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NURS 3514 - Mental Health > Week 11 Eating Disorders > Flashcards

Week 11 Eating Disorders Flashcards

1
Q

define: nutrition

A
  • the science of optimal cellular metabolism and its impact on health and disease.”
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2
Q

define: eating disorders

A
  • characterized by alterations in normal eating patterns that are marked by distinct and persistent disturbances in eating behaviors, weight regulation, and perceptions towards body weight and shape.
  • complex and can be a potentially lethal psychiatric illness that requires long-term treatment
  • Disorders in eating - Altered relationship with food – Rules
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3
Q

stats on ED

A

Primary Care Settings,
In the ER: 16% adolescents screened positive on a validated questionnaire for ED (Dooley-Has, 2013)
Long-term care settings: Older Adults: 50% of Quebec men and women 67-to-84 years in age were dissatisfied and/or misperceived their current body size (Roy, 2015)
Others?

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4
Q

“ED does not discriminate” what does this mean

A
  • “ Eating disorders are serious but treatable mental and physical illnesses that can affect people of every age, sex, gender, race, ethnicity, and socioeconomic group.”
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5
Q

what is “unrestricted eating”

A
  • healthy (balance food, exercise, image)
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6
Q

what is “watchful eating” (4)

A
  • identify as a dieter
  • begins counting calories
  • wtaching fitbit
  • exercise to change body
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7
Q

what are examples of clinical eating disorders

A
  • anorexia
  • bulimia
  • binge eating
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8
Q

what is “increasing weight and shape preoccupation”

A
  • more rigid
  • insistent calorie counting & tracking
  • chemical supplements
  • binge/purge increases
  • start to restrict
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9
Q

what are some risk factors for developing eating disorders (8)

A
  • Body image distortion
  • Struggling with finding one’s identity
  • History of trauma
  • Difficult transition time
  • Perfectionism
  • Emotional eating
  • BULLYING
  • SOCIETAL MESSAGES
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10
Q

what are some warning signs that may indicate disordered eating (6)

A
  • Changes in regular eating habits
  • Changes in mood, social relationships
  • Rituals with food or exercise
  • Physical changes – weight, etc.
  • Rules about food intake
  • Secretiveness around eating
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11
Q

more ED stats

A
  • Affect 2 to 3% of persons in the Canadian Population (Statistics Canada, 2016)
  • Anorexia nervosa; Bulimia nervosa
  • Binge-eating disorder
  • More commonly seen in females, although males may manifest disorder differently
  • First appears between 12 and 25 with peaks at 14 and 18 years
  • High rates of psychiatric co-morbidity, e.g., anxiety, depression, OCD
  • Western Cultures
  • Long-term implications: physical, psychological health and social aspects of one’s life
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12
Q

info on anorexia nervosa

A
  • 0.3 to 1% lifetime prevalence (Statistics Canada, 2015)
  • Age of onset – adolescence, early adulthood
  • Female-to-male ratio 10:1
  • Culturally defined body weight expectations
  • Perfectionism, ritualistic
  • Familial predisposition
  • Highest death rate of any psychiatric disorder
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13
Q

describe recovery of anorexia nervosa (3)

A
  • % who fully recover is modest
  • 1 year relapse rate of close to 50%
  • Substantial proportion continue to have struggles with body image, disordered eating, or other psychiatric difficulties
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14
Q

what are some potential causes of anorexia

A
  • biological theories
  • psychosocial theories
  • family-based theories
  • sociocultural thoeires
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15
Q

describe the biological theories of anorexia

A
  • genetic disposition

- biochemical

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16
Q

describe the psychosocial theories of anorexia (3)

A
  • separation-individuation theory
  • struggles around identity, body image, perfection, control
  • cognitive –> all or nothing
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17
Q

describe the family-based theories of anorexia (2)

A
  • altered family dynamics

- negative parental comments

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18
Q

describe sociocultural theories of anorexia (2)

