Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

1. http://youtu.be/QSqtVDIwnHo Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

2. Etiology Biologic Factors Sociocultural Factors • Diet and fitness industry • Fashion industry • Women’s movement • Peer pressure Familial Factors • Poor conflict resolution • Separation, individuation • ENMESHED Psychological Factors • Perfectionism • Social insecurity • Alexithymia • Low self-esteem • Immaturity • Compliance • Sense of ineffectiveness • Interpersonal distrust Thinness is power in crisis: secondary gains

3. High-Risk Personality Traits Anorexia Nervosa Bulimia Nervosa Low self-esteem Avoid conflict: complies Feels ineffective Alexithymia Interceptive deficits Impulsive Emotional dysregulation • Low self-esteem • Avoid conflict: complies • Feels ineffective • Alexithymia • Interceptive deficits • Perfectionist • Emotional immature • Avoid risk/harm

4. Cycle of Eating Disorders

5. Epidemiology • Sex ratio • Age of onset • Cross-cultural • Mortality • Comorbidity

6. Behavioral Symptoms of Anorexia Nervosa • Self-starvation • Compulsive behaviors regarding food • May use laxatives or diuretics, and excessive exercise • Wearing baggy clothes

7. Physical Symptoms of Anorexia Nervosa • Weight loss 15% below ideal • Amenorrhea • Bradycardia, subnormal body temperature • Cachexia, sunken eyes, dry skin • Lanugo on face • Constipation • Cold sensitivity

8. Psychological Symptoms of Anorexia Nervosa • Denial of seriousness of low weight • Body image disturbance • Irrational fear of weight gain • Constant striving for perfect body • Self-concept unduly influenced by shape and weight • Preoccupation with food, cooking • Delayed psychosexual development (little interest in sex, relationships)

9. Behavioral Symptoms of Bulimia Nervosa • Recurrent episode of binge eating • Purging behavior to compensate • Self-induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise

10. Physical Symptoms of Bulimia Nervosa • Fluid and electrolyte imbalances • Hypokalemia, alkalosis, dehydration, idiopathic edema • Cardiovascular • Hypotension, dysrhythmias, cardiomyopathy • Endocrine • Hypoglycemia, menstrual dysfunction • Gastrointestinal • Constipation, diarrhea, gastroparesis, esophageal reflux, esophagitis, esophageal tears, dental enamel erosion

11. Psychological Symptoms of Bulimia Nervosa • Body image disturbance • Persistent over concern with weight, shape, proportions • Mood swings, irritability • Self-concept unduly influenced by weight • Use improved coping strategies. • Exhibit more functional behaviors within family system. • Attend group therapy. • Interact with helpful peers. • Keep appointments to monitor behaviors and medications.

12. Prognosis • Variable for each case • Many follow pattern of relapses and remissions; others slowly improve over time • More promising for those who seek and continue treatment • Meds in addition to varied therapy most effective

13. Discharge Criteria • Be free from self-harm. • Achieve minimum normal weight. • Consume adequate calories to maintain normal weight. • Demonstrate ability to comply with post discharge regimen. • Verbalize understanding of underlying psychological issues. • Demonstrate coping skills to respond to stress • Attend group therapy sessions

14. Assessment Therapeutic alliance is vital. Assess: • Willingness for treatment • Treatment history • Patterns and perceptions regarding weight • Body dissatisfaction • Body image distortion • Dieting history • Binge eating • Feelings regarding binge behaviors • Food cravings • Purging behaviors • Menstrual history • Medical side effects of eating disorder • Comorbidity factors

15. Nursing Diagnoses Anorexia Nervosa • Anxiety • Disturbed body image • Nutrition imbalance: less than body requirements • Social isolation Bulimia Nervosa • Ineffective coping • Deficient fluid volume • Chronic low self-esteem

16. Outcome Identification • Participate in therapeutic contact with staff. • Consume adequate calories for age, height, and metabolic need. • Maintain fluid and electrolyte balance. • Demonstrate more effective coping strategies. • Manage family dysfunction more effectively. • Verbalize awareness of underlying psychological issues. • Perceive normal body weight and shape as acceptable.

17. Implementation • Ensure safe, nonthreatening environment • Prevent self-harm • Therapeutic alliance • Behavioral program to restore weight, nutrition • Structured environment with clear limits • Behavioral plan to reward compliance • Encourage expression of feelings

18. Nursing Interventions • Help increase client understanding of body image distortion. • Emphasize client capability to eat small portions without binging. • Maintain clear boundaries. • Avoid power struggles. • Intervene in anxiety. • Give positive feedback for adherence to plan. • Engage in group therapy. • Assist to identify issues (e.g., esteem, identity disturbance). • Teach adaptive strategies. • Collaborate with dietician to teach nutrition. • Collaborate with interdisciplinary staff

19. Biologic and Pharmacologic Treatment Modalities Biologic • Medical monitoring/hospitalization • Correcting deficiencies/imbalances Pharmacologic • SSRIs- consider most effective • Prozac is drug of choice (60mg or > needed to have antibulimic effect) Useful in preventing relapses in wt restored clients • Wellbutrin is contraindicated d/t lowering seizure threshold • Use of antianxiety meds is sparing d/t goal for toleration and coping behaviors. • Other meds: K+, Fe supplements, Reglan, stool softeners

20. Psychotherapeutic Treatment Modalities • Individual psychotherapy • Behavioral • Contracts • Exposure and response prevention • Cognitive • Reframing • Cognitive restructuring • Family therapy • Decrease secondary gain • Uncover family dysfunction • Group therapy • Safe disclosure • Minimize manipulation and secondary gain • Expressive therapies

21. Adjunctive Therapy • Occupational therapy • Nutrition education and counseling • Interdisciplinary treatment team • Community support groups