Transcript Chapter 16*Eating Disorders

Chapter 16Eating
Disorders
Anorexia Nervosa
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Maintenance of subnormal levels of
weights for age/height: below 85% or BMI
< 17.5
◦ Intense fear of weight gain
◦ Disturbance in self-image
◦ Obsessive preoccupation with food
◦ Compulsive exercise
◦ Physiologic symptoms
Anorexia Nervosa Subtypes
Restricting type
◦ Weight loss achieved through dieting,
starvation, excessive exercise
 Binge eating/purging type
◦ Binge eatingeating a larger amount of
food than one would normally eat in a
discrete period of time
◦ Purgingevacuation by the digestive
tract by self-induced vomiting or
excessive use of laxatives/diuretics
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Anorexia Nervosa (cont.)
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Incidence and etiology
◦ Often begins at 13 to 18 years of age
◦ 90% women
◦ Symptoms commonly follow stressful
events
Anorexia Nervosa (cont.)
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Clients with anorexia nervosa
◦ Typically well-educated, middle to upper
class
◦ May be shy, orderly, overly sensitive to
rejection
◦ Often have unresolved family conflicts
◦ Heightened feelings of inferiority, selfimposed guilt, unreasonable expectations
for perfection
◦ Attempt to gain control of life by
controlling body
Bulimia Nervosa
Binge eating with repeated attacks to the
self and self-induced destructive methods
to prevent weight gain
 Subgroups: purging and nonpurging
 DSM-IV-TR criteria: behavior occurs at
least 2x a week for 3 months
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Bulimia Nervosa (cont.)
Craving for high-calorie/sweet food
Shame
Secretive eating/stashing of food
Depression
Induced vomiting
Laxative/diuretic/enema use (compensatory
methods)
 Normal height/weight with little variation
 Associated anxiety/personality disorder
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Bulimia Nervosa (cont.)
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Incidence and etiology
◦ Onset typically during adolescence or early
adulthood
◦ More common in femalesalso seen in
males
◦ All cultural and socioeconomic groups
◦ Chronic patternusually lasts 5-10 years
◦ Substance abuse common
◦ Interpersonal relationships affected
Binge-Eating Disorder
Not officially classified as mental disorder
 Diagnosisat least two binge-eating
episodes in a 6-month period
 Similar to bulimia nervosa with slightly
different pattern
◦ Recurrent binge-eating episodes not
followed by purging behaviors
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Binge-Eating Disorder (cont.)
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Signs and symptoms
◦ The person tends to be overweight or
obese
◦ Guilt and shame about eating
◦ Cycle of eating as coping mechanism
◦ Food consumption usually quick and by
oneself
◦ Excess of 10,000 calories at once
◦ Often history of other psychological
problems
Binge-Eating Disorder (cont.)
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Incidence and etiology
◦ Affects males and females equally
◦ Media emphasis on weight/appearance
◦ Low self-image
◦ Impulsive behaviors
Treatment of Eating Disorders
Cognitive-behavioral psychotherapy
 Goals
◦ Reversal of restrictive or maladaptive
patterns of eating and thinking about
food
◦ Reestablishment of healthy eating habits
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Treatment of Anorexia Nervosa
Family therapy
◦ See how maladaptive family behaviors
are intertwined in the client’s eating
disorder
 Behavior therapy
◦ Reward contract
◦ Gradual increase in caloric intake
 Medications
◦ Antidepressant/antianxiety medications
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Treatment of Bulimia Nervosa
Education about healthy eating
 Self-inventory of eating, binging, purging
activities
 Behavioral methods
 Relaxation techniques
 Antidepressant medicationscombined
with psychotherapy
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Nursing Process Applied
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Assessment
◦ Information about dietary intake and
eating patterns should be gathered with
caution
◦ Active listening and open-ended
techniques
 “Tell me how you feel about your
body”
 “How do you feel after eating?”
Nursing Process Applied (cont.)
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Selected nursing diagnoses may include
◦ Altered nutrition, less than body
requirements
◦ Ineffective individual coping
◦ Fluid volume deficit
◦ Social isolation
Nursing Process Applied (cont.)
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Expected outcomes may include
◦ Consumes adequate nutritional intake
◦ Verbalizes decreased fear and anxiety
related to weight gain
◦ Identifies family roles and boundaries
Nursing Process Applied (cont.)
Interventions
◦ The nurse may have multiple roles
◦ Plan of care
 Evaluation
◦ Normal weight for height/age
◦ Realistic self-image
◦ Sense of control over self/coping skills
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Question
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Tell whether the following statement is
true or false.
Anorexia nervosa occurs equally
frequently in both men and women.
Answer
False
 Rationale: Although anorexia nervosa
can affect both men and women, more
than 90% of cases occur in women. This
statistic may be related to cultural
pressure for women to maintain a certain
ideal of thinness.
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Question
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Tell whether the following statement is
true or false.
Currently, binge-eating disorder is not
categorized as a mental illness by the
DSM-IV-TR.
Answer
True
 Rationale: Binge-eating disorder presents
much the same clinical picture as bulimia
nervosa, but it does not involve the same
purging behaviors. It is not categorized as
a mental illness by the DSM-IV-TR, but it
is still considered an eating disorder.
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Question
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Evacuation of the digestive tract by selfinduced vomiting or excessive use of
laxatives and diuretics is called
A. Binging
B. Purging
C. Compensatory methods
D. Amenorrhea
Answer
B. Purging
 Rationale: Someone with an eating
disorder may follow episodes of binge
eating with purging, a self-destructive
method to evacuate the digestive tract.
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