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Mental health depends on establishing an equilibrium between bodily needs, drives, and demands from the environment. A balance must be maintained between the basic human urges, self-centered wishes, and the demands of both conscience and society at every stage of human development. Eating and feeding behaviors are bound up with family dynamics and are often a barometer of the family's emotional climate and parent-child interactions. A positive feeding relationship is a concrete measure parents can be taught to provide for the child's healthy psychosocial development. Although the development of eating disorders is complex and caused by a multiplicity of factors, community-wide education by nurses about nutrition and feeding at successive developmental levels from infancy to old age can decrease the incidence of eating disorders in the community. Evaluation of prevention programs is essential to guarantee the refinement of preventive efforts over time.

Nurses who remember that control of behavior belongs to the client, not the staff, will be less likely to become enmeshed in power struggles. Gartside states, "The destruction of self is the ultimate rebellion--yet rebellion can be a healthy phase of development. To help individuals back towards healthy rebellion, we must listen to our clients." Listening and limit setting are nurses' most effective approaches for dealing with manipulation.

Nurses providing care for individuals with eating disorders should identify and test the effectiveness of various milieu factors and nursing therapeutics employed in the treatment of these often-debilitating disorders. Nurses offer presence, role modeling, surveillance, and emotional and physiologic support while guiding reluctant patients to explore and experiment with new behaviors. Nurses provide flexibility, empathy, and rational limit setting in response to the unique and shifting needs of each patient. This interpersonal dynamic is often extremely different from that experienced in the patient's family of origin and, thus, contributes to the essential "interpersonal conditions" that are necessary for the patient to engage meaningfully in treatment. The prevalence of eating disorders suggests that nurses are likely to encounter people with eating disorders in many settings. Nurses should be skilled at spotting disordered eating among an array of clinical presentations (e.g., amenorrhea, disturbed family relationships, athletic injuries) because people engaged in disordered eating are hesitant to volunteer such information. In addition to the shame associated with disordered eating is the stigma associated with psychiatric treatment. Seeking help from a nurse may be perceived as less stigmatizing than seeking care from a psychiatrist. Thus, nurses may serve as important points of entry for the hesitant patient. The initial contact is so essential in setting the stage for the continuation and denouement of therapy. Finally, nurses and patients with disordered eating share at least one commonality. Both groups are predominantly women. The prevailing culture has been implicated repeatedly as a major factor in contributing to the prevalence of disordered eating. Nurses experience the influences of paternalism in their professional practice and confront daily the pressures of socially constructed feminine ideals. These gender-sensitive ways of knowing, which nurses bring to the treatment relationship, should be further analyzed as substantive dimensions with treatment and preventive potential.

Providing truly holistic care means that nurses must recognize that their clients are sexual beings and that they often suffer from sexual concerns and problems related to their past history and their current medical problems. In addition to helping clients move toward physical wellness, nurses should intervene with intrapersonal and interpersonal problems affecting client's sexual feelings and behaviors.

While the clinical syndrome of anorexia nervosa is currently receiving a great deal of scientific and clinical interest, few research findings predict successful outcomes. The most effective approach to date gleans intervention strategies from the behavioral model. This approach does not negate individual, family, and group approaches but gives direction for the maintenance of the individual in a therapeutic milieu. The work of the Task Force of the National Group for Classification of Nursing Diagnoses gives guidance for the development of adequate assessment tools and standardized care plans. Ultimately, outcome criteria should be available for prediction and testing.

Addictive eating disorders have been a part of history and have only recently been recognized as psychiatric disorders. Increased publicity has enabled family and friends of eating disordered individuals to recognize the disease and seek help for them from trained medical professionals. Everyone is "at risk," but certain subpopulations have been "coming out of the closet" in epidemic proportions. An ever-increasing number of high school-aged and college-aged females have developed some form of eating disorder, from fad diets to self-induced vomiting. In these individuals, the obsession with thinness takes priority over family, friends, schoolwork, or career. Strangely enough, the eating disordered person's addiction is not to food but to the feeling of numbness her behavior brings. Over time, the need to control is desperately sought and many patients transfer their obsession to other patterns of self-abuse. Nursing intervention should include setting the appropriate example in terms of the professional's relationship with food, while providing much needed emotional support. An innovative method of intervention available to nursing professionals includes the use of creative, visual imagery to repeatedly diffuse fear and anxiety about food until a level of personal autonomy over the disorder and other emotional concerns is achieved. Therefore, a system of recovery can be designed for the anorectic or bulimic patient and the experience of recovery from the eating disorder can be a lifelong process of personal growth.