Chapter 18: Eating Disorders

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

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

Developmental factors 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)

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

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

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

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

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

Bulimia Nervosa (cont’d) Onset: late adolescence, early adulthood (average age 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

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

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)

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

Hospital admission only for medical necessity Community settings 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

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)

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