1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 23Eating Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Eating disorders are fascinating, confusing, challenging and deeply disturbing. Physicians, nurses, psychotherapists and other medical and mental health providers frequently find themselves confused and feel overwhelmed when dealing with these disorders. —Sobel, 2005

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives Differentiate the terms anorexia nervosa, bulimia nervosa, and obesity Explain why obesity is not categorized as an eating disorder Discuss the following theories of eating disorders: genetic or biochemical; psychological or psychodynamic; and family systems Discuss the following theories of obesity: genetic or biologic, and behavioral Describe at least five clinical symptoms shared by clients with anorexia nervosa and clients with bulimia nervosa

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Articulate the rationale for medical evaluation of a client with an eating disorder or the diagnosis of obesity State the criteria for inpatient treatment of a client with an eating disorder Identify the medical complications of anorexia nervosa, bulimia nervosa, and obesity Construct an assessment tool to identify clinical symptoms of an eating disorder Formulate a plan of care for a client with the diagnosis of bulimia nervosa

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Statistics of Eating Disorders About 1% of female adolescents between the ages of 10 and 20 have anorexia. Approximately 4% of college-aged women have bulimia or bulimic patterns. There seems to be an increase in the incidence of middle-aged women with anorexia and bulimia. An estimated 5% to 10% of individuals diagnosed with anorexia and 10% to 15% diagnosed with bulimia are male. Approximately 60% of adult Americans, both male and female, are overweight. And 34% are considered to be obese. About 31% of American teenage girls and about 28% of boys are overweight.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Anorexia and Bulimia Genetic or biochemical theories Psychological and psychodynamic theories Family systems theories

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Obesity Genetic or biological theories Behavioral theories

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics: Anorexia Nervosa Dry, flaky, or cracked skin Brittle hair and nails; hair beginning to fall out Amenorrhea or menstrual irregularity Constipation Hypothermia due to loss of subcutaneous fat Decreased pulse, blood pressure, and basal metabolic rate Skeletal appearance; BMI of 16 or below Presence of lanugo (downy soft body hair seen on newborn infants) Loss of appetite Callus formation on finger (Russell’s sign) due to self-induced purging Dental caries Total lack of concern about symptoms

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Client with Anorexia Nervosa Wearing of loose-fitting clothing to hide physical appearance as it changes

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics: Bulimia Nervosa Chronic inflammation of the lining of the esophagus Rupture of the esophagus Dilation of the stomach Rupture of the stomach Electrolyte imbalance or abnormalities, leading to arrhythmias of the heart and metabolic alkalosis Heart problems, irreversible heart failure, and death due to abuse of ipecac syrup Chronic enlargement of the parotid glands Dehydration Irritable bowel syndrome or abnormal dilation of the colon Rectal prolapse, abscess, or bleeding Rupture of the diaphragm, with entrance of the abdominal contents into the chest cavity Dental erosion; gum disease Chronic edema Fungal infections of the vagina or rectum

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics: Binge Eating Disorder Recurrent episodes of binge eating without purging Lack of control over eating History of repeated attempts to lose or stabilize an individual’s weight

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment tools Physical examination Laboratory tests Transcultural considerations

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Imbalanced nutrition less than body requirements Imbalanced nutrition more than body requirements Anxiety Disturbed body image Constipation Diarrhea Fatigue Deficient fluid volume Impaired social interaction Compromised family coping Risk for impaired skin integrity Chronic low self-esteem

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Short-term outcomes –Stabilizing any existing medical condition including weight loss –Normalizing eating behaviors –Decreasing clinical symptoms of a comorbid psychiatric disorder such as anxiety or depression Long-term outcomes –Helping the client develop more constructive coping mechanisms –Helping the client and family resolve any psychological issues that precipitated the eating disorder

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Criteria for hospitalization: –Suicidal ideation is exhibited. –Severe purging or self-destructive behavior is out of control. –Psychosis is evident. –Family is demonstrating crisis. –Environment is nonsupportive. –The client fails to respond to outpatient interventions. –Any life-threatening condition based on laboratory data monitored during treatment is occurring.

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance with meeting basic needs –Creation of a safe environment –Stabilization of medical condition –Stabilization of behavior Medication management Interactive therapies –CBT and IPT –Solution-focused brief therapy –Family therapy Self-help and support groups Client education

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Evaluation is an ongoing process. Clients will improve their prognosis by doing the following: Attending a specific support group Keeping scheduled appointments with a therapist or community mental health nurse Participating in family therapy

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Binge eating Body mass index Cachexia Developmental obesity Obesity Purging Reactive obesity Russell’s sign

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote by Sobel: “Eating disorders are fascinating, confusing, challenging and deeply disturbing. Physicians, nurses, psychotherapists and other medical and mental health providers frequently find themselves confused and feel overwhelmed when dealing with these disorders.” Why do you think Sobel stated that eating disorders are fascinating? How are they confusing? Why are they challenging? In what way are they deeply disturbing? ?