1. Chapter 18: Eating Disorders

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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)

16. 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