Eating Disorders Flashcards
Illnesses associated with maladaptive eating regulation responses include
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorders
Predisposing Factors for Eating Disorders
- Psychological (Rigidity, perfectionism)
- Environmental (Illnesses, sexual abuse, drug abuse, media influences)
- Familial (Increased risk in female relatives)
- Biological (Probable relationship to serotonin and dopamine levels)
- Sociocultural (Shifting cultural norms for young women to face multiple, ambiguous, often contradictory role expectations)
Implications for Eating Disorders
- More common in females; males more reluctant to seek treatment
- Sociocultural norms result in distorted body image
- Eating disorders can cause biological changes: altered metabolic rates, profound malnutrition, possibly death
- Eating obsessions can cause psychological problems (e.g., depression, isolation, emotional lability)
Anorexia Nervosa
- Serious mental illness characterized by intense irrational beliefs about ones shape and weight, including fear of gaining weight.
- Refuses to eat because of distorted self-perception of fatness
- Starvation ensues and can become a chronic illness.
Anorexia Nervosa Statistics
- Anorexia nervosa in approximately 0.5 – 1% of females
- About 5 – 10% of people with anorexia are male
- Usual onset between 13 – 20 years but can occur at any age
- Estimated mortality – 5% of those with the disorder
Coping Mechanisms: Anorexia
- Happiest when fasting, losing weight, or achieving weight goals
-Severely maladaptive use of denial; often angry with others’ concern or attempts to help - **Issue not really about weight but about controlling life and fears of maturity, independence, failure, sexuality, or parental demands (Believe they have solved problem by controlling their food intake and their bodies)
Medical Problems Related To Anorexia
- Patients 30% below ideal body weight often have life-threatening clinical and laboratory findings
- People who vomit and use laxatives or diuretics, regardless of weight, usually have health problems
- Metabolic and endocrine abnormalities result from malnutrition / starvation
Starvation and malnutrition from anorexia can cause what medical problems?
- Amenorrhea
- Osteoporosis
- Hypometabolic symptoms (cold intolerance, bradycardia)
- Hypotension
- Constipation
- Acid-base
- Fluid-electrolyte disturbances, e.g., pedal edema
Bulimia Nervosa
- Uncontrolled binge eating alternating with vomiting or dieting (purging calories)
- More common than anorexia
- Same patient may have bulimia and anorexia
Bulimia Nervosa occurs
- Occurs in people of normal weight but people may be obese or thin*
- Occurs usually at 15-18 years old
Coping Mechanisms: Bulimia
- Defense mechanisms (Avoidance, denial, isolation of affect, intellectualization)
- Usually upset about bingeing and purging behavior; realize not in control
- Regard symptoms as preferable to weight gain; years before accept treatment
What are medical problems related to bulimia?
- Potassium depletion and hypokalemia from vomiting, laxative or diuretic abuse
- Gastric, esophageal, bowel abnormalities common in patients with bulimia
- May erode dental enamel, cause enlarged parotid glands
Bulimia: Symptoms of Potassium Depletion
- Muscle weakness
- Cardiac arrhythmias
- Conduction abnormalities
- Hypotension
Binge Eating
- Consuming large amounts of calories in contained amount of time (after experiencing significant distress)
- Differs from bulimia because person does not attempt to prevent weight gain nor are purging behaviors used. (Can be normal weight but repeated bingeing will lead to obesity)
Medical Problems RT Binge Eating
- Excess weight -> serious health problems (i.e Hypertension, cardiac problems, sleep apnea, difficulty with mobility, DM, etc. )
- Increased weight -> exacerbate health problems
- Medical problems are common
Comorbid Mental Illness
- Depression or dysthymia in 50 – 75% of people with anorexia and bulimia
- Obsessive-compulsive disorder in up to 25% of patients with anorexia
- Patients with bulimia have increased rates of anxiety disorders, PTSD, substance abuse, and mood disorders
Assessment of Eating Disorders: Full Physical Assessment includes
- Vital signs
- Weight
- Skin
- CV system
- Evidence of laxatives, diet pills, diuretic abuse
- Vomiting
- Dental exam
Assessment: Psychiatric History
- Dieting
- Substance abuse
- Family Assessment
- Medications
Assessment: Screening
Adding these two questions may be as effective as more extensive questionnaires to identify people with eating disorders:
- Are you satisfied with your eating patterns?
- Do you ever eat in secret?
Outcomes for Patients with Eating Disorders
- Patient will restore healthy eating patterns and normalize physiological parameters related to body weight and nutrition
- For patients with anorexia and bulimia, this means eating 100% of meals without bingeing and purging
- Encourage obese patients to leave something (2 – 5%) on plate at mealtime
Nursing Care for Patients with Eating Disorders include
-Nutritional Stabilization
-Physiological stabilization (Highest priority!)
-Counseling about healthy eating patterns and behaviors is essential aspect of nursing care for all patients, regardless of whether they need to gain, lose, or maintain weight
-Nutritional assessment education, ongoing support are essential
-Exercise: Focus exercise program on physical fitness and not working off calories
-Consult recreational therapist or exercise physiologist to help maximize therapeutic value of exercise regimen
-Help patient solve problems and make decisions after identifying alternatives
-Encourage patient to list high-risk situations that cue maladaptive eating, purging behaviors
Family involvement
Group therapies
Pharmacological Interventions: Anorexia
SSRI’s - Prozac and Zyprexa
Pharmacological Interventions: Bulimia
Antidepressants + CBT
Pharmacological Therapy: Binge Eating
- SSRI’s - treats the disorder and helps in short term but patients will regain significant weight
- Belviq (lorcaserin) - make individuals feel full after eating
- Qsymia (topiramate and phentermine) – produces feelings of fullness and appetite suppressant
- Surgical interventions – bariatric surgery
Awareness of Cognitive Distortions
- Patient to monitor and record eating, bingeing and purging behavior and thoughts and feelings regarding weight, shape and food.
- Cues that trigger eating responses
- Thoughts, feelings, assumptions with cues
- Connection between these and eating regulation responses.
- Consequences from eating responses
Feeding and Elimination Disorders include
- PICA
- Avoidance/Restrictive
- Rumination
- Enuresis
- Encopresis
PICA
Eating non-food items following childhood (sometimes seen in pregnancy)
Rumination
- Regurgitation with chewing, reswallowing or splitting
- There is not an underlying GI reason and is independent of other eating disorders or medical illness
Avoidance/Restrictive
- Avoiding or restricting foods
- Starts in early childhood
- Low BMI
- Dependent on enteral feeding
- Nutritional deficiency
- No distortion of body image
- Not medically explain in any other illness
Enuresis
- Behavioral disorder in children older than five
- Involuntary or intentional voiding of urine in clothing or bed
- Occurs twice weekly for more than three months
Subtypes of enuresis
- Nocturnal
- Diurnal
- Nocturnal and Diurnal
Encopresis
- Behavioral disorder in children older than 4
- Involuntary or intentional inappropriate passing of feces
- Occurs once monthly for more than three months
Nursing Management of Feeding and Elimination Disorders
- Psychoeducation
- Avoid punitive measures
- Skin assessments
- Managing dietary and toileting activities
