Eating Regulation Responses and Eating Disorders, Chapter 24

Eating Regulation Responses & Eating Disorders Eating Disorders occur across the life span Bulimia and Anorexia may be present in the same patient Both are ↑risk in first-degree female relatives with eating disorders Patient with eating disorders often have depression, anxiety and substance abuse

Eating Regulation Responses & Eating Disorders > females 50-75% of people with Anorexia or Bulimia have depression OCD can be found in 25% of patients with Anoroxia Nervosia Exhibit rigidity, ritualism, and meticulousness – often from early childhood

Eating Regulation Responses & Eating Disorders Binge eaters often report fluctuation of self-esteem Sexual abuse reported in 20-50% of patients with Anorexia or Bulimia Nurses first must examine their own feelings about weight and size

Eating Regulation Responses & Eating Disorders Eating disorders include: Anorexia nervosa Bulimia nervosa Bing eating disorder Night eating syndrome

Overlapping Relationships Among Eating Disorders(Stuart, 2013, p. 480)

Eating Regulation Responses & Eating Disorders Anorexia Nervosa Intense irrational beliefs about body, shape Intense fear of gaining weight even when under weight Body weight 15% below expected minimal normal weight for age and height Female menstrual cycle absent for at least 3 consecutive cycles Use denial as their coping mechanism

Eating Regulation Responses & Eating Disorders Anorexia (cont) Many anorexia nervosa patients recover within 5 years but for some this can be a chronic illness May consume as little as 200 calories daily Many are preoccupied by food and are employed in the food industry

Eating Regulation Responses & Eating Disorders Bulimia Nervosa More common than anorexia nervosa Binge eating then purge Self-induced vomiting Check for callus on a finger Misuse of laxatives, diuretics, enemas Chewing and spitting Early treatment = good response

Eating Regulation Responses & Eating Disorders Binge Eating Disorder Consume large amounts of calories and do not attempt to prevent weight gain Chronic in nature 19-40% obese people who seek help with weight to control binge eat Assess-what is meant by a binge (calories)

Eating Regulation Responses & Eating Disorders Night Eating Syndrome In the new DSM-V Night eaters experience 2 awakenings a night associated with food Symptoms associated with night eating syndrome Morning anorexia Difficulty staying asleep Depression in the evening

Eating Regulation Responses & Eating Disorders Assessment Full physical examination Dental examination Psychiatric history Weight history Pattern of menstruation Compulsive exercise patterns Use of laxatives, diuretics, diet pills

Eating Regulation Responses & Eating Disorders Important assessment with eating disorders is the patient’s motivation to change their behavior Anorexia is about controlling life and fears For some the only control they have is their food Bulimia patients have problems with their weight and resort to purging/laxatives, etc.

Eating Regulation Responses & Eating Disorders Medical Complications Anorexia - metabolic and endocrine abnormalities result from malnutrition/starvation Bulimia – potassium depletion and hypokalemia : related to purging, laxative, or diuretic abuse Excess weight – HTN, cardiac problems, sleep apnea, mobility, diabetes

Eating Regulation Responses & Eating Disorders Interventions Nutrition stabilization Exercise- physical fitness not calories Cognitive behavioral interventions Body image interventions Body image distortion- discrepancy between the patient’s actual size and the perceived body size Body dissatisfaction-degree of unhappiness that a person feels about body size

Eating Regulation Responses & Eating Disorders Interventions (cont) Family involvement Families should be engaged and included Group therapy CBT, psychoeducational, psychodynamic, and interpersonal models Encourage patients to express their feelings Medications SSRIs have had considerable to modest to no effect