Eating disorder2019pptx 2
- 1. Eating Disorders Rebecca L White, MSN, FPMHNP, FNP
- 2. Overview • Eating Disorders –A condition where one spends more time eating or not eating • response to external cues –A preoccupation with food
- 3. Overview of Eating Disorders • More common among females • Behavioral & Affective disorders – Major depression in self or 1st degree relatives – Social Phobia – Obsessive compulsive Disorder – Alcoholism – Substance Abuse – Addictive behaviors- Laxative usage, Poor impulse control, Anxiety disorders, Obsessive compulsive personality
- 4. DMS IV-Anorexia Nervosa –Refusal to maintain body weight • at or above the minimally normal weight –Weight is less than 85% of that expected • Failure to make expected weight gain during a period of growth (adolescent) –Intense fear of gaining weight even though underweight • In clients with menses, the absence of menses for 3 consecutive menstrual cycles –Amenorrhea
- 5. Anorexia Nervosa • Although hungry-refuses to eat because of distorted self-perception of fatness –Starvation ensues –Can become chronic illness • Estimated mortality from anorexia nervosa –5% of those with the disorder
- 6. DMS V-Anorexia Nervosa • Persistent restriction of energy intake leading to significantly low body weight –in context of what is minimally expected for age, sex, developmental trajectory, and physical health • Usual onset between 13-20 years –but can occur in any age • Erskine, Whiteford & Pike, 2016
- 7. DMS IV • Bulimia Nervosa •The binge eating and inappropriate behaviors must occur at least twice a week for 3 months •Does not occur exclusively with episodes of Anorexia Nervosa
- 8. DSM-V-Bulimia Nervosa • Binge eating and compensatory behaviors – occur for at least once a week for at least three months • In DMS V all of these types of behaviors are lumped together – clinicians now recognize that sufferers can engage in a variety of behaviors
- 9. DMS IV-Bulimia Nervosa –Recurrent episodes of binge eating. • Eating, in a discrete period of time (within a 2 hour period), an amount of food that is definitely larger than most people would eat during the similar period of time & under similar circumstance • A sense of lack of control over-eating during an episode • Inappropriate compensatory behavior-self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting and or excessive exercise
- 10. Binge Eating Disorder • Consuming large amounts of calories in contained amount of time • Differs from bulimia because person does not attempt to prevent weight gain –Purging behaviors not used –Prevalence: approximately 2%-4% of population
- 11. Eating Disorders: Night Eating • Pattern of awakening during night associated with food intake –Not yet listed as separate eating disorder in DSM-IV-TR –Estimated 1.5% in general population –Make up 27% of severely obese population seeking surgical treatment
- 12. Eating Disorders • Suicide behaviors are more likely seen in Bulimia • A male to female ratio 1:9 for anorexia nervosa • Bulimia nervosa – 1% to 4 % of adolescents-most are young adult females • Only 0.4% of males
- 13. Overlapping Relationships Among Eating Disorders
- 14. Continuum of Adaptive Eating Responses
- 15. Eating Disorders • Eating disorders more common among females – males more reluctant to seek treatment • Sociocultural norms result in distorted body image
- 16. Eating Disorders- Biological Changes • Altered Metabolic Rates • Profound Malnutrition • Possibly Death • Eating obsessions can cause psychological problems – Depression, Isolation, Emotional Lability
- 17. Assessment • Complete biological, psychological, sociocultural evaluations • Full physical examination – vital signs; weight; skin; cardiovascular system; evidence of laxatives, diet pills, diuretic abuse, and/or vomiting; dental examination • Psychiatric history – dieting and substance use, family assessment, medications
- 18. Behaviors: Binge Eating • Person with bulimia typically average weight or slightly overweight with unsuccessful dieting history • Binges related to stressful situations – Several times weekly to more than 10 times/day or occasional
- 19. Systems affected by Eating Disorders • Central nervous system • Renal • Hematological • Gastrointestinal • Metabolic • Endocrine • Cardiovascular
- 21. Clinical Manifestations of Eating Disorders • Plot growth parameters – BMI, Height and Weight • Client with Anorexia Nervosa present as in a state of hibernation – Hypothermia, Bradycardia, Lanugo in the arms & back
- 22. Vital Signs/Appearance • Emaciated with loss of SQ tissue(AN) • Full appearing facies 2nd to parotid & submaxillary swelling (BN) • Pigmentation of the chest and abdomen (AN) • Loss of pubic and scalp hair (AN) • Tachycardia and /or orthostatic hypotension (BN) • Distended abdomen & decreased bowel sounds (AN)
- 23. Vital Signs/Appearance • Binging and Purging – Scratches, scars or callus over knuckles – Petechiae and subconjunctival hemorrhages form severe wrenching – Dental caries, enamel erosions, or discoloration – Parotid Hypertrophy
- 24. Medical Problems Related to Anorexia • Potassium depletion – hypokalemia from vomiting, laxative or diuretic abuse • Symptoms of potassium depletion – muscle weakness, cardiac arrhythmias, conduction abnormalities, hypotension • Gastric, esophageal, bowel abnormalities • Erode dental enamel, cause enlarged parotid glands
