfood substances into their mouth or eat them.

Examples of Substances Associated With Pica

Reported substances include:

• Dirt, clay, sand, stones, and pebbles
• Hair and fingernails
• Paper, pencil erasers, and string
• Ice
• Paint chips, chalk, plaster, coal, and wood
• Plastic, vinyl gloves, and laundry starch
• Lead and wire
• Cigarette butts and burnt matches
• Feces
• Needles and light bulbs

These examples show that pica can involve many different substances.

Who Is More Likely to Develop Pica?

Pica is more common in children.

It is also the most common feeding and eating disorder among clients with developmental disabilities.

Causes of Pica

Pica may be associated with several possible causes.

These include:

• Iron-deficiency anemia
• Zinc deficiency
• Poor diet
• Malnutrition
• Starvation
• Poor judgment related to development
• Obsessive-compulsive disorder

Nutritional deficiencies may contribute to the desire to eat nonfood substances.

Health Risks of Pica

The health effects of pica depend on what the person eats.

Possible outcomes range from little or no harm to serious medical complications.

Examples include:

• Chipped teeth
• Lead toxicity
• Intestinal obstruction
• Life-threatening complications

Safety: Clients with pica should be prevented from continuing to eat nonfood substances.

Preventing further nonfood eating can allow medical problems, including nutritional deficiencies or lead toxicity, to be diagnosed.

Treatment depends on the cause of the pica and the severity of the cravings. Medical treatment may include psychosocial therapy or medication.

Diagnosis and Treatment of Feeding and Eating Disorders

Feeding and eating disorders are complex conditions, but recovery is possible.

Early diagnosis and treatment can improve the chance of a successful outcome.

Recognizing the Need for Professional Treatment

People who remain focused on food and weight, even when they are thin, may benefit from exploring their thoughts and relationships with a therapist.

A doctor who specializes in eating disorders should generally diagnose anorexia nervosa and rule out other physical disorders.

Some individuals can receive treatment without staying in a hospital. This is called outpatient treatment.

Other individuals may need hospitalization to address:

• Dangerously low body weight
• Binge-eating behaviours

Weight Restoration and Therapy

The most effective treatment strategies include restoring body weight and using individual, family, and group therapies.

Important weight-related facts include:

• The goal of weight restoration is to bring body weight to within 10% of normal.
• Weight gain of approximately 0.5 to 1.4 kg (1 to 3 lb.) per week is considered safe and desirable.

Psychotherapy is a form of therapy in which a client explores thoughts, feelings, and behaviours with guidance from a mental health specialist.

Individual, family, and group therapies can help address the psychological aspects of eating disorders.

Supporting Clients With Feeding and Eating Disorders

As a CCA, your approach to a client with a feeding or eating disorder should be patient, compassionate, encouraging, and nonjudgemental.

These disorders can involve shame, emotional pain, and difficult feelings about food and body image.

Be Patient and Compassionate

A client may respond with anger or deny needing your presence or support.

Do not assume that this reaction means the client does not need understanding or compassion.

Remember that feeding and eating disorders are complex. Food and body-weight concerns may reflect cultural pressures or deeper personal struggles.

Encourage the Person, Not the Disorder

Help the client see themselves as more than their eating disorder.

One way to do this is by discussing other parts of the client’s life.

You can talk about interests and activities that are unrelated to food, weight, or appearance.

This keeps attention on the person rather than only on the disorder.

Avoid Blame, Shame, and Appearance Comments

Do not blame or shame a client for having a feeding or eating disorder.

Avoid commenting on the client’s appearance or weight, including comments intended as compliments.

Why it matters: Comments about looks or weight can reinforce the person’s preoccupation with body image.

Instead, focus on the person’s interests and other aspects of life.

Use a Positive, Nonjudgemental Approach

Avoid negative statements about the client’s behaviours.

When discussing concerns:

• Use a positive approach.
• Choose a neutral, comfortable place.
• Choose a comfortable time for the discussion.
• Avoid judgmental language.

Respectful communication is an important part of supporting someone who may already be experiencing shame or emotional distress.

Help Prevent the Eating of Nonfood Substances

When supporting a client with pica, prevent the client from continuing to eat nonfood substances.

This helps make it possible for medical issues, such as nutritional deficiencies or lead toxicity, to be identified.

The client’s treatment may vary depending on the cause of pica and the severity of the cravings.

Know What to Report

Report to your supervisor if:

• You hear vomiting.
• You see evidence that a client is refusing food.

Ask your supervisor for guidance on how to deal with these symptoms appropriately.

Common Mix-Ups

Wrong Idea	Better Idea
Anorexia nervosa and anorexia in older long-term care clients mean the same thing.	Anorexia nervosa involves distorted body image and fear of weight gain. Older clients may refuse food for other reasons.
Everyone with anorexia nervosa avoids binge eating.	Some people with anorexia nervosa also experience binge-eating and purging episodes.
A person with bulimia nervosa must be extremely thin.	Many people with bulimia nervosa have a normal body weight, while some are overweight.
Binge eating is simply eating because of intense hunger.	Binge eating involves loss of control and is often linked to stress, depression, or low self-esteem.
Complimenting a client on weight or appearance is always encouraging.	Appearance comments can reinforce the client’s concern about body image and weight.