2Eating DisordersView of continuum: anorexia (eat too little); bulimia (eat too chaotically); obesity (eat too much)CategoriesAnorexia nervosaBinge eatingPurgingBulimia nervosa
3Etiology 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
4Developmental factors Etiology (cont’d)Developmental factorsStruggle for autonomy, identityOverprotective or enmeshed familiesBody image disturbance/dissatisfactionSeparation-individuation difficultiesFamily influences (family dysfunction, childhood adversity)Sociocultural factors (media, pressure from others)
5Cultural Considerations Increased prevalence in industrialized countriesMost common in United States, Canada, Europe, Australia, Japan, New Zealand, South AfricaLess frequent among African Americans in United StatesEqual among Hispanic, Caucasian women
6QuestionTell whether the following statement is true or false:One current biologic theory about eating disorders is that it involves a disruption in the cerebellum portion of the brain.
7AnswerFalseOne of the biologic theories of eating disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.
8Anorexia NervosaRefusal or inability to maintain minimally normal body weightIntense fear of gaining weight or becoming fatSignificantly disturbed perception of body shape or sizeSteadfast inability or refusal to acknowledge seriousness of problem or even that one exists
9Anorexia Nervosa (cont’d) Onset: usually between ages 14 and 18Denial early on; depression and lability with progression; isolation; medical complications (Table 18.2)Treatment: often difficult; client resistant, uninterested, denies problem
10Anorexia Nervosa (cont’d) Medical managementWeight restoration/nutritional rehabilitationRehydration/correction of electrolyte imbalancesPsychopharmacology: amitryptyline, cyproheptadine, olanzapine, fluoxetinePsychotherapyFamily therapyIndividual therapyCognitive behavioral therapy
11Bulimia NervosaRecurrent 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, contemptUsually normal weight
12Bulimia Nervosa (cont’d) Onset: late adolescence, early adulthood (average age of 18 to 19 years)Often begins during or after dieting episodePossible restrictive eating between binges; secretive storage/hiding of foodTreatmentCognitive behavioral therapyPsychopharmacology: antidepressants
13QuestionThe typical age of onset for anorexia is which of the following?10 to 14 years14 to 18 years18 to 22 years22 years and older
14Answer14 to 18 yearsMost commonly, anorexia begins between the ages of 14 and 18 years.
15Eating Disorders and Nursing Process Application AssessmentHistory: 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
16Eating Disorders and Nursing Process Application (cont’d) Assessment (cont’d)Thought process, content: preoccupation with food or dietingSensorium, intellectual processesJudgment, insightSelf-concept: low self-esteemRoles, relationshipsPhysiologic/self-care considerations (Table 18.2)
17Eating Disorders and Nursing Process Application (cont’d) Data analysis/outcome identificationInterventionsEstablishing nutritional eating patterns (inpatient treatment if severe)Identifying emotions, developing coping strategies (self-monitoring for bulimia)Dealing with body image issuesProviding client, family educationEvaluation
18Hospital admission only for medical necessity Community settings Community-Based CareHospital admission only for medical necessityCommunity settingsPartial hospitalization or day treatment programsIndividual or group outpatient therapySelf-help groups
19Mental Health Promotion Education of parents, children, young people about strategies to prevent eating disordersEarly identification, appropriate referralRoutine screening of young women for eating disorders (Box 18.2)
20QuestionTell whether the following statement is true or false:Self-monitoring is an effective technique that a client with anorexia can use.
21AnswerFalseSelf-monitoring is an effective technique that a client with bulimia can use.
22Self-Awareness Issues Feelings of frustration when client rejects helpBeing seen as “the enemy” if you must ensure that client eatsDealing with own issues about body image, dieting