Eating disorders
DSM- 5 criteria for Bulimia Nervosa
-Characterized by pattern of recurrent episodes of binge eating characterized by both: Episodic eating an amount of food that is larger than most people would eat during a similar period of time A sense of lack of control over eating during the episode, defined by a feeling that one cannot stop eating or control what /how much one is eating -Recurrent inappropriate compensatory behavior to prevent weight gain Self-induced vomiting Misuse of laxatives, diuretics, enemas, medications Fasting Excessive exercise -Self evaluation is unduly influenced by body shape and weight.
Binge-Eating Disorder
Eating significantly larger-than-normal amounts in a discrete time period, until uncomfortably full Sense of lack of control No compensatory purging
Emotional and behavioral symptoms of BED:
Eating to the point of discomfort or pain Eating much more food during a binge episode than during a normal meal or snack Eating faster during binge episodes Feeling that your eating behavior is out of control Frequent dieting without weight loss Frequently eating alone Hoarding food Hiding empty food containers Feeling depressed, disgusted or upset over the amount eaten Depression or anxiety
Family Dynamics
Families are seriously affected You may see in families: Enmeshment/blurred boundaries High Control May also tend to isolate from one another
Goals
The overall goal of treatment for the individual with anorexia nervosa is gradual weight restoration A target weight is usually chosen by the treatment team in collaboration with a dietitian. Target weight for discharge from treatment is usually 90% of average for age and height. Help the client to learn more effective ways of coping with the demands of life. The goal of nursing interventions with anxious clients with bulimia is to help them: Recognize events that create anxiety Avoid binge eating and purging in response to anxiety Verbalize acceptance of normal body weight without intense anxiety
Physical Symptoms Anorexia
Thin appearance Abnormal blood counts Fatigue Dizziness or fainting Brittle nails Hair that thins, breaks or falls out Soft, downy hair covering the body Menstrual irregularities or loss of Menstruation (amenorrhea) Constipation Dry skin Frequently being cold Irregular heart rhythms Low blood pressure Dehydration Bone loss LABS
More social risk factors
Transitions- Whether it's heading off to college, moving, landing a new job or a relationship breakup, change can bring emotional distress. One way to cope, especially in situations that may be out of someone's control, is to latch on to something that they can control, such as their eating patterns, which can eventually lead to an eating disorder if taken to an extreme. Sports, work and artistic activities-Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight. Media and society-The media, such as television and fashion magazines, frequently focus on body shape and size. Exposure to these images may lead some people to believe that thinness equates to success and popularity.
Anorexia Nervosa: Specific Interventions
Tube feeding Intravenous therapy Weighing the client daily Observing bathroom behavior Recording intake and output Observing the client during meals
Eating Disorders
Anorexia nervosa and bulimia nervosa are not single diseases, but syndromes with multiple predisposing factors (genetic, social, psychological) and a variety of characteristics.
Medications
Antidepressants SSRIs Treat underlying depressive symptoms Reduce binge eating and vomiting Symptom control: Anxiety Depression Obsessions Impulse control
Obesity: Contributing Factors
Eating habits Managing negative feelings Eating as a reward Eating as a stress reducer Connection between pleasure and eating Increased caloric and fat intake Decreased physical activity
Discharge Criteria
Be free from self-harm. Achieve minimum normal weight. Consume adequate calories to maintain normal weight. Demonstrate ability to comply with postdischarge regimen. Verbalize understanding of underlying psychologic issues. 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.
Bulimia emotional & behavioral symptoms
Constant dieting Feeling that you can't control your eating behavior Eating until the point of discomfort or pain Self-induced vomiting Laxative use Excessive exercise Unhealthy focus on body shape and weight Having a distorted, excessively negative body image Going to the bathroom after eating or during meals Hoarding food Depression or anxiety
Bulimia Nervosa
Cyclical condition Episodes of binge-eating and purging Skipping meals sporadically Strict dieting or fasting
Psychologic 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 (and little interest in sex, relationships) CONTROL!!
Eating Disorder Risk Factors
Gender. Teenage girls and young women Age- Although eating disorders can occur across a broad age range — from preadolescents to older adults — they are much more common during the teens and early 20s. Possible genetic predisposition -- Relatives of clients with eating disorders are 5 to 10 times more likely to develop an eating disorder. Family influences- People who feel less secure in their families, whose parents and siblings may be overly critical, or whose families tease them about their appearance are at higher risk of eating disorders. Emotional disorders- People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder. Dieting-People who lose weight are often reinforced by positive comments from others and by their changing appearance. This dieting may be taken too far and lead to an eating disorder.
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. Ensure that the client survives!
Bulimia Physiologic Symptoms
Hypokalemia - suspect bulimia if otherwise unexplained in an at-risk individual Damaged teeth and gums Swollen salivary glands in the cheeks Sores in the throat and mouth and on hands/knuckles Abnormal bowel functioning Bloating Dehydration Fatigue Dry skin Irregular heartbeat: dangerous! Menstrual irregularities or loss of menstruation May appear to be normal weight
Use of anabolic steroids (males)
Increased risk for gay or bisexual males Predominately an issue in industrialized, developed countries Not solely a problem of specific cultural groups
Treatment
Intensive Outpatient Programs (IOP) Partial Hospitalization Programs (PHP) Inpatient Programs Solution-focused approaches CBT- (for food phobia) Medications
Eating disorder assessment
Medical history and physical examination Dramatic weight loss or gain Client misperceptions Denial Physical/medical symptoms Co-morbidities Depression Anxiety Dieting history Binge eating Food cravings Purging behaviors Menstrual history Feelings regarding restricting/binging/ purging behaviors Blurred boundaries
Obesity
Most common form of malnourishment in U.S. Results from a variety of combinations of psychosocial and physiological factors People who are 35 percent or more above ideal body weight are at high risk for developing medical problems
Eating Disorder Screening and Assessment
Nurses can provide screening and education in schools, clinics, homes, health fairs, health clubs Individuals at risk: low self-esteem, irrational behavior related to food, excessive exercise, and other factors
DSM 5 BED
Recurrent binge eating Episodes associated with 3 + of following Eating more rapidly, eating until uncomfortably full, eating large amts of food when not hungry, eating alone due to embarrassment, feeling disgusted, depressed or guilty after overeating Marked distress 2 days a week for 6 months
Emotional and behavioral symptoms of anorexia
Refusal to eat Denial of hunger Excessive exercise Flat mood or lack of emotion Difficulty concentrating Preoccupation with food
DSM 5 criteria for Anorexia
Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected. Intense fear of gaining weight or becoming fat, even though under weight. Disturbance in the way one's body weight or shape are experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight. Amenorrhea may be seen in post-menarchal girls and women
Hallmarks of Anorexia Nervosa
Rigidity and control Rigid rules Obsessive rituals Food Exercise
Behavioral symptoms of Anorexia
Skipping meals Making excuses for not eating Eating only a few certain "safe" foods, usually those low in fat and calories Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing Weighing food Cooking elaborate meals for others but refusing to eat them themselves Repeated weighing of themselves Body checking: Frequent checking in the mirror for perceived flaws Wearing baggy or layered clothing Complaining about being fat
Criteria for inpatient admission
Suicidal or severely out of control behavior Severe emaciation Cardiac arrhythmias Fluid and electrolyte imbalances Need for intensive inpatient therapy
Obesity qualifications
Technically not an Eating Disorder BMI 25-29.9 is considered overweight BMI >30 obese BMI = ( Weight in Pounds / ( Height in inches ) x ( Height in inches ) ) x 703
