1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20 Eating Disorders

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology Biologic factors –Genetic vulnerability –Disruptions in the nuclei of the 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology (cont.) 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations Increased prevalence in industrialized countries –Most common in the United States, Canada, Europe, Australia, Japan, New Zealand, South Africa –Less frequent among African Americans in the United States –Equal among Hispanic, Caucasian women

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? One current biologic theory about eating disorders is that it involves a disruption in the cerebellum portion of the brain.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: One of the biologic theories of eating disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa Refusal or inability to maintain minimal 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

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa (cont.) Onset: usually between ages 14 and 18 Denial early on; depression and lability with progression; isolation; medical complications (see Table 20.2) Treatment: often difficult; patient resistant, uninterested, denies problem

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa (cont.) Medical management –Weight restoration/nutritional rehabilitation –Rehydration/correction of electrolyte imbalances Psychopharmacology: amitriptyline, cyproheptadine, olanzapine, fluoxetine Psychotherapy –Family therapy –Individual therapy –Cognitive–behavioral therapy

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bulimia Nervosa (cont.) 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

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The typical age of onset for anorexia is which of the following? –A. 10 to 14 years –B. 14 to 18 years –C. 18 to 22 years –D. 22 years and older

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. 14 to 18 years Rationale: Most commonly, anorexia begins between the ages of 14 and 18 years.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Eating Disorders and Nursing Process Application (cont.) Assessment (cont.) –Thought process, content: preoccupation with food or dieting –Sensorium, intellectual processes –Judgment, insight –Self-concept: low self-esteem –Roles, relationships –Physiologic/self-care considerations (see Table 20.2)

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Eating Disorders and Nursing Process Application (cont.) Data analysis/nursing diagnoses Outcome identification: –Establish adequate nutritional eating patterns –Eliminate compensatory behaviors (excessive exercise, laxatives, diuretics, purging) –Demonstrate positive coping mechanisms –Verbalize acceptance of body image with ideal body weight

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Eating Disorders and Nursing Process Application (cont.) 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 patient, family education Evaluation

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 –Healthy People 2020

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 (see Boxes 20.1 and 20.2)

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Self-monitoring is an effective technique that a patient with anorexia can use.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Self-monitoring is an effective technique that a patient with bulimia can use.

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Feelings of frustration when patient rejects help Being seen as “the enemy” if you must ensure that the patient eats Dealing with own issues about body image, dieting