- 25. Medical Problems Related to Binge Eating • Excess weight – serious health problems • Excess weight – hypertension, cardiac problems, sleep apnea, difficulties with mobility, diabetes mellitus • Death • Osteoporosis
- 26. Co-morbid Mental Illnesses • Depression or dysthymia – 50%-75% of people with anorexia and bulimia • Obsessive-compulsive disorder – 25% of patients with anorexia nervosa • Patients with bulimia – increased rates of anxiety disorders, posttraumatic stress disorder, substance abuse, mood disorders
- 27. Diagnostic Testing • Anorexia Nervosa – CBC – Sedimentation Rate – Complete Metabolic Panel – Endocrine-FSH, Luteinizing Hormone, Estradial, TSH, Cortisol – Urine Ph and UA – EKG
- 28. Predisposing Factors • Psychological – rigidity, perfectionism • Environmental – illnesses, sexual abuse, drug abuse, media influences • Familial – increased risk in female relatives • Biological – probable relationship to serotonin and dopamine levels • Sociocultural – shifting cultural norms for young women to face multiple, ambiguous, often contradictory role expectations
- 29. Coping Skills • Important part of assessment of patients with maladaptive eating regulation responses • Important in engaging patients reluctant to treat their eating disorder –Psychoeducational material –Advantages/disadvantages of symptoms –Personal values
- 30. Coping Mechanisms: Anorexia Nervosa • Happiest when fasting, losing weight, or achieving weight goals – Severely maladaptive use of denial – often angry with others’ concern or attempts to help • Issue not really about weight – about controlling life – fears of maturity, independence, failure, sexuality, or parental demands – believe they have solved problem by controlling their food intake and their bodies
- 31. Coping Mechanisms • Defense mechanisms with bulimia – avoidance, denial, isolation of affect, intellectualization – Usually upset about binging and purging behavior • realize not in control • Regard symptoms as preferable to weight gain • Night eating syndrome patients distressed, especially if obese – readily seek treatment
- 32. Stuart Stress Adaptation Model: Eating Regulation Responses
- 33. Eating Disorders
- 34. Short Term Goals • Patient-identify cognitive distortions about food, weight, body shape – Develop nutritionally balanced menus – Accurately describe body dimensions • Exercise moderately – Nutritionally, medically stable – Demonstrate positive family interactions • Describe complications of eating disorder behaviors
- 35. Nursing Interventions • Aimed at restoration of nutrition and hydration, correcting electrolyte imbalances • Development of more adaptive coping mechanism • Improvement of body image and self esteem
- 36. Evidence-Based Treatment for Bulimia Nervosa • Manual-based CBT is treatment of choice – Several antidepressants produced short-term reductions in binge eating, purging • CBT with antidepressants may affect bulimia slightly by treating co-morbid anxiety, depression
- 37. Treatment for Eating Disorders • Behavior modification • Family Therapy • Individual therapy • Pscyhopharmacology • Support Groups • Treatment of any other mental illness
- 38. Treatment for Eating Disorders Hospitalization Required • Weight loss greater than 30 % below normal – BMI less than 16 • Continued weight loss • History of rapid weight loss without patient treatment – a rapid weight loss over 3 months
- 39. Body Mass Index BMI • is a number calculated from a person's weight and height • is a fairly reliable indicator of body fatness for most people – research has shown that BMI correlates to direct measures of body fat – BMI is an inexpensive and easy-to-perform method of screening for weight categories that may lead to health problems.
- 40. References • Erskine, H. E., Whiteford, H. A., & Pike, K. M. (2016). The global burden of eating disorders. Current opinion in psychiatry, 29(6), 346-353. • Erskine, H. E., Moffitt, T. E., Copeland, W. E., Costello, E. J., Ferrari, A. J., Patton, G., ... & Scott, J. G. (2015). A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychological medicine, 45(7), 1551-1563. • Godart, N., Radon, L., Curt, F., Duclos, J., Perdereau, F., Lang, F., ... & Corcos, M. (2015). Mood disorders in eating disorder patients: Prevalence and chronology of ONSET. Journal of Affective Disorders, 185, 115-122.
Editor's Notes
- #22: Lanugo is the growth of fine, downy hair on the face and body of anorexics. It's a sign that the body's natural defenses are at work. Actually, this "peach fuzz" is likely an adaptive attempt by the body to trap and retain heat when the insulating effect of body fat is missing. It's almost like a naturally-grown blanket that helps keep the anorexic warm.
- #24: Enlargement of the salivary glands can occur in patients with anorexia nervosa (AN). This enlargement appears to be related to both the nutritional deficiencies and the bizarre eating habits (particularly the bulimia and vomiting) characteristic of these patients. In some patients, the salivary gland enlargement persists despite return to normal weight.