eating disorders anorexia nervosa and bulimia nervosa n.
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http:// youtu.be/QSqtVDIwnHo. Eating Disorders: Anorexia Nervosa and Bulimia Nervosa. Etiology. Biologic Factors Sociocultural Factors Diet and fitness industry Fashion industry Women’s movement Peer pressure Familial Factors Poor conflict resolution Separation, individuation

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Presentation Transcript
etiology
Etiology

Biologic Factors

Sociocultural Factors

  • Diet and fitness industry
  • Fashion industry
  • Women’s movement
  • Peer pressure

Familial Factors

  • Poor conflict resolution
  • Separation, individuation
  • ENMESHED

Psychological Factors

  • Perfectionism
  • Social insecurity
  • Alexithymia
  • Low self-esteem
  • Immaturity
  • Compliance
  • Sense of ineffectiveness
  • Interpersonal distrust

Thinness is power in crisis: secondary gains

high risk personality traits
High-Risk Personality Traits

Anorexia Nervosa

Bulimia Nervosa

Low self-esteem

Avoid conflict: complies

Feels ineffective

Alexithymia

Interceptive deficits

Impulsive

Emotional dysregulation

  • Low self-esteem
  • Avoid conflict: complies
  • Feels ineffective
  • Alexithymia
  • Interceptive deficits
  • Perfectionist
  • Emotional immature
  • Avoid risk/harm
epidemiology
Epidemiology
  • Sex ratio
  • Age of onset
  • Cross-cultural
  • Mortality
  • Comorbidity
behavioral symptoms of anorexia nervosa
Behavioral Symptoms of Anorexia Nervosa
  • Self-starvation
  • Compulsive behaviors regarding food
  • May use laxatives or diuretics, and excessive exercise
  • Wearing baggy clothes
physical symptoms of anorexia nervosa
Physical Symptoms of Anorexia Nervosa
  • Weight loss 15% below ideal
  • Amenorrhea
  • Bradycardia, subnormal body temperature
  • Cachexia, sunken eyes, dry skin
  • Lanugo on face
  • Constipation
  • Cold sensitivity
psychological symptoms of anorexia nervosa
Psychological 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 (little interest in sex, relationships)
behavioral symptoms of bulimia nervosa
Behavioral Symptoms of Bulimia Nervosa
  • Recurrent episode of binge eating
  • Purging behavior to compensate
    • Self-induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise
physical symptoms of bulimia nervosa
Physical Symptoms of Bulimia Nervosa
  • Fluid and electrolyte imbalances
    • Hypokalemia, alkalosis, dehydration, idiopathic edema
  • Cardiovascular
    • Hypotension, dysrhythmias, cardiomyopathy
  • Endocrine
    • Hypoglycemia, menstrual dysfunction
  • Gastrointestinal
    • Constipation, diarrhea, gastroparesis, esophageal reflux, esophagitis, esophageal tears, dental enamel erosion
psychological symptoms of bulimia nervosa
Psychological Symptoms of Bulimia Nervosa
  • Body image disturbance
  • Persistent over concern with weight, shape, proportions
  • Mood swings, irritability
  • Self-concept unduly influenced by weight
  • 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.
prognosis
Prognosis
  • Variable for each case
  • Many follow pattern of relapses and remissions; others slowly improve over time
  • More promising for those who seek and continue treatment
  • Meds in addition to varied therapy most effective
discharge criteria
Discharge Criteria
  • Be free from self-harm.
  • Achieve minimum normal weight.
  • Consume adequate calories to maintain normal weight.
  • Demonstrate ability to comply with post discharge regimen.
  • Verbalize understanding of underlying psychological issues.
  • Demonstrate coping skills to respond to stress
  • Attend group therapy sessions
assessment
Assessment

Therapeutic alliance is vital.

Assess:

  • Willingness for treatment
  • Treatment history
  • Patterns and perceptions regarding weight
  • Body dissatisfaction
  • Body image distortion
  • Dieting history
  • Binge eating
  • Feelings regarding binge behaviors
  • Food cravings
  • Purging behaviors
  • Menstrual history
  • Medical side effects of eating disorder
  • Comorbidity factors
nursing diagnoses
Nursing Diagnoses

Anorexia Nervosa

  • Anxiety
  • Disturbed body image
  • Nutrition imbalance: less than body requirements
  • Social isolation

Bulimia Nervosa

  • Ineffective coping
  • Deficient fluid volume
  • Chronic low self-esteem
outcome identification
Outcome Identification
  • Participate in therapeutic contact with staff.
  • Consume adequate calories for age, height, and metabolic need.
  • Maintain fluid and electrolyte balance.
  • Demonstrate more effective coping strategies.
  • Manage family dysfunction more effectively.
  • Verbalize awareness of underlying psychological issues.
  • Perceive normal body weight and shape as acceptable.
implementation
Implementation
  • Ensure safe, nonthreatening environment
  • Prevent self-harm
  • Therapeutic alliance
  • Behavioral program to restore weight, nutrition
  • Structured environment with clear limits
  • Behavioral plan to reward compliance
  • Encourage expression of feelings
nursing interventions
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
biologic and pharmacologic treatment modalities
Biologic and Pharmacologic Treatment Modalities

Biologic

  • Medical monitoring/hospitalization
  • Correcting deficiencies/imbalances

Pharmacologic

  • SSRIs- consider most effective
    • Prozac is drug of choice (60mg or > needed to have antibulimic effect)

Useful in preventing relapses in wt restored clients

  • Wellbutrin is contraindicated d/t lowering seizure threshold
  • Use of antianxiety meds is sparing d/t goal for toleration and coping behaviors.
  • Other meds: K+, Fe supplements, Reglan, stool softeners
psychotherapeutic treatment modalities
Psychotherapeutic Treatment Modalities
  • Individual psychotherapy
  • Behavioral
    • Contracts
    • Exposure and response prevention
  • Cognitive
    • Reframing
    • Cognitive restructuring
  • Family therapy
    • Decrease secondary gain
    • Uncover family dysfunction
  • Group therapy
    • Safe disclosure
    • Minimize manipulation and secondary gain
  • Expressive therapies
adjunctive therapy
Adjunctive Therapy
  • Occupational therapy
  • Nutrition education and counseling
  • Interdisciplinary treatment team
  • Community support groups