A
  • societal messages

- idealization of thinness/achieving the perfect body

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19
Q

what is included in the DSM5 cirteria for anorexia

A
  • body weight
  • fear of weight gain
  • body image distortion
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20
Q

describe the criteria of “body weight” for anorexia

A
  • Restriction of energy intake relative to requirements leading to a significantly low body weight (defined as a weight that is less than minimally normal, or for children/adolescents, less than that minimally expected)
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21
Q

describe the criteria of “fear of weight gain” for anorexia

A
  • Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
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22
Q

describe the criteria of “body image distortion” for anorexia

A
  • Disturbance in the way one’s body weight or appearance is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current body weight
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23
Q

what are 2 subtypes of anorexia

A
  • bingeing/purging

- restricting

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24
Q

describe the restricting subtype of anorexia

A
  • Weight loss related to restricting intake alone

- No regular engagement in bingeing or purging behaviors

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25
Q

describe the bingeing/purging subtype of anorexia

A
  • Regular episodes of bingeing (eating large quantitates of food in one sitting) and purging (use of laxatives, emetics, diuretics, or enemas)
  • Unlike bulimia, don’t maintain a healthy weight
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26
Q

see slide 9 of ppt for eating disorder continuum

A

…. (its a picture)

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27
Q

what are some “whole body” complications of anorexia (2)

A
  • weakness

- lassitude r/t malnutrition

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28
Q

what are some neuro complications of anorexia

A
  • decreased brain volume
  • increased ventricular size
  • neuro deficits in cognitive processing
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29
Q

what are some CNS complications of anorexia (3)

A
  • apathy
  • poor concentration r/t cognitive impairment
  • depression
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30
Q

what are some CVS complications of anorexia (60

A
  • palpitations
  • weakness
  • SOB
  • chest pain r/t ortho hypotension
  • irregular slow pulse
  • peripheral vasoconstriction
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31
Q

what are some skeletal complications of anorexia

A
  • bone pain w exercise r/t arrested skeletal growth
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32
Q

what are some muscular complications of anorexia (2)

A
  • weakness

- muscle aches r/t muscle wasting (loss of fat)

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33
Q

what are some reproductive complications of anorexia (2)

A
  • arrested psychosexual development

- loss of menses

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34
Q

what are some endocrine complications of anorexia (5)

A
  • fatigue
  • cold intolerance
  • diuresis
  • vomiting
  • hypothermia
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35
Q

what are some hematologic complications of anorexia (2)

A
  • bruising

- clotting abnormalities

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36
Q

what are some GI complications of anorexia (6)

A
  • vomitting
  • abdominal pain
  • constipation
  • abnormal bowel sounds
  • abdominal distension
  • diarrhea
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37
Q

what are some GU complications of anorexia (2(

A
  • ptting edema r/t lowered glomerular filtration rate

- danger of renal calculi

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38
Q

what are some dermatologic complications of anorexia (5)

A
  • lanugo a common development
  • dry cracking skin
  • brittle nails r/t dehydration
  • acrocyanosis
  • hair thinning
39
Q

stats on bulimia nervosa

A
  • Lifetime prevalence, 1 to 3% (more prevalent than anorexia nervosa) (Statistics Canada, 2015)
  • Onset is between ages 18-24 (older than anorexia nervosa)
  • First-degree relatives more likely to develop
  • Ratio of male-to-female ~ 1:4
  • Related to Western culture social values
  • Comorbid conditions, including anxiety, depression, substance use disorders, BPD, ADHD
40
Q

what are some causes of bulimia (2)

A
  • biological

- psychosocial theories

41
Q

describe the biological causes of bulimia (4)

A
  • dieting
  • neuropathic changes reverse when symptoms subside
  • genetic
  • serotonin lvls
42
Q

describe the psychosocial theories of bulimia (3)

A
  • Separation – individuation theories
  • Cognitive theory explains distorted thinking.
  • Chaotic families with unclear boundaries
43
Q

what is the DSM 5 criteria of bulimia (4)

