1. Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
Chapter 18:
Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. Etiology Biologic Factors Genetic Serotonin abnormality
Sociocultural Factors
Diet and fitness industry
Fashion industry
Women’s movement
Peer pressure

3. Etiology, cont’d. Immaturity Compliance Sense of ineffectiveness
Psychologic Factors
Perfectionism
Social insecurity
Affective insecurity
Interoceptive deficits
Alexithymia
Low self-esteem
Immaturity
Compliance
Sense of ineffectiveness
Interpersonal distrust

4. Etiology, cont’d. Familial Factors Enmeshment Poor conflict resolution
Separation, individuation

5. Figure 18-1 The cycle of eating disorders.

6. Epidemiology Sex ratio Age of onset Cross-cultural Mortality
Comorbidity

7. Behavioral Symptoms of Anorexia Nervosa
Self-starvation
Compulsive behaviors regarding food
May use laxatives or diuretics, excessive exercise, and vomiting
Wearing baggy clothes

8. Physical Symptoms of Anorexia Nervosa
Weight loss 15% below ideal
Amenorrhea
Bradycardia, subnormal body temperature
Cachexia, sunken eyes, dry skin
Lanugo on face
Constipation
Cold sensitivity

9. Psychologic Symptoms of Anorexia Nervosa
Denial of seriousness of low weight
Body image disturbance
Irrational fear of weight gain
Constant striving for perfect body
Self-concept unduly influenced by shape and weight
Preoccupation with food, cooking
Delayed psychosexual development (little interest in sex, relationships)

10. Behavioral Symptoms of Bulimia Nervosa
Recurrent episode of binge eating
Purging behavior to compensate
Self-induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise

11. Physical Symptoms of Bulimia Nervosa
Fluid and electrolyte imbalances
Hypokalemia, alkalosis, dehydration, idiopathic edema
Cardiovascular
Hypotension, dysrhythmias, cardiomyopathy
Endocrine
Hypoglycemia, menstrual dysfunction
Gastrointestinal
Constipation, diarrhea, gastroparesis, esophageal reflux, esophagitis, esophageal tears, dental enamel erosion, parotid gland enlargement

12. Psychologic Symptoms of Bulimia Nervosa
Body image disturbance
Persistent over concern with weight, shape, proportions
Mood swings, irritability
Self-concept unduly influenced by weight

13. Discharge Criteria Be free from self-harm.
Achieve minimum normal weight.
Consume adequate calories to maintain normal weight.
Demonstrate ability to comply with postdischarge regimen.
Verbalize understanding of underlying psychologic issues.

14. Discharge Criteria, cont’d.
Use improved coping strategies.
Exhibit more functional behaviors within family system.
Attend group therapy.
Interact with helpful peers.
Keep appointments to monitor behaviors and medications.

15. Assessment Therapeutic alliance is vital. Assess:
Willingness for treatment
Treatment history
Patterns and perceptions regarding weight
Body dissatisfaction
Body image distortion

16. Assessment, cont’d. Assess: Dieting history Binge eating
Feelings regarding binge behaviors
Food cravings
Purging behaviors
Menstrual history
Medical side effects of eating disorder
Comorbidity factors

17. Nursing Diagnoses Anorexia Nervosa Anxiety Disturbed body image
Nutrition imbalance: less than body requirements
Social isolation
Bulimia Nervosa
Ineffective coping
Deficient fluid volume
Chronic low self-esteem

18. Outcome Identification
Participate in therapeutic contact with staff.
Consume adequate calories for age, height, and metabolic need.
Maintain fluid and electrolyte balance.
Demonstrate more effective coping strategies.
Manage family dysfunction more effectively.
Verbalize awareness of underlying psychologic issues.
Perceive normal body weight and shape as acceptable.

19. Planning Avoid power struggles
Need consistent, collaborative efforts by client, family, interdisciplinary staff

20. Implementation Ensure safe, nonthreatening environment
Prevent self-harm
Therapeutic alliance
Behavioral program to restore weight, nutrition
Structured environment with clear limits
Behavioral plan to reward compliance
Encourage expression of feelings

21. Nursing Interventions
Help increase client understanding of body image distortion.
Emphasize client capability to eat small portions without binging.
Maintain clear boundaries.
Avoid power struggles.
Intervene in anxiety.

22. Nursing Interventions, cont’d.
Give positive feedback for adherence to plan.
Engage in group therapy.
Assist to identify issues (e.g., esteem, identity disturbance).
Teach adaptive strategies.
Collaborate with dietician to teach nutrition.
Collaborate with interdisciplinary staff.

23. Biologic and Pharmacologic Treatment Modalities
Medical monitoring/hospitalization
Correcting deficiencies/imbalances
Pharmacologic
SSRIs
Specific drugs for medical side effects of the disorders

24. Psychotherapeutic Treatment Modalities
Individual psychotherapy
Behavioral
Contracts
Exposure and response prevention
Cognitive
Reframing
Cognitive restructuring

25. Psychotherapeutic Treatment Modalities, cont’d.
Family therapy
Decrease secondary gain
Uncover family dysfunction
Group therapy
Safe disclosure
Minimize manipulation and secondary gain
Expressive therapies

26. Adjunctive Therapy Occupational therapy
Nutrition education and counseling
Interdisciplinary treatment team
Community support groups