Eating Disorders Flashcards
COMMONALITY: Based on irrational misperception of body image
People with eating disorders (EDs) have cognitive distortions that are the result of processing errors in the brain
FATAL
COMMON DIAGNOSTIC CATEGORIES/criterias
Types of eating disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorders
Obesity
COMMON DIAGNOSTIC CATEGORIES/criterias
EDs are connected to the underlying emotions of:
Anxiety
Dysphoria (state of dissatisfaction with life)
Low self-esteem
Feelings of lack of control -often seen; control: what eat - feelings of control when feel out of control
Cognitive distortion
Eating disorders are deadly
Treatment involves whole family
Significant co-morbidity with:
The Academy for Eating Disorders (AED) advises to always assess for psychiatric risk, including suicidal and self-harm thoughts, plans, and/or intent
Co-morbidity
Mood and anxiety disorders
Substance abuse
Body dysmorphic disorders
Impulse control disorders
Personality disorders, especially borderline and obsessive-compulsive personality disorders
Some going on with eating disorders
Significant co-morbidity with:
Lose so much weight; see lot males
Loss of Appetite/refusal to eat
Loss of menstrual period
Dieting with relish - pride not eating and control over what eating
Denial of hunger
Excessive exercising/frequent weighing - obsessed with scale
Use of laxatives and/or vomiting
Layered clothing - masters at hiding weight
Bizarre eating habits
Intolerance to cold
Leaving for the bathroom after meals - also with Bulimia
May also vomit
Tend not to eat
Red or raw knuckles - also with Bulimia
FATAL because electrolytes can get out
RED FLAGS—ANOREXIA
1.Which is characteristic of the diagnosis of anorexia nervosa?
A.Obsession with weight gain
B.Body image disturbance
C.Disregard for the feelings of others
D.Healthy family relationships
Correct answer: B
The distortion in body image by a client diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated.
Perfectionist (expect be perfect)/low self-esteem - lot shoulds
Female: 12-25; increase in 8-11 y.o.
Seeks to rule life by controlling body
Often uninformed & fear sex - uninformed about sex - afraid getting breasts/menstrual cycles; stop eating menstrual cycle goes away
Shy, timid, neat
High energy level/high achiever
Often dependent esp upon parents
Common characteristics often identified with anorexia
Treatment as quickly as possible - give areas where can be involved or have a say or control
Be consistent/Behavior Modification
Individual therapy/self-esteem, identify
Give them ways to be in control
Watch labs/electrolytes - deadly because electrolytes out of balance
Expect gain ¼ to ½ lb/week (anorexia) - really low
Family Therapy - impacts entire fam becomes issue what eating/not eating; involve fam in therapy
Medications/antidepressants - not uncommon to give; dependent on what going on with them; may be on antianxiety
General treatment
Way cope - lifelong thing to help them cope with them
Outcomes need to be measurable within specific, realistic time frames, as determined for each individual patient (e.g., within 3 weeks, by discharge). - slow down weight gain
Patient will:
Outcomes identification anorexia nervosa
Refrain from self-harm - cutting can be big issue; SI; SAFETY
Normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks
Achieve 85% to 90% of ideal body weight
Be free of physical complications
Demonstrate two new, healthy eating habits. Participate in the treatment of associated psychiatric symptoms (e.g., defects in mood, self-esteem)
Participate in long-term treatment to prevent relapses - common to have relapses with nay eating disorders
Patient will:
Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (binging)
Eat huge amount food in short period of time then binge to self-inducing to get rid of it; knuckles very raw; get rid of whatever consumed; often sweets
Feel guilty then get rid of it
Watch electrolytes and labs because will potentially kill them
The episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Bulimia Nervosa: Nursing process: assessment
- Excessive concern about wt.
