eating disorders Flashcards
anorexia kills more ppl
than any other DSM5 diagnosis (w/ the exception of opioids)
anorexia - High comorbidity with
personality d/o (esp. OCD), depression, anxiety d/o
anorexia - age of onset
Age of onset: 10-20 yo, but this is changing
anorexia and hunger
decreased interoceptive awareness - ability to notice and respond to bodily cues like hunger
anorexia - characteristics
difficulty expressing anger, non-assertiveness
low self-esteem
perfectionism
fear of sexuality, emotional maturation - afraid to date
enmeshed families (overprotective, rigid, difficulty w/ individuation)
“people-pleasers”
dichotomous thinking
anorexia - physical - just body weight %
emaciation (<75% IBW = hospitalization)
anorexia - prognosis
Prognosis: < 50% recover fully
anorexia - nursing process- should you argue w/ them?
Avoid power struggles
Don’t underestimate their impairment
bulimia - biologic - what neurotransmitter
biologic (low serotonin/tryptophan),
bulimia - High comorbidity with
BPD, depression, PSA, anxiety d/os
bulimia - Age of onset
Age of onset: 14-24 (but growing in women age 25-45)
bulimia - characteristics - how does it differ from anorexia?
similar to those for anorexia, but (unlike anorexia) they recognize that their eating behaviors are abnormal and often seek help
binging and purging (sense of lack of control)
impulsive
bulimia - physical
Often normal weight
Salivary (parotid) gland inflammation, esophageal varices, dental erosion
electrolyte imbalances, seizures, ipecac cardiac arrhythymias
metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea)
scars or reddened areas on knuckles
bulimia - what therapy?
Cognitive behavioral therapy
binge eating - treatment (binge eating is el diablo)
DBT, meds (SSRIs are often used which also help tx the common comorbid depression; appetite suppressants), Overeater’s Anonymous
Rumination
regurgitating food
bulimia - meds- just 1
Meds: SSRIs (esp Prozac) in high doses (60 mg/day)
bulimia - teach pt what coping skills
Teach assertiveness, healthy boundaries
Teach recognition of triggers, alternative coping mechanisms
what is important with anorexia?
Interdisciplinary approach: consistency is important
Family (Maudsley) and individual therapy
what to avoid during acute phase of anorexia?
No meds during acute phase
what to assess for with anorexia?
Teach assertiveness
Suicide assessment (comorbid depression is common!)
what meds for anorexia
SSRIs and Olanzapine may be helpful once normal weight has been restored
