1. Mental Health Nursing II NURS 2310 Unit 9 Eating Disorders

2. Anorexia Nervosa

3. Definition Prolonged loss of appetite; self-starvation with a disruption in metabolism due to inadequate calorie intake. Incidence & Population Affected Increased in the past 30 years Affects approximately 1% of young women – –Occurs predominantly in females aged twelve to thirty – –Less than 10 percent of cases are males

4. Etiology & Characteristics Morbid fear of obesity Gross distortion of body image; sees self as “fat” when obviously underweight Preoccupation/obsession with food – –hoarding or concealing food – –preparing elaborate meals for others while severely restricting self Refusal to eat; marked weight loss May include extensive exercising Physiological symptoms include amenorrhea, hypothermia, bradycardia, hypotension, edema, lanugo, and metabolic changes

5. Diagnostic Criteria Refusal to maintain body weight at or above a minimally normal weight for age and height Intense fear of gaining weight or becoming fat, even though underweight Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or denial of the seriousness of the current low body weight Amenorrhea

6. Bulimia Nervosa

7. Definition Excessive, insatiable appetite; episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time, followed by inappropriate compensatory behaviors to rid the body of the excess calories.

8. Incidence & Population Affected More prevalent than anorexia nervosa Affects approximately 4% of young women – –Onset occurs in late adolescence or early adulthood – –Occurs mainly in populations with an abundant availability of food, and in which the ideal of beauty is thinness

9. Etiology & Characteristics Persistent overconcern with personal appearance Weight fluctuations common due to alternating binges and fasts Excessive vomiting and laxative/diuretic abuse may lead to problems with dehydration and electrolyte imbalances Gastric acid in vomitus contributes to the erosion of tooth enamel Individual may experience tears in the gastric or esophageal mucosa

10. Diagnostic Criteria Recurrent episodes of binge eating Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months Self-evaluation is unduly influenced by body shape and weight

11. Obesity

12. Definition Chronic disease defined by having a Body Mass Index (BMI) of more than 30. Incidence & Population Affected 61% of the U.S. population age 20 or older are overweight; 27% are obese; 4.7% are morbidly obese Affects black women more than white women, and white men more than black men 6 times more prevalent among lower socioeconomic classes

13. Etiology & Characteristics May have a genetic component Lifestyle factors; lack of physical activity Leads to problems with hyperlipidemia, hyperglycemia, diabetes mellitus, osteoarthritis due to trauma to weight- bearing joints, angina and respiratory insufficiency due to increased workload of the heart and lungs Food is considered a social outlet Depression/low self-esteem May involve binge-eating disorder

14. Diagnostic Criteria (Binge-Eating Disorder) Recurrent episodes of binge eating in which one does not feel in control of what/how much is being consumed Binge-eating episodes are associated with – –eating much more rapidly than normal – –eating until feeling uncomfortably full – –eating alone because of being embarrassed by how much one is eating – –feeling depressed or guilty after overeating Marked distress regarding binge eating The binge eating occurs, on average, at least 2 days a week for 6 months

15. Nutritional Deficits

16. Electrolyte imbalances Nutrient deficits Malnutrition Poor glucose control Deficiency in vital fats Vitamin deficiencies

17. Treatment Modalities

18. Education – –Learning healthy eating patterns Weight management – –Nutrition education – –Exercise program – –Surgery Individual therapy – –Cognitive-behavioral therapy (CBT) – –Coping with thoughts and feelings Family therapy Psychopharmacology – –Antidepressants – –Anxiolytics

19. Milieu Therapy *Focuses on behavior modification Changing maladaptive eating behaviors Empowering client to take control of treatment Contract for privileges based on weight gain or weight maintenance Goals of therapy agreed upon by client and staff System of rewards and privileges can be earned by client, who is given ultimate control – –Client chooses whether or not to abide by the contract – –Client is made accountable for choices and behaviors