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week 6-eating disorders Flashcards

1
Q

what is an eating disorder?

A

Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions

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2
Q

what are the types of eating disorders?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
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3
Q

Bio/psycho/social/ spiritual risk factors for eating disorders.

A

spiritual
1. sense of well-being
2. quality of life
3. attitudes

biologic
1. dieting
2. metabolic rate

social
1. ideals of beauty
2. media
3. fashion
4. cultural

psychological
1. low self-esteem
2. body dissatisfaction
3. ineffectiveness/lack of assertiveness

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4
Q

Continuum of Eating Experience:

A

unrestricted eating
-healthy eating, exercise, weight, and body image
-eating and appearance not an issue
-may include binge eating

watchful eating
-identifies self as a dieter, body sculptor
-attends to food composition and calories
-begins calorie counting, tracking exercise
-modifies daily caloric, fat and carbs
-exercises and/or weight trains to change body appearance

increasing weight and shape preoccupation
-more rigidly adheres to food selection and eating patterns
-insistent calorie counting, preoccupation with food composition and exercise
-tracks weight losses and gains
-pattern of yo-yo dieting may emerge with overeating as a response to dietary restriction
-ingests chemical preparations and supplements to target appearance ideals
-restricts/avoids food intake; binge eating and purging may increase in frequency and/or duration

clinical eating disorders
-anorexia nervosa
-binge-eating disorder
-bulimia nervosa

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5
Q

what is binge eating?

A

Rapid, episodic, impulsive, and uncontrollable ingestion of large amount of food over a short period of time (1 to 2 hours)

Eating followed by guilt, remorse, and severe dieting

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6
Q

dietary restraint

A

Restricting intake is believed to explain the relationship between dieting and binge behaviour.

Restraining intake is predictive of overeating.

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7
Q

what is the diagnostic criteria for anorexia nervosa?

A

-Restriction of energy intake relative to requirements leading to a significantly low body weight

-Intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain even though at a significantly low weight

-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 persistent lack of recognition of the seriousness of current low body weight

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8
Q

what are the 2 types of anorexia nervosa?

A

restricting type and binge eating/purging type

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9
Q

anorexia nervosa - restricting type

A

-dieting
-fasting
-excessive exercise

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10
Q

anorexia nervosa- binge eating/purging type

A

-self-induced vomiting
-misuse of laxatives
-misuse of diuretics
-misuse of enemas
-difference from bulimia is pt is underweight

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11
Q

anorexia nervosa causes..

A

Higher all-cause mortality than all other psychiatric disorders with the exception of substance abuse and postpartum admission.

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12
Q

Bio/psycho/social/s piritual aetiologies for clients with Anorexia Nervosa

A

spiritual
-spiritual distress

biologic
1. increased genetic vulnerability
2. dieting –> starving
3. overexercising
4. decreased awareness of hunger
5. OCD
6. decreased serotonin activity

social
1. idealization of thinness- media
2. pursuit of thinness
3. enmeshment w/ family
4. overprotective family

psychological
1. separation- individuation struggle
2. sexuality conflicts
3. decreased awareness of emotional use
4. feminist view–> role pressures
5. negative body image- body dissatisfaction

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13
Q

Anorexia Nervosa: Diagnostic Criteria (DSM-5, 2013)

A

-Onset in adolescence or early adulthood.

-Chronic condition with relapses characterized by significant weight loss.

-Body image distortion

-The individual perceives his or her body disparately from how the world or society views it.

-Low body weight

-DSM-5:
* Does not require presence of amenorrhoea
* Use of body mass index (BMI) cutoffs to denote severity

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14
Q

Anorexia Nervosa: Aetiology

A

-Dieting—a risk factor and aetiology.

-Little evidence to substantiate dysregulations in appetite *–satiety systems.

-No evidence of brain structure changes as a cause. -Genetic research on eating disorders is evolving.
-Biopsychosocial model best explains aetiology.

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15
Q

Anorexia Nervosa: Social Theories

A

Social expectations
* Societal norms and expectations.
* Media, fashion industry, peer pressure.
* Body dissatisfaction is related to low self- esteem, depression, dieting, binging, and purging.

Family responses
* Enmeshment
* Overprotectiveness

Spiritual
* Core struggles in eating disorders are spiritual in nature.
* Individuals tend to lose the ability to affirm
their self-worth and identity.
* Feeling distant and disconnected from family and friends.