- Frequent overeating
- Binging often on sweets
- Expresses guilt or shame overeating
- Disappears after meal - going to purge
- Depressive mood
- Weight may be appropriate for height or may be slightly overweight - outwardly hard to identify
RED FLAGS–BULIMIA
Outcomes need to be measurable and with realistic, but specific, time goals as determined for the individual patient
Include in goal setting in what they want to be the outcome
Patient will…..
Outcomes identification bulimia nervosa
Refrain from binge-purge behaviors - not binge; what do besides it
Demonstrate 2 new skills for managing anxiety
Obtain & maintain normal electrolyte balance
Be free of self-directed harm
Express feelings in a nonfood-related manner
Name two personal strengths - improve self-esteem
Patient will…..
Terror of gaining weight
Preoccupation with food
Views self as fat even when emaciated
Judges self-worth by weight
Prominent parotid glands, if purging
Peculiar handling of food:
Cutting food into small bits
Pushing food around the plate
Maintaining a rigorous exercise regimen - not purge but will exercise to get rid of it
Controls what they eat to feel powerful to overcome feelings of helplessness
Anorexia Nervosa
Binge eating
Self-induced vomiting
Laxative and diuretic abuse
History of anorexia nervosa in one quarter to one third of individuals
Depressive signs and symptoms
Problems with interpersonal relationships
Prominent parotid glands, if purging
Bulimia Nervosa
A body mass index of 30 is considered obese.
Obesity can contribute to increases in morbidity and mortality. - can be fatal
Can be overweight and healthy; watch biases
Eating disorder in DSM-5
Obese people are at higher risk for: lot things
Obesity
Hyperlipidemia
Diabetes mellitus
Osteoarthritis
Angina
Cardiac issues
Respiratory insufficiency
Obese people are at higher risk for: lot things
The DSM-5 identifies binge eating disorder (BED) as an eating disorder that can lead to obesity - can lead to being overweight; not look emaciated
Is a variant of compulsive overeating
Often symp of severe depression
Is an eating pattern that resembles that of obesity
Recurrent episodes of thinking about and eating large amount of food occur in a short period
Not restrict or purge food
Feelings of disgust, depression, and guilt are expressed after bingeing
Binge-eating disorder (BED) is now recognized as a specific disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).
Is noted as a symptom of depression
Binge eating disorder (BED)
The individual binges on large amounts of food, as in bulimia nervosa
BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories - not try get rid of food; feel bad about binging but not get rid of it
The DSM-5 identifies binge eating disorder (BED) as an eating disorder that can lead to obesity - can lead to being overweight; not look emaciated
In approximately 50% of obese binge eaters, no attempt to restrict dietary intake occurs before bingeing - just binge; not purge it
Effective treatment for obese binge eaters integrates behavior modification, improvement of depressive symptoms (identify that and then improve BED), and achievement of the appropriate weight
Effective program for BED integrates modification with noted associated mood changes, working toward an appropriate weight
Relationship with food
Binge-eating disorder and obese binge eaters
NOT IN DSM-5
Aware what eating and want eat healthy; so focused on quality, not quantity
Orthorexia is an eating disorder that involves an unhealthy obsession with healthy eating. Revolves around food quality, not quantity. Not focused on losing weight.
Avoidant food intake
Go to the extreme
There may be extreme limitation on diff food groups that result in only consuming less than a total of 10 ingredients if actually eating: missing nutrients, vitamins and other things need to stay health; Allowing food to revolve around one’s daily schedule.
Obsession with meal planning and food label and what eat
Not in DSM-5, but under Avoidant/Restrictive Food Intake (ARFID) as a broad diagnostic category. - seeing more and more of it
Not have well-rounded eating plan; missing other things; hurts body
Orthorexia
Nursing care of the client with an eating disorder is aimed at restoring nutritional balance diet - eating nutritionally; getting healthy balance in life; gain control in what eat - less anxiety - self esteem increases
Emphasis is also placed on helping the client gain control over life situations often (often root cause) in ways other than inappropriate eating behaviors - where in life have control in healthy way; control issue often
Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance - focus on these
Planning and implementation