A
  • Recurrent episodes of binge eating (Large amount of food in a discrete period of time, A sense of lack of control)
  • Recurrent inappropriate compensatory behaviour such as self-induced vomiting, use of laxatives, etc.)
  • Binge eating and purging occur at least once a week over 3 months
  • Self-evaluation is unduly influenced by body shape and weight
44
Q

describe a supporting diagnosis r/t bulimia

A
  • Individuals may not be underweight (typically “normal” to slightly overweight)
45
Q

describe the binge/purge cycle

A
  • begins w tension & stress (emotion, event)
  • cravings for “forbidden” food
  • binge earing (out of control, zoned out, look down and see empty packagas, particularly of “off limit” food)
  • then panic and guilt
  • purge to avoid weight gain (often a short timespan after binge, relief of physical & emotional pain, brief calm, similar to self harm)
  • results in shame and disgust in one’s own behaviors (self-loathe, physical pain of feeling stuffed, emotional pain of guilt)
  • followed by strict dieting to regain control (restrict calories, extreme exercise)
46
Q

describe the nurses role r/t the binge/purge cycle

A
  • The nurse will want to work with the client to address anxiety, focus on treatment and interventions related to weight suppression, dietary restraint as well as purging behaviors.
  • Work with clients to interrupt the cycle and normalize eating habits.
47
Q

what are the cardiac complications of bulimia

A
  • cardiac abnormalities r/t cardiomyopathies
48
Q

what are the metabolic complications of bulimia (3)

A
  • electrolyte abnormalities
  • weakness
  • poor skin turgor
49
Q

what are the productive complications of bulimia (2)

A
  • fertility problems

- scant menses

50
Q

what are the GI complications of bulimia (4)

A
  • abdominal pain
  • automatic vomiting
  • esophagitis
  • bowel problems in laxative users
51
Q

what are the integ complications of bulimia (2)

A
  • scarring

- callouses on dorsum of hand

52
Q

what are the oropharyngeal complications of bulimia (2)

A
  • dental erosion

- pharyngeal pain

53
Q

what are 3 aspects of bulimia

A
  • uncontrolled binge eating
  • weight gain prevention
  • self-worth based on evaluation of one’s image/weight
54
Q

how often do bingeing and purging behaviors have to occur to fall under the DSM V criteria for a diagnosis of bulimia

A
  • at least 1x/week for 3 months
55
Q

describe the impact of eating disorders

A
  • long term health implications
  • psychological/social implications
  • family/friends
  • treatment challenges for the person, family, nurses
56
Q

describe the treatment challenges for eating disorders for the person (4)

A
  • developing insight
  • agreeing to treatment
  • finding resources
  • where is the person in the stages of change model?
57
Q

describe the treatment challenges for eating disorders for the family (2)

A
  • understanding

- finding help & resources

58
Q

describe the treatment challenges for eating disorders for the nurses (4)

A
  • understanding
  • not sure how to help
  • feeling inadequate
  • feeling frustrated
59
Q

describe assessment of eating disorders: history of illness (5)

A
  • current weight, height, BMI, weight history (max and min weights)
  • age of onset (first concern w weight, progression of symptoms & diet history, cognitive symptoms)
  • co-occurring disorders
  • social functioning
  • exploring goals for recovery (“where do you see yourself moving forward in your recovery)
60
Q

describe the SCOFF questionnaire (5)

A
  • Do you make yourself SICK because you fell uncomfortably full?
  • Do you worry that you have lost CONTROL over what you eat?
  • Have you lost OVER 10 lbs. in a 3-month period?
  • Do you believe that you are FAT when others say you are thin?
  • Would you say that FOOD dominates your life?
61
Q

what is the SCOFF questionnaire

A
  • solely a screening tool , do not rely on it
  • consider factors contributing to its accuracy
  • 5 simple screening question validated (measures what intends to measure) both in specialist and primary care settings
  • Though not diagnostic, a score of 2 or more positive answers should raise your index of suspicion of a case, highlighting need for more detailed history as delineated below.
62
Q

what potential risks could accompany the SCOFF questionnaire (2)

