Spotting Eating Disorders in the ED

Eating Disorders can take months, even years, to treat effectively. But ED nurses who can identify patients with such a disorder can help get them on the right track to healing. A big challenge, however, is that patients with eating disorders often go to great lengths to conceal the problem.

Recognizing eating disorders in the ED, helping patients understand they are ill and steering them to ongoing mental and physical care requires preparation far in advance of the patient encounter, experts say. “For most eating disorders, recovery is a very long-term process,” said Bobbi O'Brien, RN, PhD, clinical psychologist at Eating Disorders Associates in Torrance, Calif. “You can get through the acute part, the medical part, pretty quick. But the rest — psychiatric issues, body image, self-esteem, co-occurring depression or anxiety disorders, family dynamics — that can take 10 years or more.”

Psychiatry’s diagnostic manual, the DSM-IV-TR, recognizes three main categories of eating disorders: anorexia nervosa, bulimia nervosa and eating disorders-not otherwise specified. Patients with anorexia have an obsessive fear of gaining weight, and so dangerously limit food intake. They might alternately “purge” nutrients by using laxatives or diuretics, or by inducing vomiting. Patients with bulimia, meanwhile, will eat in binges, followed by behaviors such as purging or fasting to compensate for the overeating.

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