Chapter 17 Eating Disorders Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Eating Disorders Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified (NOS) Binge eating disorder Needs evidence-based validation Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Common Characteristic Significant disturbance in the perception of body shape and weight Perfectionism, obsessive thoughts and actions related to food, the need to be people pleasers, the need to be in control Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Theories Viewed as syndromes based on a cluster of symptoms Neurobiological Altered neurotransmitters Neuroendocrine Abnormalities noted Causal relationship possible May be result of starvation or abnormal eating behavior Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Theories Psychological models Core psychopathology Feelings of Low self esteem Self-doubts about personal worth Feelings produce harsh self-judgment focused on weight Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Theories Sociocultural models Genetic models Internalization of societal ideal of thinness Incidence of eating disorders increases in societies in which women have a choice in social roles Conflictual roles Genetic models Strong genetic link for eating disorders Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Signs and Symptoms and Clinical Presentations of Anorexia and Bulimia Anorexia nervosa (Table 17-1) Terror of gaining weight Low weight Bulimia nervosa (Table 17-1) Binge eating behaviors Often purging after binging Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Medical Complications of Anorexia and Bulimia Nervosa Medical complications ( Box 17-1) Cardiovascular Electrolyte imbalance Osteoporosis Amenorrhea Dehydration Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Anorexia Nervosa Personality characteristics Perfectionism Obsessive thoughts and actions relating to food Need to control If weight below 75% ideal weight, hospitalization to provide immediate stabilization Weight restoration and weight monitoring Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Anorexia Nervosa: Nursing Process Assessment Nursing diagnosis Outcome criteria Short-term Long-term Planning Refeeding syndrome See assessment guidelines on page 307 in addition to common cognitive distortions on page 309. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Anorexia Nervosa: Intervention Acute phase/basic level intervention Milieu therapy Precise meal times and menus Observation during and after meals Regularly scheduled weighing Counseling Cognitive distortions, anxiety, dysphoria, low self-esteem, feeling of lack of control Health teaching Self-care Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Anorexia Nervosa: Intervention Long-term treatment/advanced practice interventions Chronic illness that waxes and wanes Psychotherapy Psychopharmacology Fluoxetine (Prozac) Olanzapine (Zyprexa) Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Anorexia Nervosa: Evaluation If weight falls below the goal, treatment is changed. Long-term outcome less favorable than that for bulimia nervosa Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Bulimia Nervosa Personality characteristics Sensitive to perceptions of others May feel Shame Out of control Low self-esteem Unworthiness Dysphoria Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Bulimia Nervosa: Nursing Process Assessment Nursing diagnosis Outcome criteria Short-term Long-term Planning Review assessment guidelines on page 311. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Bulimia Nervosa: Intervention Acute phase/basic level intervention Milieu therapy Interrupt binge-purge cycle Prevent disordered eating behaviors Counseling Health teaching Long-term treatment/advanced practice interventions Psychotherapy Cognitive-behavioral therapy Psychopharmacology Fluoxetine (Prozac) Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Bulimia Nervosa: Evaluation Normalize eating pattern Maintain regular exercise plan Weight in normal range for height Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Binge Eating Disorder A variant of compulsive overeating Reported in 20% to 30% of obese clients No compensatory behaviors Major depression a significant comorbidity Most effective treatment is cognitive-behavioral therapy SSRIs used in treatment Overwhelming majority recover Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.