EATING DISORDERS

Anorexia Nervosa and Bulimia

EATING DISORDERS
Canadian singer Alanis Morissette has admitted that she struggled with anorexia and bulimia between the ages of 14 and 18, but is now recovered. "I work out about two times a week instead of nine," she said. "I'm still a part of society, but I'm better able to challenge it than when I was 14."

EATING DISORDERS
Elton John The legendary British musician and composer entered rehabilitation in 1990 for substance abuse problems and bulimia. Post-recovery, he came out as a homosexual, and today enjoys as much success as ever. In 1997, he was knighted by Queen Elizabeth II.

EATING DISORDERS
In one of the most widely publicized deaths due to anorexia, singer Karen Carpenter suffered cardiac arrest at age 32 as a direct result of self-starvation.

EATING DISORDERS
British-born actress Kate Winslet admits to eating disorder problems in her youth, though she has, over the years, put on a healthy amount of weight. "I'm happy with the way I am," she says now. "I'm not like American film stars. I'm naturally curvy. This is me, like it or lump it."

EATING DISORDERS
Pop singer Paula Abdul admits to struggling with bulimia and issues with compulsive overexercise in the past. Today, she is one of three judges on the Fox show American Idol, amidst scandal surrounding alleged drug use.

EATING DISORDERS
England's beloved Princess Diana, activist and ex-wife of Prince of Wales Charles, confessed self-harm and bulimia to the British media. Diana died tragically in a car accident involving a paparazzi chase in August 1997.

EATING DISORDERS
Are severe disturbances in eating behavior accompanied by distortion in body image and self- perception

ANOREXIA NERVOSA
Is a self- starvation syndrome in which the person relentlessly pursues thinness, sometimes to the point of fatal emaciation as the person becomes preoccupied with food and body.

TWO MAIN FORMS OF ANOREXIA NERVOSA:

1. RESTRICTING TYPE- food intake is limited 2. BINGE- EATING OR PURGING TYPE- engages in regular binge- eating or purging behavior

Causes of Anorexia Nervosa

1. 2. 3. 4. Genetic Biological Behavior and Environmental Psychological

1. Genetic
Female most often affected Siblings- 10 to 20 fold higher risk of developing the DO

2. Biological
Below normal levels of SEROTONIN and NOREPINEPHRINE

Above normal levels Of CORTISOL and VASOPRESIN

3. BEHAVIORAL ANDENVIRONMENTAL
Societal standards Stress

PSYCHOLOGICAL FACTORS

Low selfesteem thus becomes

Perfectionist to compensate

Does not know how to deal with painful feelingspowerless to control the environment= caloric restriction

PSYCHOLOGICAL FACTORS

Subconscious efforts to protect self from issues surrounding sexuality

FAMILTY DYNAMICS

- ABUSE

- CHAOTIC
- ACHIEVER - TROUBLE WITH RESOLVING CONFLICTS AND EXPRESSING ANGER

- PASSIVE AND AGRESSIVE PARENT

- SUPERFICIALLY POWERFUL MOTHER - DISTANT FATHER TO AN ADOLESCENT DAUGHTER

PHYSICAL SIGNS AND SYMPTOMS:

KEY FEATURE- self imposed starvation( despite emaciation), history of 15% or greater wt. Loss with no organic reasons, morbid dread of being fat and compulsion to be thin. Emaciated appearance skeletal muscle atrophy Loss of fatty tissues Breast tissue atrophy

PHYSICAL Signs and symptoms

Lanugo bowel distention Dryness or loss of scalp hair Hypotension slow reflexes Bradycardia loss of libido Painless salivary gland enlargement Fatigue amenorrhea Sleep difficulties Cold intolerance Constipation

PSYCHOSOCIAL Signs and symptoms

Preoccupation with body size Distorted body image Description of self as fat Dissatisfaction with a particular aspect of the appearance Low self- esteem Social isolation Perfectionism

PSYCHOSOCIAL Signs and symptoms

Paradoxical obsession with food such as preparing elaborate food for others Feelings of despair, worthlessness, and hopelessness Suicidal thoughts paranoid

BEHAVIORAL SIGNS AND SYMPTOMS

Wearing oversized clothing Layering of clothing Restless activity and vigor Avid exercising with no apparent fatigue Outstanding academic or athletic performance

Treatment of Anorexia Nervosa

Aim: Promote weight gain Correct malnutrition Resolve the underlying psychological dysfunction 1. Psychotherapy 2. Weight restoration within 10% of normal - Reasonable diet - Vitamin and mineral supplements - Activity curtailment as needed

Treatment of Anorexia Nervosa

Psychotherapy: - group, family or individual psychotherapy - Behavior modification, with privileges based on weight gain. HOSPITALIZATION : - Rapid weight loss equal to 15% or more of normal body mass - Persistent bradycardia - Systolic BP of 90 mm Hg or lower

