copyright © 2014 wolters kluwer health | lippincott williams & wilkins chapter 20 eating...
TRANSCRIPT
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 20
Eating Disorders
Chapter 20
Eating Disorders
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Eating DisordersEating Disorders
• View of continuum: anorexia (eat too little); bulimia (eat too chaotically); obesity (eat too much)
• Categories– Anorexia nervosa
• Binge eating• Purging
– Bulimia nervosa
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EtiologyEtiology
• Biologic factors– Genetic vulnerability
– Disruptions in the nuclei of the hypothalamus relating to hunger and satiety (satisfaction of appetite)
– Neurochemical changes (norepinephrine, serotonin); not known if these changes cause disorders or are result of eating disorders
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Etiology (cont.)Etiology (cont.)
• Developmental factors– Struggle for autonomy, identity – Overprotective or enmeshed families – Body image disturbance/dissatisfaction– Separation–individuation difficulties
• Family influences (family dysfunction, childhood adversity)
• Sociocultural factors (media, pressure from others)
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Cultural ConsiderationsCultural Considerations
• Increased prevalence in industrialized countries– Most common in the United States, Canada, Europe,
Australia, Japan, New Zealand, South Africa
– Less frequent among African Americans in the United States
– Equal among Hispanic, Caucasian women
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QuestionQuestion
• 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.
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AnswerAnswer
• False
• Rationale: One of the biologic theories of eating disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.
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Anorexia Nervosa Anorexia Nervosa
• Refusal or inability to maintain minimal normal body weight
• Intense fear of gaining weight or becoming fat
• Significantly disturbed perception of body shape or size
• Steadfast inability or refusal to acknowledge seriousness of problem or even that one exists
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Anorexia Nervosa (cont.)Anorexia Nervosa (cont.)
• Onset: usually between ages 14 and 18
• Denial early on; depression and lability with progression; isolation; medical complications (see Table 20.2)
• Treatment: often difficult; patient resistant, uninterested, denies problem
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Anorexia Nervosa (cont.)Anorexia Nervosa (cont.)
• Medical management– Weight restoration/nutritional rehabilitation– Rehydration/correction of electrolyte imbalances
• Psychopharmacology: amitriptyline, cyproheptadine, olanzapine, fluoxetine
• Psychotherapy– Family therapy– Individual therapy– Cognitive–behavioral therapy
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Bulimia NervosaBulimia Nervosa
• Recurrent episodes of binge eating (secretive); compensatory behaviors to avoid weight gain (purging, use of laxatives, diuretics, enemas, emetics, fasting, excessive exercise)
• Recognition of behavior as pathologic; feelings of guilt, shame, remorse, contempt
• Usually normal weight
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Bulimia Nervosa (cont.)Bulimia Nervosa (cont.)
• Onset: late adolescence, early adulthood (average age of 18 to 19 years)
• Often begins during or after dieting episode
• Possible restrictive eating between binges; secretive storage/hiding of food
• Treatment – Cognitive–behavioral therapy– Psychopharmacology: antidepressants
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QuestionQuestion
• The typical age of onset for anorexia is which of the following?
– A. 10 to 14 years
– B. 14 to 18 years
– C. 18 to 22 years
– D. 22 years and older
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AnswerAnswer
• B. 14 to 18 years
• Rationale: Most commonly, anorexia begins between the ages of 14 and 18 years.
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Eating Disorders and Nursing Process ApplicationEating Disorders and Nursing Process Application
• Assessment
– History: model child, no trouble, dependable (anorexia); eager to please and conform, avoid conflict (bulimia)
– General appearance, mood: slow, lethargic, emaciation (anorexia); not unusual (bulimia)
– Mood, affect: labile
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Eating Disorders and Nursing Process Application (cont.)Eating Disorders and Nursing Process Application (cont.)
• Assessment (cont.)– Thought process, content: preoccupation with food or
dieting– Sensorium, intellectual processes– Judgment, insight– Self-concept: low self-esteem – Roles, relationships– Physiologic/self-care considerations (see Table 20.2)
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Eating Disorders and Nursing Process Application (cont.)Eating Disorders and Nursing Process Application (cont.)
• Data analysis/nursing diagnoses
• Outcome identification:– Establish adequate nutritional eating patterns– Eliminate compensatory behaviors (excessive
exercise, laxatives, diuretics, purging)– Demonstrate positive coping mechanisms– Verbalize acceptance of body image with ideal body
weight
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Eating Disorders and Nursing Process Application (cont.)Eating Disorders and Nursing Process Application (cont.)• Data analysis/outcome identification
• Interventions– Establishing nutritional eating patterns (inpatient
treatment if severe)– Identifying emotions, developing coping strategies
(self-monitoring for bulimia)– Dealing with body image issues– Providing patient, family education
• Evaluation
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Community-Based CareCommunity-Based Care
• Hospital admission only for medical necessity
• Community settings– Partial hospitalization or day treatment programs
– Individual or group outpatient therapy
– Self-help groups
– Healthy People 2020
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Mental Health Promotion Mental Health Promotion
• Education of parents, children, young people about strategies to prevent eating disorders
• Early identification, appropriate referral
• Routine screening of young women for eating disorders (see Boxes 20.1 and 20.2)
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QuestionQuestion
• Is the following statement true or false?
• Self-monitoring is an effective technique that a patient with anorexia can use.
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AnswerAnswer
• False
• Rationale: Self-monitoring is an effective technique that a patient with bulimia can use.
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Self-Awareness IssuesSelf-Awareness Issues
• Feelings of frustration when patient rejects help
• Being seen as “the enemy” if you must ensure that the patient eats
• Dealing with own issues about body image, dieting