Nutrition - Anorexia Nervosa and Bulimia Nervosa
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Clinical Picture
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder.
Anorexia Nervosa
- Intense fear of gaining weight
- Experience significant differences in:
oSensation of taste
oAppetite
oSatiety
- These unique, unpleasant sensations help to perpetuate the disorder, leading to
restriction and sometimes purging.
- DSM-5 Criteria includes:
oRestricting energy intake to below requirements
oSignificant loss of weight and malnourishment
oIntense fear of weight gain or persistent interference with weight gain
oDisturbance of body image
oSelf-evaluation linked to body weight or shape.
Anorexia Nervosa Types
- Restricting type
oDuring the last 3 months, the individual has not engaged in recurrent episodes of
binge-eating or purging behavior.
- Binge-eating/purging type
oDuring the last 3 months, the individual has engaged in recurrent episodes of
binge-eating or purging behavior.
Anorexia Nervosa Epidemiology
- Lifetime prevalence of 0.5% does not represent the actual prevalence.
oFewer than half seek help.
oIndividuals tend to conceal symptoms.
- Commonly begins during adolescence or in young adults.
Comorbidity
- Bipolar disorder
- Anxiety disorders
- Depressive disorders
- Obsessive-compulsive disorder
- Posttraumatic stress disorder (PTSD) and other trauma-related disorders
- Alcohol or substance use disorder.
Risk Factors
- Biological factors
oGenetics
oNeurobiological
- Cognitive factors
- Environmental factor
Nursing Process
- General Assessment
oPerception of the problem
oEating habits
oHistory of dieting or purging
oMethods used to achieve weight control.
oValue attached to a specific shape and weight.
oInterpersonal and social functioning
oMental status & physiological parameters
- Self-assessment
- Assessment Guidelines
oPatient’s perception of the problem
oVital signs, review of systems, appearance
oScreen for suicide or self-harm behaviors
oNutritional and fluid intake
oDaily activities
oLaboratory testing review
Nursing diagnoses
- Impaired nutritional status
- Impaired cardiac output
- Electrolyte/fluid imbalance
- Disturbed body image
- Ineffective Coping
- Chronic low self-esteem
- Powerlessness
Outcomes identification
- Improved nutritional intake, cardiac output, electrolyte balance, and fluid balance
- Positive body image: Congruence between body reality
- Effective coping & positive self-esteem
Planning
- Refeeding syndrome
Anorexia Nervosa Interventions
- Suicidal ideation first
- Psychosocial interventions
- Pharmacotherapy/medical intervention
- Psychotherapy
- Nutrition
- Health teaching and health promotion
- Safety and teamwork
Treatment Modalities
- Biological Treatments
oPharmacotherapy
- Integrative Medicine
oYoga, massage, acupuncture, bright light therapy
- Psychological Therapies
oInsight-oriented individual therapy
oAdolescent-focused therapy (AFT)
oFamily therapy (F-BT)
oCognitive-behavioral therapy (CBT)
Bulimia Nervosa
- DSM-5 Criteria
oRecurrent episodes of binge eating
oRecurrent inappropriate compensatory behavior
oBoth occur, on average, at least once a week for 3 months.
oSelf-evaluation is unduly influenced by body shape and weight.
oDisturbance does not occur exclusively during episodes of anorexia nervosa.
Epidemiology
Comorbidity
- Depressive disorders
- Anxiety disorders
- Bipolar disorder
- Alcohol and substance use disorders.
- PTSD and other trauma-based disorders
- Borderline personality disorder
Bulimia Nervosa Risk Factors
- Genetic (60%)
- Neurobiological
- Cognitive Factors
oAttachment challenges
oSelf-evaluation based on weight and shape.
- Environmental Factors
oInternalization of a thin body ideal
oBullying
Assessment
- Patient’s perception
- Vital signs, systems review & appearance.
- Psychosocial history
- Nutritional & fluid intake
- Daily activities
- Laboratory testing review
Diagnoses and Outcomes
- Nursing Diagnoses
oImpaired cardiac output, electrolyte imbalance, disturbed body image, risk for
difficulty coping, risk for powerlessness, low self- esteem, and risk for social
isolation.
- Outcomes
oElectrolytes in balance; improved cardiac output; improved body image;
improved coping; positive self-esteem; verbalizes confidence; makes informed
life decisions; expresses independent decision-making; willing to call others for
assistance; develops sense of belonging.
Planning and Implementation
- Inpatient care
oInterrupt destructive cycles
oNormalize eating habits.
oTherapy for underlying causes
oTreatment of comorbidities
oCounseling
oHealth teaching and health promotion
oTeamwork and safety
- Advanced practice interventions
oPsychotherapy
Treatment Modalities
- Biological Treatment: Pharmacotherapy
oAntidepressants: Fluoxetine (Prozac)
oOther antidepressants
- Advanced Practice Interventions
oCognitive-behavioral therapy (CBT)
oMixed-method approach for refractory cases
oOthers: dialectical behavioral therapy (DBT), interpersonal therapy (IPT), and
acceptance and commitment therapy (ACT)
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