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16
Q

Anorexia Nervosa: Assessing Illness Severity
BMI

A

MILD BMI more than 17
MODERATE BMI 16-16.99
SEVERE 15-15.99
EXTREME <15

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17
Q

Interdisciplinary Treatment for eating disorders
goals/treatment

A

GOALS:
* Initiating nutritional rehabilitation
* Resolving conflicts around body image disturbance
* Increasing effective coping
* Addressing underlying conflicts
* Assisting family with healthy functioning and communication

TREATMENT MODALITIES:
* Hospitalization necessary if health deteriorates
* Interdisciplinary approach
* Pharmacologic approaches

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18
Q

what is bulimia nervosa?

A

-Recurrent episodes of binge eating.
-Does not come to the attention of parents and peers
as quickly as AN.
-Treatment is outpatient therapy.
-Usually normal weight.

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19
Q

Diagnostic Criteria: Bulimia Nervosa

A

-Recurrent episodes of binge eating

-A sense of lack of control over eating during the episode

-Recurrent compensatory behaviors to prevent weight gain including self- induced vomiting, misuse of laxatives, diuretics or other medications, fasting, excessive exercising

-Binge eating and compensatory behaviors occur at least once a week for three months

-Self-evaluation is unduly influenced by body shape and weight

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20
Q

Binge Purge Cycle

A

-dietary restraint (hunger)
-binge eating
-shame humiliation failure
-dieting +/or purging via vomiting, exercising, laxatives, diuretics, emetics

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21
Q

Bulimia Nervosa: Assessing Illness Severity

A

MILD
1-3 episodes of compensatory behaviors/week

MODERATE
4-7 episodes of compensatory behaviors/week

SEVERE
8-13 episodes of compensatory behaviors/week

EXTREME
14+ episodes of compensatory behaviors/week

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22
Q

Interdisciplinary Treatment for bulimia

A

Usually takes place in an outpatient setting

  • Focuses on psychological issues including:
  • Boundary setting and separation–individuation conflicts
  • Changing problematic behaviours and dysfunctional thought patterns and attitudes
  • Spiritual component
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23
Q

Binge-Eating Disorder

A

-Ingestion of a large amount of food in a short period of time.

-Sense of loss of control during the binge.

-Distress regarding the binge.

-Eating until uncomfortably full.

-Feelings of guilt or depression following the binge.

-Purging does not occur with BED.

-Recurrent episodes of binge eating that occur on average at least once a week for a period of 3 months

-Influenced by such cues as dietary restraint, hunger, and negative affective states

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24
Q

Eating Disorders: Non-Pharmacological Treatment: Psychotherapy

A

Enhanced Cognitive Behavioral Therapy (CBT-E)
Family Therapy
Interpersonal Psychotherapy
Dialectical Behavior Therap

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25
Q

Dialectical Behaviour Therapy

A
  • Combines numerous cognitive–behavioural approaches
  • Requires monitoring and commitment by the patient
  • Individual therapy
  • Building skills through skills group
  • Mindfulness
  • Interpersonal effectiveness
  • Emotion regulation
  • Distress tolerance skills

most common type of therapy for ED

26
Q

Eating Disorders: Non-Pharmacological Interventions
Enhanced Cognitive Behavior Therapy (CBT-E)

A

An empirically supported staged treatment designed specifically to help individuals with eating disorder achieve their personal recovery goals
* Staged Treatment
* Stage1 focused on understanding eating problem
* Stage 2 understanding processes that are maintaining the eating problem
* Stage 3 Addressing concerns about shape and eating, enhancing ability to deal with day to day events and moods, addressing extreme dietary restraint
* Stage 4 Dealing with setbacks and maintaining gains

27
Q

Eating Disorders: Non-Pharmacological Interventions
Enhanced Cognitive Behavior Therapy (CBT-E)
-benefits and drawbacks

A

BENEFITS
* Well researched * User friendly
DRAWBACKS
* Intervention may not always be available in all jurisdictions

28
Q

Eating Disorders: Nursing Assessment

A
  • Screening
  • SCOFF eating disorders screening tool
  • CAGE screen for alcohol disorders
  • Assessment
  • Head-to-toe assessment
  • Vital signs
  • Weight
  • BMI
  • Laboratory tests
  • Mental Status Examination
  • Suicide Risk Assessment
29
Q

Eating Disorders: Nursing Interventions

A

-Monitoring nutritional intake
-Monitoring physical health status
-Supportive counselling
-Crisis Prevention & Intevention
-Skill Teaching Distress Tolerance
-Skill Teaching Mindfulness
-Skill Teaching
-Emotion Regulation
-Skill Teaching
-Interpersonal Effectiveness
-Individual advocacy
-Systems level advocacy
-Public Education

30
Q

Personality

A
  • Complex pattern of characteristics, largely outside of the person’s awareness.
  • Distinctive patterns of perceiving, feeling, thinking, coping, and behaving.
  • Emerges within biopsychosocial framework
31
Q

Personality Disorder

A

An enduring pattern of deviant inner experiences and behaviour.
* Differs from cultural expectations.
* Pervasive, inflexible, and stable.
* Leads to distress or impairment

To receive a DSM-5 diagnosis of PD, an individual must demonstrate the criteria behaviours persistently and to such an extent that they impair the ability to function socially and occupationally.

-* No sharp division exists between normal and abnormal personality functioning.

32
Q

CLUSTER A
Social Aversion

A

Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

33
Q

CLUSTER B
Dysregulation in Emotions and Behaviour

A

Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Anti-Social Personality Disorder

34
Q

CLUSTER C Fearfulness

A

-Avoidant personality disorder
-Dependent personality disorder
-Obsessive-
compulsive personality disorder

35
Q

severity of disorder

A
  • Five reliable, clinically relevant, core components of (mal)adaptive personality functioning have been identified:
  • Self-control
  • Identity integration
  • Relational capacities
  • Responsibility
  • Social concordances
36
Q

Common Features and Diagnostic Criteria

A
  • Deviate in the following:
  • Cognitive Pattern (schema)
  • Affectivity and emotional stability (emotions)
  • Interpersonal functioning/self-identity
  • Impulse control and destructive behaviour
37
Q

Cluster A Disorders: Paranoid Personality Disorder

A

Features
* Mistrustful, avoid relationships that cannot control
* Persistent ideas of self-importance
* Will be hypervigilant to any environmental changes
* Difficulty with developing and maintaining relationships

38
Q

Cluster A Disorders: Schizoid Personality Disorder #1

A

Features
* Expressively impassive and interpersonally unengaged
* Introverted and reclusive, engage in solitary activities
* Communication sometimes confused and lacks focus
* Incapable of forming social relationships
* Minimum introspection, self-awareness, and interpersonal experiences

39
Q

Cluster A Disorders: Schizotypal Personality Disorder

A
  • Features
  • Eccentric
  • Pattern of social and interpersonal deficits
  • Void of close friends
  • Odd beliefs
  • Ideas of reference
  • When psychotic, symptoms mimic schizophrenia
40
Q

Cluster B: Borderline Personality Disorder

A
  • Pervasive patterns of instability of interpersonal relationships, self-image, and affects, as well as marked impulsivity that begins by early adulthood and is present in a variety of contexts
  • Problem areas
  • Regulating moods
  • Affective instability
  • Identity disturbances
  • Unstable interpersonal relationships
  • Cognitive dysfunction
  • Dysfunctional behaviours
  • Risk for suicide
  • Affective instability—shifts in moods
  • Identity disturbance (identify diffusion)
  • Role absorption—narrow definition of self
  • Painful incoherence—internal disharmony
  • Inconsistency in thoughts, feelings, and actions
  • Lack of commitment
  • Unstable interpersonal relationships
  • Fear of abandonment
  • Unstable, insecure attachments
  • Overidealize/intense relationships
41
Q

Cluster B: Borderline Personality Disorder-cognitive and dysfunctional

A
  • Cognitive dysfunctions
  • Maladaptive schemas
  • Dichotomous thinking
  • Dissociation
  • Dysfunctional behaviours
  • Impaired problem solving
  • Impulsivity
  • Self-injurious behaviours (parasuicidal behaviour)
  • Compulsive * Episodic
  • Repetitive
  • Risk Factors
  • Physical and sexual abuse
  • Childhood neglect
42
Q

Aetiology: Biosocial Theories

A
  • Millon
  • Distinct disorder that develops as a result of both biologic and psychological factors.
  • Personality is shaped by (a) active–passive behaviour, (b) pleasure–pain, and (c) sensitivity to self or others.
  • Linehan
  • Emotional vulnerability, self-invalidation, unrelenting crises, inhibited grieving, active passivity, and apparent competence
43
Q

Antisocial Personality Disorder

A
  • Behaviourally impulsive
  • Interpersonally irresponsible
  • Fail to adapt to the ethical and social standards of community
  • Interpersonally engaging, but in reality lack empathy
  • Easily irritated, often aggressive
  • Comorbid with alcohol and drug abuse
44
Q

Histrionic Personality Disorder

A

Attention seeking, life of the party, uncomfortable with single relationship
* Lively and dramatic and draw attention to themselves by their enthusiasm, dress, and apparent openness
* Become depressed when not centre of attention
* Culturally influenced
* May co-occur with BPD, DPD, and ASPD, as well as anxiety disorders, substance abuse, and mood disorders

45
Q

Narcissistic Personality Disorder

A
  • Grandiose degree of self-love and self-importance
  • Lacks empathy for others
  • Inexhaustible need for attention
  • Fantasies about power, unlimited success
  • Experiences personal insecurities
  • Aetiology—unknown
46
Q

Cluster C Disorders
Avoidant personality disorder

A
  • Avoiding interpersonal contacts and social situation
  • Perceiving themselves as socially inept
47
Q

Cluster C Disorders
Dependent

A
  • Submissive pattern
  • Cling to others to be taken care of
  • Prevalent in clinical samples
48
Q

Cluster C Disorders
Obsessive– compulsive

A
  • Different than OCD.
  • Not as many obsessions and compulsions
  • Functioning is not impacted
49
Q

Personality Disorders: Pharmacological Treatments

A

Antidepressants
Anxiolytics
Antipsychotics
Mood stabilizers

50
Q

Personality Disorders: Non-Pharmacological Treatments

A

Psychodynamic Psychotherapy
Interpersonal Psychotherapy
Dialectical Behavior Therapy
Behavior Therapy
Cognitive Therapy

51
Q

Personality Disorders: Nursing Interventions

A

-Crisis prevention & intervention
-Supportive counselling
-Symptom and Behavior monitoring and Management
-Symptom and Skill Teaching
behavior Distress Tolerance monitoring and management
-Skill Teaching Mindfulness
-Skill Teaching
-Emotion Regulation
-Skill Teaching
-Interpersonal Effectiveness
-Individual advocacy
-Systems level advocacy
-Public Education

52
Q

Oppositional Defiant Disorder

A
  • Angry/irritable mood, argumentative/defiant behavior, blames others for mistakes or misbehavior, vindictiveness, disruption at school or work and in relationships with others
53
Q

Conduct Disorder

A

Aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules

54
Q

Intermittent Explosive Disorder

A

Aggressive outburst that are out of proportion to the event that triggered them, impulsive, cause much distress for the person and cause problems at work or home

55
Q

Pyromania

A
  • Repeated impulses or strong desires to set intentional fires
56
Q

Kleptomania

A

Involuntary, impulsive and irresistible stealing of objects that are not needed for personal use or other forms of use

57
Q

Disruptive, Impulse Control & Conduct Disorders

A

DIFFICULTY CONTROLLING AGGRESSIVE BEHAVIORS
Conduct Disorder
Oppositional Defiant Disorder
Intermittent Explosive Disorder

DIFFICULTIES WITH SELF- CONTROL
Intermittent Explosive Disorder
Kelptomania Pyromania

DIFFICULTIES WITH IMPULSIVITY
Kleptomania
Pyromania
Opposistional Defiant Disorder

58
Q

Disruptive Impulse control & Conduct Disorders: Non-Pharmacological Treatment

A

Parent Management Training
Cognitive Behavior Therapy
Family Therapy
Functional Family Therapy
Cognitive Therapy

59
Q

Disruptive Impulse Control & Conduct Disorders: Nursing Interventions

A

Skill teaching
Anger Management
Facilitating Family Interventions
Supportive Counselling
Crisis Prevention & Intervention
Symptom & Behavior Monitoring & ManagementDisruptive Impulse Control & Conduct Disorders: Nursing Interventions

60
Q

Mental Disorders: Cultural Perspectives & Experiences

A
  • Culture affects the way we express our thoughts, emotions and behaviors
  • There are cultural differences in the way illness is manifested and treated
  • One of the main differences seen across cultures is the way illness is expressed
61
Q

Bio/psycho/social/spiritual interventions for individuals with BPD.

A

spiritual
1. teach mindfulness or other distress-reducing skills
2. maintain compassionate attitude
3. support hope
4. support spiritual actives

social
1. milieu management
2. help establish new relationships for support
3. group skills
4. assertiveness classes

biologic
1. manage medications
2. prevent harm to self and others
3. establish regular sleep routines
4. encourage adequate nutrition
5. observer for eating disorders

psychological
1. recognize abandonment and intimacy fears
2. identify triggers for self-injury
3. track emotional regulation
4. teach and reinforce desired behaviours and communication skills

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