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EATING DISORDER

EATING DISORDER. By Ni Ketut Alit A Faculty Of Nursing Airlangga University. REFERENCES. Black , J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care . J.B. Lippincott.co.

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EATING DISORDER

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  1. EATING DISORDER By Ni Ketut Alit A Faculty Of Nursing Airlangga University

  2. REFERENCES • Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care. J.B. Lippincott.co. • Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins. • Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins. • Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia: W.B. Saunders Company. • Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B. Saunders Company. • Journals and article related to..

  3. EATING DISORDERS • Current Western beauty standards equate thinness with health and beauty • There has been a rise in eating disorders in the past three decades • The core issue is a morbid fear of weight gain • Two main diagnoses: • Anorexia nervosa • Bulimia nervosa

  4. ANOREXIA NERVOSA • The main symptoms of anorexia nervosa are: • A refusal to maintain more than 85% of normal body weight • Intense fears of becoming overweight • A distorted view of body weight and shape • Amenorrhea

  5. Anorexia Nervosa • There are two main subtypes: • Restricting type • Lose weight by restricting “bad” foods, eventually restricting nearly all food • Show almost no variability in diet • Binge-eating/purging type • Lose weight by vomiting after meals, abusing laxatives or diuretics, or engaging in excessive exercise • Like those with bulimia nervosa, people with this subtype may engage in eating binges

  6. Anorexia Nervosa • About 90–95% of cases occur in females • The peak age of onset is between 14 and 18 years • Around 0.5% of females in Western countries develop the disorder • Many more display some symptoms

  7. Anorexia Nervosa • The “typical” case: • A normal to slightly overweight female has been on a diet • Escalation to anorexia nervosa may follow a stressful event • Separation of parents • Move or life transition • Experience of personal failure • Most patients recover • However, about 2 to 6% become seriously ill and die as a result of medical complications or suicide

  8. Anorexia Nervosa: The Clinical Picture • The key goal for people with anorexia nervosa is thinness • The driving motivation is FEAR: • Of becoming obese • Of losing control of body shape and weight

  9. Anorexia Nervosa: The Clinical Picture • Despite their dietary restrictions, people with anorexia are extremely preoccupied with food • This includes thinking and reading about food and planning for meals • This relationship is not necessarily causal • It may be the result of food deprivation, as evidenced by the famous.

  10. Anorexia Nervosa: The Clinical Picture • People with anorexia nervosa also demonstrate distorted thinking: • Often have a low opinion of their body shape • Tend to overestimate their actual proportions • Adjustable lens assessment technique – overestimate size by 20% • Hold maladaptive attitudes and beliefs • “I must be perfect in every way” • “I will be a better person if I deprive myself” • “I can avoid guilt by not eating”

  11. Anorexia Nervosa: The Clinical Picture • People with anorexia may also display certain psychological problems: • Depression (usually mild) • Anxiety • Low self-esteem • Insomnia or other sleep disturbances • Substance abuse • Obsessive-compulsive patterns • Perfectionism

  12. Caused by starvation: Amenorrhea Low body temperature Low blood pressure Body swelling Reduced bone density Slow heart rate Metabolic and electrolyte imbalance Dry skin, brittle nails Poor circulation Lanugo Anorexia Nervosa: Problems

  13. BULIMIA NERVOSA • Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: • Bouts of uncontrolled overeating during a limited period of time • Often objectively more than most people would/could eat in a similar period

  14. Bulimia Nervosa • The disorder is also characterized by compensatory behaviors, which mark the subtype of the condition: • Purging-type bulimia nervosa • Vomiting • Misusing laxatives, diuretics, or enemas • Nonpurging-type bulimia nervosa • Fasting • Exercising excessively

  15. Bulimia Nervosa • Like anorexia nervosa, about 90–95% of bulimia nervosa cases occur in females • The peak age of onset is between 15 and 21 years • Symptoms may last for several years with periodic letup

  16. Bulimia Nervosa • Patients are generally of normal weight • May be slightly overweight • Often experience weight fluctuations • “Binge-eating disorder” may be a related diagnosis • Symptoms include a pattern of binge eating with NO compensatory behaviors (such as vomiting) • This condition is not yet listed in the DSM

