1. Chapter 17 Eating Disorders
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2. Eating Disorders Anorexia nervosa Bulimia nervosa
Eating disorder not otherwise specified (NOS)
Binge eating disorder
Needs evidence-based validation
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3. 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
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4. 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
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5. Theories Psychological models Core psychopathology Feelings of
Low self esteem
Self-doubts about personal worth
Feelings produce harsh self-judgment focused on weight
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6. 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
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7. 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
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8. Medical Complications of Anorexia and Bulimia Nervosa
Medical complications ( Box 17-1)
Cardiovascular
Electrolyte imbalance
Osteoporosis
Amenorrhea
Dehydration
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9. 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
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10. 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.
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11. 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
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12. Anorexia Nervosa: Intervention
Long-term treatment/advanced practice interventions
Chronic illness that waxes and wanes
Psychotherapy
Psychopharmacology
Fluoxetine (Prozac)
Olanzapine (Zyprexa)
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13. Anorexia Nervosa: Evaluation
If weight falls below the goal, treatment is changed.
Long-term outcome less favorable than that for bulimia nervosa
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14. Bulimia Nervosa Personality characteristics
Sensitive to perceptions of others
May feel
Shame
Out of control
Low self-esteem
Unworthiness
Dysphoria
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15. Bulimia Nervosa: Nursing Process
Assessment
Nursing diagnosis
Outcome criteria
Short-term
Long-term
Planning
Review assessment guidelines on page 311.
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16. 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)
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17. Bulimia Nervosa: Evaluation
Normalize eating pattern
Maintain regular exercise plan
Weight in normal range for height
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18. 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
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