A
  • reliant on participants responses

- responses could be linked to who is asking the questions (power differential, parents present)

63
Q

treatment decisions for eating disorders are based on? (5)

A
  • Weight; physical status
  • Suicidality
  • Presence of co-morbid disorders
  • Motivation to recover (cooperation with treatment)
  • Impairment and ability to care for self; ability to exercise control
64
Q

what are possible treatment settings & programming for eating disorders (4)

A
  • Hospitalization/Partial hospitalization (full day outpatient)
  • Residential treatment centre – i.e., Westwind Eating d/o Recovery Centre (Brandon, MB)
  • Intensive outpatient - outpatient
  • Family Therapy
65
Q

describe the mental health act r/t treatment of eating disorders

A
  • the Mental Health Act would only be used as a last resource, where a client would require in-hospital treatment (in meeting the criteria under the mental health act) and were not willing to be admitted as a voluntary patient.
  • The Eating Disorders program at Health Sciences Centre has reported that most of their admissions are voluntary.
66
Q

what is a priority w treatment of eating disorders

A
  • physical recovery –> refreeding and nutrition
67
Q

what is included in interdisciplinary treatment of eating disorders (5)

A
  • Normalization of eating
  • Cognitive Therapy
  • Social Rehabilitation
  • Spiritual Care
  • Interdisciplinary Team
68
Q

what is included in physical recovery of eating disorders (7)

A
  • Nutritional Therapy – Note potential for “Refeeding Syndrome”
  • Weight restoration
  • Set point weight (healthy target weight) vs. desired weight
  • Normalization of digestion and elimination functions
  • Normalization of homeostasis (BP, temp, HR)
  • Normalization of blood work (K+, Na+, CO2)
  • Normalization of hormonal function
69
Q

nutritional therapy typically starts with

A
  • 1600 calories , increasing by approx 300 calories per day until consistent weight gain is achieved
70
Q

what is refeeding syndrome (3)

A
  • potentially life-threatening occurring within 4 to 45 days after the person starts eating again.
  • Severe electrolyte changes and potential for cardiovascular symptoms, seizures, coma and potentially death.
  • Nutritional therapy, refeeding is very closely monitored – refeeding is done slowly in calorie increments.
71
Q

who else plays a role in the physical/nutritional therapy for eating disorders

A
  • nutritionists

- dieticians

72
Q

what is included in behavioral recovery for eating disorders (2)

A
  • understanding purpose of the behaviors as attempts to manage anxiety and other uncomfortable emotions
  • developing new behavioral repertoire with food, body
73
Q

what is included in cognitive recovery for eating disorders (3)

A
  • Beliefs about weight, shape, and appearance
  • Core beliefs about perfection, control, self-esteem
  • Coping with anxiety
74
Q

what is included in emotional recovery for eating disorders (2)

A
  • Experiencing anxiety

- Coping with uncomfortable emotions

75
Q

what is included in spiritual recovery for eating disorders

A
  • Exploring, developing a sense of self, identity, purpose

- Interpersonal relationships

76
Q

describe mechanical eating

A
  • “Food is medicine” philosophy
  • Eating by prescription, according to a preset meal plan designed to meet the individual’s nutritional needs
  • Does not rely on hunger or satiety, food rules or rituals
    100 % completion of nutrition
77
Q

how is nutrition schedules w mechanical eating

A
  • Nutrition is scheduled over the day in the form of 3 meals and 3 snacks per day
78
Q

mechanical eating is a way of…

A
  • This is a way of normalizing eating – scheduling of food intake at proper intervals – to retain the body’s internal cues – which have been disrupted – and reducing the risk of over and under eating.
79
Q

describe meal & snack support in treatment of eating disorders (5)