  17. Bulimia Nervosa • Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia from friends or the media • In one study: • 50% of college students reported periodic binges • 6% tried vomiting • 8% experimented with laxatives at least once

  18. Bulimia Nervosa: Binges • For people with bulimia nervosa, the number of binges per week can range from 2 to 40 • Average: 10 per week • Binges are often carried out in secret • Binges involve eating massive amounts of food rapidly with little chewing • Binge-eaters commonly consume more than 1500 calories (often more than 3000 calories) per binge episode

  19. Bulimia Nervosa: Binges • Binges are usually preceded by feelings of tension and/or powerlessness • Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and “discovery”

  20. Bulimia Nervosa: Compensatory Behaviors • After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects • The most common compensatory behaviors: • Vomiting • Affects ability to feel satiated  greater hunger and bingeing • Laxatives and diuretics • Almost completely fail to reduce the number of calories consumed

  21. Bulimia Nervosa: Compensatory Behaviors • Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating • Over time, however, a cycle develops in which purging  bingeing  purging…

  22. Bulimia Nervosa • The “typical” case: • A normal to slightly overweight female has been on an intense diet • Research suggests that even among normal subjects, bingeing often occurs after strict dieting • For example, a study of binge-eating behavior in a low-calorie weight loss program found that 62% of patients reported binge-eating episodes during treatment

  23. Bulimia Nervosa vs. Anorexia Nervosa • Similarities: • Onset after a period of dieting • Fear of becoming obese • Drive to become thin • Preoccupation with food, weight, appearance • Elevated risk of self-harm or attempts at suicide • Feelings of anxiety, depression, perfectionism • Substance abuse • Disturbed attitudes toward eating

  24. Bulimia Nervosa vs. Anorexia Nervosa • Differences: • People with bulimia are more worried about pleasing others, being attractive to others, and having intimate relationships • People with bulimia tend to be more sexually experienced • People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia • People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping

  25. Bulimia Nervosa vs. Anorexia Nervosa • Differences: • People with bulimia tend to be controlled by emotion – may change friendships easily • People with bulimia are more likely to display characteristics of a personality disorder • Different medical complications: • Only half of women with bulimia experience amenorrhea vs. almost all women with anorexia • People with bulimia suffer damage caused by purging, especially from vomiting and laxatives

  26. Causes Eating Disorders • Most theorists subscribe to a multidimensional risk perspective: • Several key factors place individuals at risk • More factors = greater risk • Leading factors: • Sociocultural conditions (societal and family pressures) • Psychological problems (ego, cognitive, and mood disturbances) • Biological factors

  27. Causes Eating Disorders: Societal Pressures • Many theorists argue that current Western standards of female attractiveness have contributed to the rise of eating disorders • Standards have changed throughout history toward a thinner ideal

  28. Causes Eating Disorders: Societal Pressures • Certain groups are at greater risk from these pressures: • Models, actors, dancers, and certain athletes • Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms • 20% of surveyed gymnasts met full criteria for an eating disorder

  29. Causes Eating Disorders:Societal Pressures • The socially-accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight • About 50% of elementary and 61% of middle school girls are currently dieting

  30. Causes Eating Disorders : Family Environment • Families may play a critical role in the development of eating disorders • As many as half of the families of those with eating disorders have a long history of emphasizing thinness, appearance, and dieting • Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves

  31. Causes Eating Disorders : Family Environment • Abnormal family interactions and forms of communication within a family may also set the stage for an eating disorder • Minuchin cites “enmeshed family patterns” as causal factors of eating disorders • These patterns include overinvolvement in, and overconcern about, family member’s lives • Such families can be affectionate and loyal but can also foster clinginess and dependency • Children are allowed little room for individuality and independence

  32. Causes Eating Disorders Ego Deficiencies and Cognitive Disturbances • Bruch : eating disorders are the result of disturbed mother–child interactions which lead to serious ego deficiencies in the child and to severe cognitive disturbances

  33. Causes Eating Disorders :Ego Deficiencies and Cognitive Disturbances • Bruch : parents may respond to their children either effectively or ineffectively • Effective parents accurately attend to a child’s biological and emotional needs • Ineffective parents fail to attend to child’s internal needs; they feed when the child is anxious, comfort when the child is tired, etc. • Children who receive such parenting may grow up confused and unaware of their own internal needs; they are unable to identify their own emotions

