Eating and Personality Disorders
Medical risks in eating disorders, and approaches for personality disorders
| Anorexia nervosa | Bulimia nervosa | Binge-eating disorder | |
|---|---|---|---|
| Pattern | Restriction, low weight, intense fear of weight gain, distorted body image | Binges + purging (vomiting, laxatives, exercise); often normal weight | Binges without purging; distress, shame |
| Physical signs | Bradycardia, hypotension, low temperature, lanugo, missed periods, bone loss, low K⁺ | Low K⁺, metabolic alkalosis, dental erosion, swollen parotid glands, knuckle calluses (Russell's sign), dysrhythmias | Weight gain, metabolic problems |
| Medications | No approved drug; treat nutrition first | Fluoxetine (FDA-approved). Bupropion is contraindicated (seizures) | Lisdexamfetamine (FDA-approved); CBT |
Nursing in eating disorders
- Refeeding syndrome: as feeding restarts, phosphate, K⁺ and Mg²⁺ can crash → heart failure, dysrhythmias. Start slowly; check electrolytes daily at first.
- Supervise meals and observe for ~1 hour afterward (purging); bathroom access supervised as ordered.
- Weigh at the same time, same scale, in a gown, often with the patient facing away.
- Focus on feelings and control issues, not food; consistent team approach; family-based therapy for teens.
- Cardiac monitoring if electrolytes are abnormal.
Personality disorder clusters
| A: odd, eccentric | Paranoid, schizoid, schizotypal |
| B: dramatic, emotional | Antisocial, borderline, histrionic, narcissistic |
| C: anxious, fearful | Avoidant, dependent, obsessive-compulsive personality |
Borderline personality disorder
Unstable relationships and mood, fear of abandonment, impulsivity, self-harm, splitting (people are all good or all bad). DBT is the main therapy. Safety first; clear, consistent limits; the whole team uses the same approach (prevents splitting).
Antisocial personality disorder
Disregard for others' rights, manipulation, lack of remorse, rule-breaking. Set firm, consistent limits with clear consequences; don't accept flattery or bargaining; focus on behavior, not explanations.