Treatment....
- Hypothermia - 97 F (36.1 C) or less - Medical complications of suicidal ideation - Persistent sabotage or disruption of OP treatment - Denial of the disorder and the need for treatment

NURSING INTERVENTIONS
DURING HOSPITALIZATION:
Monitor VS, nutritional status, and fluid intake and output Help pt. establish a target weight, and support her efforts to achieve this goal Negotiate an adequate food intake with the pt. Frequently offer small portions of food or drinks. Monitor the patient for suicidal potential

NURSING INTERVENTIONS
Person to person: - Maintain one to one supervision during meals. - Allow pt. to maintain control over the types and amount of food she eats. - Teach pt. to keep a journal . Liquidation Strategy: - (Acute anorexic period) nutritionally complete liquids - Tube feedings and special feedings (discuss)

NURSING INTERVENTIONS
Pound by Pound - Weigh the patient daily - Weight should increase from morning to night - Anticipate weight gain of about 1 lb per week Defusing fat fears - Edema or bloating may occur - Encourage pt to recognize and assert feelings freely. - Explain to the pt. effects of improved nutrition - Advise family to avoid discussing food with the pt.

COMPLICATIONS:
Serious medical condition due to, malnutrition, dehydration, electrolyte imbalance Increase susceptibility to infection Hypoalbuminemia and hypokalemia ( leads to ventricular arrhythmias and renal failure) Bowel changes Esophageal ulcers, erosions, tears , bleeding; tooth and gum erosion and dental carries

Memory Jogger
H U N G E R- guidepost to major features of anorexia nervosa H- has an obsession with food and weight U- underweight or emaciated N- needs go unmet because of family conflict G- gross distortion of body image E- exercise, vomits, or uses laxative and diuretics to lose weight R- refuses to eat

BULIMIA NERVOSA
Marked by episodes of binge eating (up to several times a day) followed by feelings of guilt, humiliation, depression, and selfcondemnation. Sufferers use measures to prevent weight gain.

Causes of Bulimia Nervosa

Genetic and biological factors - More common in relatives of people with bulimia nervosa - Altered serotonin levels - Other factors: - Family disturbance or conflict - Sexual abuse - Maladaptive learned behavior - Struggle for control or self- identity

SIGNS AND SYMPTOMS:

Episodic binge eating, several times a day until interrupted. Prefers food that are sweet, soft, and high in calories and carbohydrates PHYSICAL SYMPTOMS: - thin, normal, or slightly overweight in appearance, with frequent weight fluctuations - Weight within normal range - Persistent sore throat and heartburn

SIGNS AND SYMPTOMS

PHYSICAL SYMPTOMS: - Calluses or scaring on the back of the hands and knuckles - Salivary gland swelling, hoarseness, throat lacerations, and dental erosion - Tooth staining or discoloration - Abdominal and epigastric pain - amenorrhea

PSYCHOSOCIAL S/S: Perfectionism Distorted body image Exaggerated sense of guilt Feelings of alienation Recurrent anxiety s/s of depression An image of perfect student, mother, career woman Poor impulse control Chronic depression

PSYCHOSOCIAL S/S:
Low tolerance for frustration Self- consciousness Difficulty expressing such feeling of anger Impaired social or occupational adjustment History of childhood trauma History of unsatisfactory sexual relationships Parental obesity

BEHAVIORAL S/S:
Evidence of binge eating Evidence of purging Peculiar eating habits or rituals Excessive rigid exercise Withdrawal from friends and usual activities Hyperactivity Frequent weighing

TREATMENT
MUST FOCUS ON THE CAUSE NOT THE SYMPTOM - Individual, group, and family therapy, focused on behavior modification, psychoeducation. - Self- help groups - Nutrition counseling - Medications
- TCA and SSRI (Tofranil and Paxil)

TREATMENT:
HOSPITALIZATION: (if binge eating and purging caused serious physical harm) - Round the clock observation of all eating and elimination

NURSING INTERVENTIONS:
Promote an accepting, nonjudgmental atmosphere. Establish a contract Supervise the patient during mealtime Set a time for each meal, provide a pleasant, relaxed eating environment Teach patient to keep a food journal Behavior modification

NURSING INTERVENTIONS:
Encourage to talk about stressful issues. Explain about the risk of laxative, emetics, and diuretics abuse Provide assertiveness training Assess for suicide potential Monitor meds

COMPLICATIONS:
Gastric and esophageal rupture due to bingeing Dental carries, erosion of teeth, parotitis, gum infection Heart failure (ipepac syrup) Dehydration/ electrolyte imbalance (metabolic alkalosis, hypokalemia Arrythmias Irregular bowel movement and constipation

MEMORY JOGGER
R I D S B O D Y- guidepost to major features of BULIMIA R- Recurrent binge- eating episodes I- intense exercise D- diuretic, laxative, and enema use S- self- induced vomiting B- body image distortion O- ordinary eating alternating with episodes of bingeing and purging D- depression and anxiety DO may ba present Y- yo-yo effect of bingeing, guilt and depression, purging

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