● Promoting the incorporation of research findings pertaining to bulimia nervosa and other eating disorders into evidence- based healthcare practice. ● Promoting the publication of research findings pertaining to bulimia nervosa and other eating disorders in healthcare journals. ● Promoting the presentation of research findings pertaining to bulimia nervosa and other eating disorders at local, national, and international healthcare conferences and conventions. ● Promoting positive role models in print and visual media. Taking an active role in writing to media leaders to explain
● Working with their organizations’ nursing professional development departments to develop continuing education pertaining to bulimia nervosa and other eating disorders. ● Encouraging and, as appropriate, mandating that professionals attend continuing education pertaining to bulimia nervosa and other eating disorders. ● Facilitating the development of an eating disorder
the dangers of eating disorders and how unrealistic portrayals of women and men can help to facilitate the development of dangerous medical and mental health problems. recognition and treatment program as part of employee health and wellness programs within their respective organizations. Many organizations offer memberships at local gyms, smoking cessation programs, and weight loss initiatives as part of their employee health and wellness programs. What may not be addressed are the dangers and ramifications of eating disorders. The emphasis is often on losing weight without looking at how the weight is lost. Instead, the emphasis should be on achieving and maintaining a healthy weight as part of a healthy lifestyle. CHANGES PERTAINING TO EATING DISORDERS IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-5)
Before the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, binge eating was not included as a specific eating disorder. The fifth edition includes a number of changes to feeding and eating disorders, including Anorexia Nervosa The criteria for anorexia nervosa remain mostly the same as in DSM-IV. Amenorrhea has been removed as a requirement for the diagnosis of anorexia nervosa. The first criterion now focuses on behaviors and no longer includes the word refusal in terms Bulimia Nervosa Identification of symptoms is little changed from the fourth edition of the DSM . The only change in the criteria of the fifth edition is that the frequency of binge eating and compensatory Binge-Eating Disorder In the DSM-IV, binge-eating disorder was described under the category of “disorders needing further research.” In the DSM-5 , binge-eating disorder has its own diagnostic label. This has been heralded by experts in the field of eating disorders because binge-eating disorder has been used as a diagnosis for years. The criteria for binge eating are the same in both the fourth and fifth editions of the manual except that the minimum average frequency of binge eating has been changed from at least twice a week for 6 months to at least once a week over the last 3 months. This change was made, at least in part, to be consistent with the DSM-5 frequency of the binging criterion for bulimia nervosa. Because binge-eating disorder is now classified as such in the most recent edition of the DSM, it is important that it be thoroughly discussed as part of the continuing education efforts pertaining to eating disorders. Clinical Presentation Marlene works full time as a registered nurse specializing in neonatal intensive care. She is the assistant nurse manager and combines clinical with administrative responsibilities. Marlene is also a part-time graduate student. She is enrolled in a doctorate of nursing science program. Marlene often feels overwhelmed by the pressures of work and school. When these pressures become too much, Marlene eats uncontrollably. These periods of overeating, or binging, have occurred only occasionally in the past. However, during the past 3 months, binging occurred more frequently, and she is starting to gain weight. David ranks first in his high school class of 500 students. His mother is an associate professor in the chemistry department of a large prominent university. His father is an attorney who graduated near the top of his class at Harvard. Both parents expect David and his siblings to excel academically and follow in their footsteps as prominent professionals. David becomes
some pertaining to anorexia nervosa, bulimia nervosa, and binge-eating disorder. Here is a summary of some of the changes published in the DSM-5 as they pertain to eating disorders (American Psychiatric Association, 2013; Grohol, 2013). of weight management. The word was eliminated because it implied deliberate intention by the client and was difficult to assess. The second criterion has been expanded to include persistent behaviors that interfere with weight gain.
behaviors (purging) has been reduced to just once a week. In the fourth edition, the minimum was set at twice a week.
extremely anxious whenever he has to take tests, knowing that his parents expect nothing less than excellence. As a way of gaining control and dealing with his feelings of anxiety, David has begun to eat large amounts of food in one sitting. Christine is 28 years old and has been married to a well-known, highly successful young executive for the past 6 years. Six months ago, her husband abruptly announced that he had fallen in love with someone else and wanted a divorce. Christine married immediately after graduating from college and never worked outside the home. With no work history and the need to find a way to earn a living, Christine is under a great deal of pressure. Christine feels as though her life is completely out of control. She is plagued by feelings of sadness, anger, and anxiety. When these feelings overwhelm her, she finds herself eating more and more. Lately, she has begun to eat to the point of actually developing epigastric pain. She feels unhappy and guilty about eating in this way but is not able to control herself. This lack of control increases her feelings of stress and anxiety, which increases the cycle of binging. The preceding scenarios all describe individuals who are struggling with binge-eating disorder. For various reasons, they are experiencing significant stress and anxiety. They are all responding to this stress and anxiety by compulsively overeating in an attempt to cope with these negative feelings. Note that unlike persons who suffer from bulimia nervosa, people affected by binge-eating disorder do not participate in purging behaviors to rid themselves of excess calories.
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