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Chapter 20: Eating Disorders

Eating Disorders

View on continuum: anorexia (eating too little); bulimia (eating chaotically); obesity (eating too much)

Categories

Anorexia nervosa (see Box 20.1)

Restricting subtype

Binge eating and purging subtype

Bulimia nervosa

Related disorders

Binge eating disorder

Night eating syndrome

Pica and rumination

Orthorexia nervosa

Etiology #1

Biologic factors

Genetic vulnerability

Disruptions in the nuclei of the hypothalamus relating to hunger and satiety

Neurochemical changes (norepinephrine, serotonin); not known if these changes cause disorders or are result of eating disorders

Etiology #2

Developmental factors

Struggle for autonomy, identity

Overprotective or enmeshed families

Body image disturbance

Self-perceptions of the body

Family influences (family dysfunction, childhood adversity)

Sociocultural factors (media, pressure from others)

See Table 20.1

Cultural Considerations

Increased prevalence in industrialized countries

Most common in the United States, Canada, Europe, Australia, Japan, New Zealand, South Africa, other developed industrialized countries

Equal among Hispanic and Caucasian women

Less common among African American and Asian women

1. Question #1

Is the following statement true or false?

One current biologic theory about eating disorders is that it involves a disruption in the cerebellum portion of the brain.

1. Answer to Question #1

False

Rationale: One of the biologic theories of eating disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.

Anorexia Nervosa #1

Onset usually between the ages of 14 and 18

Denial early on; depression and lability with progression; isolation; medical complications (see Table 20.2)

Treatment: often difficult; client is resistant, uninterested, denies problem

Anorexia Nervosa #2

Medical management

Weight restoration/nutritional rehabilitation

Rehydration/correction of electrolyte imbalances

Psychopharmacology: amitriptyline, cyproheptadine, olanzapine, fluoxetine

Psychotherapy

Family therapy

Individual therapy

CBT

Bulimia Nervosa

Onset: late adolescence or early adulthood (average age of 18–19 years)

Binge eating frequently begins during or after dieting

Possible restrictive eating between binges

Clients aware eating behavior is pathologic; go to great lengths to hide

Treatment

CBT

Psychopharmacology: antidepressants

2. Question #2

Which of the following is the typical age of onset for anorexia?

A. 10 to 14 years

B. 14 to 18 years

C. 18 to 22 years

D. 22 years and older

2. Answer to Question #2

B. 14 to 18 years

Rationale: Most commonly, anorexia begins between the ages of 14 and 18 years.

Eating Disorders and Nursing Process Application #1

Assessment

History

Anorexia: perfectionists, eager to please

Bulimia: history of impulsive behavior

General appearance and motor behavior

Anorexia: slow, lethargic, emaciated

Bulimia: generally close to expected weight for size

Mood and affect: labile moods; sad, anxious, worried; with bulimia, initially pleasant and cheerful

Eating Disorders and Nursing Process Application #2

Assessment—(cont.)

Thought process and content: preoccupation with food or dieting

Sensorium and intellectual processes: signs of starvation in malnourished clients with anorexia

Judgment and insight

Anorexia: limited insight, poor judgment about health status

Bulimia: ashamed of behaviors

Self-concept: low self-esteem

Roles and relationships: unable to fulfill roles

Physiological and self-care considerations (see Table 20.2)

Eating Disorders and Nursing Process Application #3

Data analysis/nursing diagnoses

Outcome identification

Establish adequate nutritional eating patterns

Eliminate compensatory behaviors (excessive exercise, laxatives, diuretics, purging)

Demonstrate coping mechanisms not related to food

Verbalize feelings of guilt, anger, anxiety, excessive need for control

Verbalize acceptance of body image with stable body weight

Eating Disorders and Nursing Process Application #4

Interventions

Establishing nutritional eating patterns (inpatient treatment if severe)

Identifying emotions, developing coping strategies (self-monitoring for bulimia)

Dealing with body image issues

Providing client and family education

Evaluation

Community-Based Care

Hospital admission only for medical necessity

Community settings

Partial hospitalization or day treatment programs

Individual or group outpatient therapy

Self-help groups

Mental Health Promotion

Education of parents, children, young people about strategies to prevent eating disorders

Healthy People 2020—increase in comprehensive school education

National Eating Disorders Association guidelines

Screening questions (see Box 20.3)

3. Question #3

Is the following statement true or false?

Self-monitoring is an effective technique that a client with anorexia can use.

3. Answer to Question #3

False

Rationale: Self-monitoring is an effective technique that a client with bulimia can use.

Self-Awareness Issues

Feelings of frustration when client rejects help.

Being seen as “the enemy” if you must ensure that the client eats.

Dealing with own issues about body image and dieting.

Be empathetic and nonjudgmental.

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