Transcript bulimii
Eating Regulation Responses and Eating Disorders, Chapter 24 Eating Regulation Responses & Eating Disorders • Eating Disorders occur across the life span • Bulimia and Anorexia may be present in the same patient • Both are ↑risk in first-degree female relatives with eating disorders • Patient with eating disorders often have depression, anxiety and substance abuse Eating Regulation Responses & Eating Disorders • > females • 50-75% of people with Anorexia or Bulimia have depression • OCD can be found in 25% of patients with Anoroxia Nervosia • Exhibit rigidity, ritualism, and meticulousness – often from early childhood Eating Regulation Responses & Eating Disorders • Binge eaters often report fluctuation of self-esteem • Sexual abuse reported in 20-50% of patients with Anorexia or Bulimia • Nurses first must examine their own feelings about weight and size Eating Regulation Responses & Eating Disorders • Eating disorders include: • • • • Anorexia nervosa Bulimia nervosa Bing eating disorder Night eating syndrome Overlapping Relationships Among Eating Disorders (Stuart, 2013, p. 480) Eating Regulation Responses & Eating Disorders • Anorexia Nervosa • Intense irrational beliefs about body, shape • Intense fear of gaining weight even when under weight • Body weight 15% below expected minimal normal weight for age and height • Female menstrual cycle absent for at least 3 consecutive cycles • Use denial as their coping mechanism Eating Regulation Responses & Eating Disorders • Anorexia (cont) • Many anorexia nervosa patients recover within 5 years but for some this can be a chronic illness • May consume as little as 200 calories daily • Many are preoccupied by food and are employed in the food industry Eating Regulation Responses & Eating Disorders • Bulimia Nervosa • More common than anorexia nervosa • Binge eating then purge • Self-induced vomiting • Check for callus on a finger • Misuse of laxatives, diuretics, enemas • Chewing and spitting • Early treatment = good response Eating Regulation Responses & Eating Disorders • Binge Eating Disorder • Consume large amounts of calories and do not attempt to prevent weight gain • Chronic in nature • 19-40% obese people who seek help with weight to control binge eat • Assess-what is meant by a binge (calories) Eating Regulation Responses & Eating Disorders • Night Eating Syndrome • In the new DSM-V • Night eaters experience 2 awakenings a night associated with food • Symptoms associated with night eating syndrome • Morning anorexia • Difficulty staying asleep • Depression in the evening Eating Regulation Responses & Eating Disorders • Assessment • • • • • • • Full physical examination Dental examination Psychiatric history Weight history Pattern of menstruation Compulsive exercise patterns Use of laxatives, diuretics, diet pills Eating Regulation Responses & Eating Disorders • Important assessment with eating disorders is the patient’s motivation to change their behavior • Anorexia is about controlling life and fears • For some the only control they have is their food • Bulimia patients have problems with their weight and resort to purging/laxatives, etc. Eating Regulation Responses & Eating Disorders • Medical Complications • Anorexia - metabolic and endocrine abnormalities result from malnutrition/starvation • Bulimia – potassium depletion and hypokalemia : related to purging, laxative, or diuretic abuse • Excess weight – HTN, cardiac problems, sleep apnea, mobility, diabetes Eating Regulation Responses & Eating Disorders • Interventions • • • • Nutrition stabilization Exercise- physical fitness not calories Cognitive behavioral interventions Body image interventions • Body image distortion- discrepancy between the patient’s actual size and the perceived body size • Body dissatisfaction-degree of unhappiness that a person feels about body size Eating Regulation Responses & Eating Disorders • Interventions (cont) • Family involvement • Families should be engaged and included • Group therapy • CBT, psychoeducational, psychodynamic, and interpersonal models • Encourage patients to express their feelings • Medications • SSRIs have had considerable to modest to no effect