  34. Causes Eating Disorders: Ego Deficiencies and Cognitive Disturbances • There is some empirical support for Bruch’s theory from clinical sources • People with bulimia eat in response to emotions; many mistakenly think they are also hungry • People with eating disorders rely excessively on the opinions, wishes, and views of others • They are more likely to worry about how they are viewed, to seek approval, to be conforming, and to feel a lack of life control

  35. Causes Eating Disorders : Mood Disorders • Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depression • Theorists believe mood disorders may “set the stage” for eating disorders

  36. Causes Eating Disorders Mood Disorders • There is some empirical support for the claim that mood disorders set the stage for eating disorders • Many more people with an eating disorder qualify for a clinical diagnosis of major depressive disorder than do people in the general population • Close relatives of those with eating disorders seem to have higher rates of mood disorders • People with eating disorders, especially those with bulimia nervosa, have low levels of serotonin • Symptoms of eating disorders are helped by antidepressant medications

  37. Causes Eating Disorders : Biological Factors • Biological theorists suspect that some people inherit a genetic tendency to develop an eating disorder • Consistent with this model: • Relatives of people with eating disorders are 6 times more likely to develop the disorder themselves • These findings may be related to low serotonin

  38. Causes Eating Disorders : Biological Factors • Other theorists believe that eating disorders may be related to dysfunction of the hypothalamus • Researchers have identified two separate areas that control eating: • Lateral hypothalamus (LH) • Ventromedial hypothalamus (VMH)

  39. Causes Eating Disorders : Biological Factors • Some theorists believe that the LH and VMH are responsible for weight set point – a “weight thermostat” of sorts • Set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight level • If weight falls below set point:  hunger,  metabolism  binges • If weight rises above set point:  hunger,  metabolism • Dieters end up in a fight against themselves to lose weight

  40. Treatments for Eating Disorders • Eating disorder treatments have two main goals: • Correct abnormal eating patterns • Address broader psychological and situational factors that have led to and are maintaining the eating problem • This often requires the participation of family and friends

  41. Treatments for Anorexia Nervosa • The initial aims of treatment for anorexia nervosa are to: • Restore proper weight • Recover from malnourishment • Restore proper eating

  42. Treatments for Anorexia Nervosa • In the past, treatment took place in a hospital setting; it is now often offered in an outpatient setting • In life-threatening cases, clinicians may force tube and intravenous feeding • This may breed distrust in the patient and create a power struggle • Most common technique now is the use of supportive nursing care and high calorie diets

  43. Treatments for Anorexia Nervosa • Therapists use a mixture of therapy and education to achieve this broader goal • One focus of treatment is building autonomy and self-awareness • Therapists help patients recognize their need for independence and control • Therapists help patients recognize and trust their internal feelings

  44. Treatments for Anorexia Nervosa • Another focus of treatment is correcting disturbed cognitions, especially client misperceptions and attitudes about eating and weight • Using cognitive approaches, therapists correct disturbed cognitions and educate about body distortions

  45. Treatments for Anorexia Nervosa • Another focus of treatment is changing family interactions • Family therapy is important for anorexia • The main issues are often separation and boundaries

  46. Treatments for Anorexia Nervosa • The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa • But even with combined treatment, recovery is difficult • The course and outcome of the disorder vary from person to person

  47. Treatments for Anorexia Nervosa • Positives of treatment: • Weight gain is often quickly restored • 83% of patients still showed improvements after several years • Menstruation often returns with return to normal weight

  48. Treatments for Anorexia Nervosa • Negatives of treatment: • Close to 20% of patients remain troubled for years • Even when it occurs, recovery is not always permanent • Relapses are usually triggered by stress • Many patients still express concerns about body shape and weight

  49. Treatments for Bulimia Nervosa • Treatment programs are relatively new but have risen in popularity • Treatment is frequently offered in specialized eating disorder clinics

  50. Treatments for Bulimia Nervosa • The initial aims of treatment for bulimia nervosa are to: • Eliminate binge-purge patterns • Establish good eating habits • Eliminate the underlying cause of bulimic patterns • Programs emphasize education as much as therapy

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