Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 18: Eating...

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 18: Eating DisordersChapter 18: Eating Disorders


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


EtiologyEtiology

• Biologic factors– Genetic vulnerability– Disruptions in nuclei of 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


Etiology (cont’d)Etiology (cont’d)

• 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)


Cultural ConsiderationsCultural Considerations

• Increased prevalence in industrialized countries– Most common in United States, Canada, Europe,

Australia, Japan, New Zealand, South Africa– Less frequent among African Americans in

United States– Equal among Hispanic, Caucasian women


QuestionQuestion

• Tell whether the following statement is true or false:

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


AnswerAnswer

• False• One of the biologic theories of eating

disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.


Anorexia Nervosa Anorexia Nervosa

• Refusal or inability to maintain minimally 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


Anorexia Nervosa (cont’d)Anorexia Nervosa (cont’d)

• Onset: usually between ages 14 and 18• Denial early on; depression and lability with

progression; isolation; medical complications (Table 18.2)

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


Anorexia Nervosa (cont’d)Anorexia Nervosa (cont’d)

• Medical management– Weight restoration/nutritional rehabilitation– Rehydration/correction of electrolyte imbalances

• Psychopharmacology: amitryptyline, cyproheptadine, olanzapine, fluoxetine

• Psychotherapy– Family therapy– Individual therapy– Cognitive behavioral therapy


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


Bulimia Nervosa (cont’d)Bulimia Nervosa (cont’d)

• 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


QuestionQuestion

• The typical age of onset for anorexia is which of the following?

A.10 to 14 yearsB.14 to 18 yearsC.18 to 22 yearsD.22 years and older


AnswerAnswer

B. 14 to 18 years• Most commonly, anorexia begins between

the ages of 14 and 18 years.


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


Eating Disorders and Nursing Process Application (cont’d)Eating Disorders and Nursing Process Application (cont’d)

• Assessment (cont’d)– Thought process, content: preoccupation with

food or dieting– Sensorium, intellectual processes– Judgment, insight– Self-concept: low self-esteem – Roles, relationships– Physiologic/self-care considerations (Table 18.2)


Eating Disorders and Nursing Process Application (cont’d)Eating Disorders and Nursing Process Application (cont’d)

• 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 client, family education

• Evaluation


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


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 (Box 18.2)


QuestionQuestion

• Tell whether the following statement is true or false:

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


AnswerAnswer

• False• Self-monitoring is an effective technique that

a client with bulimia can use.


Self-Awareness IssuesSelf-Awareness Issues

• Feelings of frustration when client rejects help

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

• Dealing with own issues about body image, dieting

Date post:	26-Mar-2015
Category:	Documents
Upload:	stephanie-gibbs
View:	220 times
Download:	0 times

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 18: Eating...

Documents