Chapter 18 Eating Disorders Copyright 2011 Wolters Kluwer

Eating Disorders • View of continuum: anorexia (eat too little); bulimia (eat too chaotically);

Etiology • Biologic factors – Genetic vulnerability – Disruptions in nuclei of hypothalamus relating

Etiology (cont’d) • Developmental factors – – Struggle for autonomy, identity Overprotective or enmeshed

Cultural Considerations • Increased prevalence in industrialized countries – Most common in United States,

Anorexia Nervosa • Refusal or inability to maintain minimally normal body weight • Intense

Anorexia Nervosa (cont’d) • Onset: usually between ages 14 and 18 • Denial early

Anorexia Nervosa (cont’d) • Medical management – Weight restoration/nutritional rehabilitation – Rehydration/correction of electrolyte

Bulimia Nervosa • Recurrent episodes of binge eating (secretive); compensatory behaviors to avoid weight

Bulimia Nervosa (cont’d) • Onset: late adolescence, early adulthood (average of 18 to 19

Eating Disorders and Nursing Process Application • Assessment – History: model child, no trouble,

Eating Disorders and Nursing Process Application (cont’d) • Assessment (cont’d) – Thought process, content:

Eating Disorders and Nursing Process Application (cont’d) • Data analysis/outcome identification • Interventions –

Community-Based Care • Hospital admission only for medical necessity • Community settings – Partial

Mental Health Promotion • Education of parents, children, young people about strategies to prevent

Self-Awareness Issues • Feelings of frustration when client rejects help • Being seen as

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Eating Disorders • View of continuum: anorexia (eat too little); bulimia (eat too chaotically); obesity (eat too much) • Categories – Anorexia nervosa • Binge eating • Purging – Bulimia nervosa Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Etiology • Biologic factors – Genetic vulnerability – Disruptions in nuclei of hypothalamus relating to hunger and satiety (satisfaction of appetite) – Neurochemical changes (norepinephrine, serotonin); not known if these changes cause disorders or are result of eating disorders Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Etiology (cont’d) • Developmental factors – – Struggle for autonomy, identity Overprotective or enmeshed families Body image disturbance/dissatisfaction Separation-individuation difficulties • Family influences (family dysfunction, childhood adversity) • Sociocultural factors (media, pressure from others) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cultural Considerations • Increased prevalence in industrialized countries – Most common in United States, Canada, Europe, Australia, Japan, New Zealand, South Africa – Less frequent among African Americans in United States – Equal among Hispanic, Caucasian women Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anorexia Nervosa • Refusal or inability to maintain minimally normal body weight • Intense fear of gaining weight or becoming fat • Significantly disturbed perception of body shape or size • Steadfast inability or refusal to acknowledge seriousness of problem or even that one exists Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anorexia Nervosa (cont’d) • Onset: usually between ages 14 and 18 • Denial early on; depression and lability with progression; isolation; medical complications (Table 18. 2) • Treatment: often difficult; client resistant, uninterested, denies problem Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anorexia Nervosa (cont’d) • Medical management – Weight restoration/nutritional rehabilitation – Rehydration/correction of electrolyte imbalances • Psychopharmacology: amitryptyline, cyproheptadine, olanzapine, fluoxetine • Psychotherapy – Family therapy – Individual therapy – Cognitive behavioral therapy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bulimia Nervosa • Recurrent episodes of binge eating (secretive); compensatory behaviors to avoid weight gain (purging, use of laxatives, diuretics, enemas, emetics, fasting, excessive exercise) • Recognition of behavior as pathologic; feelings of guilt, shame, remorse, contempt • Usually normal weight Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bulimia Nervosa (cont’d) • Onset: late adolescence, early adulthood (average of 18 to 19 years) • Often begins during or after dieting episode • Possible restrictive eating between binges; secretive storage/hiding of food • Treatment – Cognitive behavioral therapy – Psychopharmacology: antidepressants Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eating Disorders and Nursing Process Application • Assessment – History: model child, no trouble, dependable (anorexia); eager to please and conform, avoid conflict (bulimia) – General appearance, mood: slow, lethargic, emaciation (anorexia); not unusual (bulimia) – Mood, affect: labile Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eating Disorders and Nursing Process Application (cont’d) • Assessment (cont’d) – Thought process, content: preoccupation with food or dieting – Sensorium, intellectual processes – Judgment, insight – Self-concept: low self-esteem – Roles, relationships – Physiologic/self-care considerations (Table 18. 2) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eating Disorders and Nursing Process Application (cont’d) • Data analysis/outcome identification • Interventions – Establishing nutritional eating patterns (inpatient treatment if severe) – Identifying emotions, developing coping strategies (self-monitoring for bulimia) – Dealing with body image issues – Providing client, family education • Evaluation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Community-Based Care • Hospital admission only for medical necessity • Community settings – Partial hospitalization or day treatment programs – Individual or group outpatient therapy – Self-help groups Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mental Health Promotion • Education of parents, children, young people about strategies to prevent eating disorders • Early identification, appropriate referral • Routine screening of young women for eating disorders (Box 18. 2) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Self-Awareness Issues • Feelings of frustration when client rejects help • Being seen as “the enemy” if you must ensure that client eats • Dealing with own issues about body image, dieting Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins