Eating Disorder West Coast University NURS 204
Sociocultural Factors • Cultural stereotypes • Preoccupation with the body • Cultural ideal of thinness • Identity and self-esteem are dependent on physical appearance
Female Attractiveness • Equated with thinness, physical fitness • Media glamorizes thinness • Thinness equated with success and happiness • Prejudice against overweight • Self-esteem enhanced for those considered attractive
Male Attractiveness • Ideal body type is lean and muscular • Emphasis on strength and athleticism • Less popular if they do not have the ideal body type
Biologic Theory • There may be a genetic predisposition for anorexia. • Relatives of clients with eating disorders are 5 to 10 times more likely to develop an eating disorder.
Psychological Factors • Perfectionism • Social and affective insecurities • Low self-esteem • Immaturity • Sense of ineffectiveness • Interpersonal distrust • Poor conflict resolution • Depression • Obsessive-compulsive disorder
Psychosocial Pressures • Frequent exposure to articles about dieting is significantly associated with lower self-esteem, depressed mood, and lower levels of body satisfaction. • Occupations, such as modeling or ballet dancers • Athletes, gymnastics
Psychosocial Considerations • Use of anabolic steroids • Predominately an issue in industrialized, developed countries • Not solely a problem of specific cultural groups
Neurotransmitters affect eating disorders • Serotonin • Low levels: increase food intake • High levels: decrease food intake • Increase eating behavior: • Norepinephrine • Neuropeptide Y • Suppresses food intake: • Dopamine
Eating Disorders • Anorexia nervosa and bulimia nervosa are not single diseases, but syndromes with multiple predisposing factors and a variety of characteristics.
Characteristics ofAnorexia Nervosa • Extreme perfectionism • Fear of gaining weight • Significant weight loss • Body image disturbance • Strenuous exercising • Peculiar food handling practices • Rigidity and control
Physical Manifestation of Anorexia Nervosa • Reduction in the following: • Heart rate • Blood pressure • Metabolic rate • Production of estrogen or testosterone • Body temperature
Physical Symptoms of Anorexia Nervosa • Weight loss 15% below ideal • Amenorrhea • Cachexia • Sunken eyes • Dry skin • Lanugo on face • Constipation • Cold sensitivity
Psychological Symptoms of Anorexia Nervosa • Denial of low weight • Body image disturbance • Irrational fear of weight gain • Preoccupied with food and cooking • Delayed psychosexual development
Bulimia Nervosa • Cyclical condition • Episodes of binge-eating and purging • Skipping meals sporadically • Strict dieting or fasting
Physical Symptoms of Bulimia Nervosa • Fluid and electrolyte imbalances • Cardiovascular Symptoms • Endocrine Symptoms • Gastrointestinal Symptoms
Psychological Symptoms of Bulimia Nervosa • Body image disturbance • Persistent over concern with weight, shape and proportions • Mood swings, irritability • Self-concept influenced by weight
Binge-Eating Disorder • Eating significantly larger-than-normal amounts in a discrete time period, until uncomfortably full • Sense of lack of control • No compensatory purging • Frequently symptoms of • an affective disorder
Assessing Clients • Willingness for treatment • Treatment history • Dramatic weight loss or gain • Medical history and physical examination • Patterns and perceptions regarding weight • Body dissatisfaction and image distortion • Physical symptoms • Denial
Assessment Continued • Assess: • Dieting history • Binge eating • Feeling regarding binge behavior • Food cravings • Purging behaviors • Menstrual history • Medical side effects • Co-morbidity factors
Nursing Diagnosis: NANDA • Anorexia: • Imbalance nutrition: Less than body requirements • Disturbed body image • Chronic low self-esteem • Anxiety • Bulimia Nervosa: • Ineffective coping • Deficient fluid volume • Chronic low self-esteem
Outcome Identification: NOC • Be free of self-harm • Adequate nutrients taken into the body for height, frame, gender, and activity level • Manage stressors, ability to self-restrain compulsive or impulsive behavior, ability to acquire, organize and use information • Positive perception of own appearance and ability to self-restrain altered perception • Verbalize understanding of underlying psychological issues
Goals • The goal of nursing interventions with anxious clients with bulimia is to help them: • Recognize events that create anxiety • Avoid binge eating and purging in response to anxiety • Verbalize acceptance of normal body weight without intense anxiety
Goals - continued • The overall goal of treatment for the individual with anorexia nervosa is gradual weight restoration/ • A target weight is usually chosen by the treatment team in collaboration with a dietitian. • Target weight for discharge from treatment is usually 90% of average for age and height.
Planning and Implementing: NIC • Manage nutrition • Establish adequate eating patterns and fluid and electrolyte balance • Assume a calm, matter-of-fact attitude • Gradual weight restoration • Tube feeding or intravenous therapy • Weigh the client daily • Record intake and output • Observe client during meals • Observe bathroom behavior
Nursing Interventions • Help increase client understanding of treatment plan. • Emphasize client capability to eat small portions without binging. • Avoid power struggles. • Intervene with anxiety. • Give positive feedback for adherence to plan. • Engage in group therapy. • Assist to identify issues (e.g., esteem, identity disturbance). • Collaborate with dietician to teach nutrition. • Collaborate with interdisciplinary staff.
Goals - continued • Providing basic nutritional education is the goal of interventions with clients that have a knowledge deficit in this area.
Nursing Interventions: Client with Anorexia Nervosa • Establish Trust • Tube feeding • Intravenous therapy • Avoid weighing the client daily • Observing bathroom behavior • Recording intake and output • Observing the client during meals
Nursing Interventions: Client with Bulimia Nervosa • Managing medications • Reducing anxiety • Managing fluids and electrolytes • Facilitating coping • Mobilizing the family • Health Teaching and Promotion
SSRIs Reduce binge eating and vomiting Symptom control Anxiety Depression Obsessions Impulse control Pharmacologic
Psychotherapeutic Treatment Modalities • Individual Psychotherapy • Family Therapy • Group Therapy • Behavioral • Contracts • Exposure and response prevention • Cognitive • Reframing • Cognitive restructuring
Adjunctive Therapy • Occupational therapy • Nutrition education and counseling • Interdisciplinary treatment team • Community support groups
Prevention • Nurses in community-based settings can play a valuable role in: • Education • Support • Referral
Screening and Education • Nurses can provide screening and education in schools, clinics, homes, health fairs, health clubs • Individuals at risk: low self-esteem, irrational behavior related to food, excessive exercise, and other factors
Prevention and Screening • Important to understand cultural factors contributing to eating disorders • Nurses can implement primary prevention and secondary screening measures