A
  • Providing the emotional, physical and environmental support to assist an individual during the process of eating
  • Health Care Providers sit with clients during meal times – to help person cope with anxiety/fears around eating
  • Role model normalized eating
  • Providing information and coaching to correct disordered eating behaviors (stopping rituals)
  • Nutrition Counselling
80
Q

describe role model normalized eating

A

– involves nurses eating meals with clients, being involved in meal planning, cooking, going shopping with clients to shop for food, ingredients to prepare (as part of a day hospital program for example)

81
Q

describe the role of CBT in treatment of eating disorders (4)

A
  • The indicated treatment for individuals with bulimia (best practice guidelines)
  • Treatment efficacy for individuals with anorexia equal to other therapies
  • Eating disorder behaviours are seen as the individual’s best attempt to avoid anxiety associated with breaking faulty rules and beliefs (cognitions)
  • Uses specific tools to uncover cognitions: food diaries, thought records, anxiety hierarchies
82
Q

what are some cognitive strategies in treatment of eating disorders (4)

A
  • determine thinking errors or rules of the eating disorder
  • write down problematic thoughts so they they can be examined
  • try thought stopping –> notice the self-deafeating thought, imagine a stop sign and replace the thought with something that is more balances and accurate
  • try writing 3 compassionate statements to yourself
83
Q

describe the role of mindfulness in the recovery of eating disorders (5)

A
  • To find the place of balance between the emotional and reasonable minds
  • To observe and label the experience without judgment, using all senses
  • To focus on one experience at a time
  • To participate and practice intuitively and naturally
  • To heighten awareness of one’s experience with food and one’s own body
84
Q

what is the “action” of exposure and response therapy

A
  • present tasks that will elicit anxiety in an individual
  • Using the anxiety hierarchy, establish tasks that will elicit anxiety with the intention of preventing the eating disorder response or ritualized behavior.
85
Q

what is the “aim” of exposure and response therapy

A
  • prevention of the eating disorder response or ritualized behavior
86
Q

what are the “modes” of exposure and response therapy

A
  • flooded or graduated
87
Q

what is of key importance w exposure and response therapy

A
  • a supportive enviro both physically and emotionally
88
Q

what is included in the anxiety hierarchy

A

(bottom) think of a forbidden food –> go to the food’s aisle in the store –> watch the food eaten –> buy the food –> eat

89
Q

describe the role of education in the recovery of eating disorders

A
  • Ongoing education about illness, symptoms and recovery

- The National Eating Disorders Association (NEDA)

90
Q

describe pt education on medication r/t eating disorders

A
  • Medication may be part of the holistic eating disorder treatment process – on a “case by case” and individual basis
  • Considerations for medication use: i.e. phase of illness and/or comorbid mental health issues (i.e. depression, anxiety)
91
Q

building skills in areas of functioning that have been affected by the eating disorder are important in the recovery of eating disorders. what are some life skills you will want to build? (11)

A
  • Self-awareness
  • Self-esteem
  • Self-care
  • Communication/Interpersonal relationships
  • Setting Boundaries
  • Independence and individuation/Self-responsibility
  • Assertiveness
  • Treatment of Impulsive Behaviors
  • Vocation and Education
  • Anger Management
  • Setting Boundaries
92
Q

describe the role of group therapy r/t recovery of eating disorders (6)

A
  • Allow one to draw strength and inspiration from peers in group
  • Allows the individual to understand that they are not alone
  • Includes discussion about body image, self-esteem, coping, communication skills, etc.
  • Need to be professionally lead
  • Best utilized in conjunction with individual therapy.
  • Can also have potential for negative effects - for i.e.
93
Q

what could be some negative aspects of group therapy?

A
  • group dynamics

- giving each other negative ideas

94
Q

Prairie is diagnosed with anorexia nervosa and is admitted to the special eating disorder unit. The initial treatment priority for her is:

A
  • to initiate a refeeding program

NURS 3514 - Mental Health (11 decks)

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