1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 16Eating Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa Individual refusal to maintain the least essential normal body weight Maintenance of subnormal levels of weights for age/height: below 85% or BMI < 17.5 –Intense fear of weight gain –Disturbance in self-image –Obsessive preoccupation with food –Compulsive exercise –Physiologic symptoms

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa Subtypes Restricting type –Weight loss achieved through dieting, starvation, excessive exercise Binge eating/purging type –Binge eatingeating a larger amount of food than one would normally eat in a discrete period of time –Purgingevacuation by the digestive tract by self- induced vomiting or excessive use of laxatives/diuretics

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa (cont.) Incidence and etiology –Often begins at 13 to 18 years of age –90% women –Symptoms commonly follow stressful events Signs & Symptoms of Anorexia Nervosa Box 16.1 Pg. 253 Associated Medical Conditions of Anorexia Box 16.2 Pg. 253

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anorexia Nervosa (cont.) Clients with anorexia nervosa –Typically well-educated, middle to upper class –May be shy, orderly, overly sensitive to rejection –Often have unresolved family conflicts –Heightened feelings of inferiority, self-imposed guilt, unreasonable expectations for perfection –Attempt to gain control of life by controlling body

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bulimia Nervosa Binge eating with repeated attacks to the self and self- induced destructive methods to prevent weight gain Subgroups: purging and nonpurging DSM-IV-TR criteria: behavior occurs at least 2x a week for 3 months

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bulimia Nervosa (cont.) Craving for high-calorie/sweet food Shame Secretive eating/stashing of food Depression Induced vomiting Laxative/diuretic/enema use (compensatory methods) Normal height/weight with little variation Associated anxiety/personality disorder

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bulimia Nervosa (cont.) Incidence and etiology –Onset typically during adolescence or early adulthood –More common in femalesalso seen in males –All cultural and socioeconomic groups –Chronic patternusually lasts 5-10 years –Substance abuse common –Interpersonal relationships affected –Typically within a normal weight range for height and weight Signs & Symptoms of Bulimia Box 16.3 Page 255 Medical Conditions Assoc. with Bulimia Box 16.4 Pg. 255

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Binge-Eating Disorder Not officially classified as mental disorder Diagnosisat least two binge-eating episodes in a 6- month period Similar to bulimia nervosa with slightly different pattern –Recurrent binge-eating episodes not followed by purging behaviors

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Binge-Eating Disorder (cont.) Signs and symptoms –The person tends to be overweight or obese –Guilt and shame about eating –Cycle of eating as coping mechanism –Food consumption usually quick and by oneself –Excess of 10,000 calories at once –Often history of other psychological problems

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Binge-Eating Disorder (cont.) Incidence and etiology –Affects males and females equally –Media emphasis on weight/appearance –Low self-image –Impulsive behaviors

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Eating Disorders Cognitive-behavioral psychotherapy –Addresses the psychologic issues of disorders Goals –Reversal of restrictive or maladaptive patterns of eating and thinking about food –Reestablishment of healthy eating habits

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Anorexia Nervosa Family therapy –See how maladaptive family behaviors are intertwined in the client’s eating disorder Behavior therapy –Reward contract –Gradual increase in caloric intake Medications –Antidepressant/antianxiety medications

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Bulimia Nervosa Education about healthy eating Self-inventory of eating, binging, purging activities Behavioral methods Relaxation techniques Antidepressant medicationscombined with psychotherapy

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPg. 257 –Information about dietary intake and eating patterns should be gathered with caution –Active listening and open-ended techniques “Tell me how you feel about your body” “How do you feel after eating?”

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Selected nursing diagnoses may includePg. 257 –Altered nutrition, less than body requirements –Ineffective individual coping –Fluid volume deficit –Social isolation

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Expected outcomes may includePg. 257 –Consumes adequate nutritional intake –Verbalizes decreased fear and anxiety related to weight gain –Identifies family roles and boundaries

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) InterventionsPg. 258 –The nurse may have multiple roles –Plan of care EvaluationPg. 258 –Normal weight for height/age –Realistic self-image –Sense of control over self/coping skills

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Anorexia nervosa occurs equally frequently in both men and women.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Although anorexia nervosa can affect both men and women, more than 90% of cases occur in women. This statistic may be related to cultural pressure for women to maintain a certain ideal of thinness.

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Currently, binge-eating disorder is not categorized as a mental illness by the DSM-IV-TR.

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Binge-eating disorder presents much the same clinical picture as bulimia nervosa, but it does not involve the same purging behaviors. It is not categorized as a mental illness by the DSM-IV-TR, but it is still considered an eating disorder.

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Evacuation of the digestive tract by self-induced vomiting or excessive use of laxatives and diuretics is called A. Binging B. Purging C. Compensatory methods D. Amenorrhea

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Purging Rationale: Someone with an eating disorder may follow episodes of binge eating with purging, a self-destructive method to evacuate the digestive tract.