NCM105 7th Eating Disorders

7/30/2019 NCM105 7th Eating Disorders

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7 Eating Disorders

EATING DISORDERS

Reported by:N3C, Group 7

Lacerna, MarkLapuz, Karen Aida M.

Llanora, Katrina L.Magsanoc, Marissa M.

Overview of Eating Disorders

In the late 1800s, doctors in England

and France described young women

who apparently used self-starvation to

avoid obesity

It was not until 1960s, however, that

anorexia nervosa was established asmental disorder

Bulimia nervosa was first described as a

distinct syndrome in 1979

Pica

It is theingestion of non-nutritive

substancessuch as paint, hair, cloth,

leaves, sand, clay and soil.

It is commonly seen in children with

mental retardation and it occasionally

occurs in pregnant patient.

Rumination

Derived from the Latin word ruminare

Means chew the cud

Repeated regurgitation and

rechewing of food.

The child brings partially digested food

up into the mouth and usually rechews

and reswallows the food.

The regurgitation does not involve

nausea, vomiting or any medical

condition

Children with rumination disorder

repeatedly regurgitate and spit-out or re-

chew their food following eating.

Usually develops in infants or young

children.

Must last at least 1 month before the

diagnosis can be made.

Do not show nausea, retching or disgust

associated with their rumination

behaviorf

Do not have associated gastrointestinal

problems that can account for the

behavior.

Symptoms usually begin between 3

and 12 months of age, and then often

remit spontaneously (particularly in

infants) after a period of time.

Rumination disorder is uncommon, and

seems to occur more often in males

than in females.

Predisposing Factors

Rumination cause is unknown.

Adverse psychosocial environment

An abnormal mother-infant

relationship

Onset and maintenance of

rumination has also beenassociated with boredom, lack of

occupation, chronic familial

disharmony, and maternal

psychopathology.

Learning-based theories


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Propose increase following positive

reinforcement, such as pleasurable

sensations produced by the

rumination (e.g., self-stimulation) or

increased attention from others

after rumination.

Maintained by negative

reinforcement when an undesirable

event (e.g., anxiety) is removed.

Organic factors

The role of medical/physical factors

in rumination is unclear. Although

an association between

gastroesophageal reflux (GER) and

the onset of rumination may exist,

some researchers have proposedthat various esophageal or gastric

disorders may cause rumination.

Dilatation of the lower end of theesophagus or of the stomach

Overaction of the sphinctermuscles in the upper portions ofthe alimentary canal

Cardiospasm

Pylorospasm

Gastric hyperacidity

Movements of the tongue

Insufficient mastication

Pathologic conditioned reflex

Aerophagy (ie, air swallowing)

Finger or hand sucking

Heredity

Although occurrences in families

have been reported, no genetic

association has been established.

Signs and Symptoms

Weight loss

Halitosis

Indigestion

Chronically raw and chapped lips

Regurgitation occurs almost every

day following most meals.

Regurgitation is generally described

as effortless and is rarely associated

with forceful abdominal contractions

or retching.

Management

The main treatment is the

Comprehensive Behavioral

Modification Plan(based on learning

principles) which is designed to promote

normal eating behavior and to

discourage ruminative behavior.

Parents may be taught parenting

techniques which aim to provide

increased attention, interaction, and

stimulation for affected children in

support of these behavior modification

goals.

They may also be encouraged to

consult with a nutritionist.

Behavior modification plans designed to

reduce and ultimately eliminate

rumination disorder symptoms need to

be applied consistently across all

environments that children encounter in

order for best results to occur.

Children who are in serious life

threatening danger due to their condition

will, of course, need to be hospitalized

until their condition stabilizes.


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Anorexia Nervosa

It is a life-threatening eating disorder

characterized by the clients refusal or

inability to maintain a minimally normal

body weight, intense fear of gaining

weight or becoming fat, significantly

disturbed perception of the shape or size

of the body, and steadfast inability or

refusal to acknowledge the seriousness of

the problem or that one even exists.

It is a condition that goes beyond out-of-

control dieting. A person with anorexia

often initially begins dieting to lose weight.

Over time, the weight loss becomes a sign

of mastery and control.

90% of clients with eating disorders are

female.

Anorexia begins between the ages of 14

and 18.

Clients with anorexia nervosa can be

classified into subgroups:

Restrictive Subtype

Dieting, fasting or excessive

exercising

Binge eating and purging subtype

Binge eating means consuming

a large amount of food (far

greater than most people eat at

one time) in a discrete period of

usually 2 hours or less.

Purging means thecompensatory behaviors

designed to eliminate food by

means of self-induced vomiting

or misuse of laxatives, enemas,

and diuretics.

Etiology

The specific cause is unknown

Biologic factors:

Familial tendency

Genetic vulnerability

Dysfunction of the hypothalamus

Family history of mood or anxiety

disorders

Risk Factors

Developmental factors

Issues of developing autonomy

and having control over self and

environment

Developing a unique identity

Dissatisfaction with body image

Family factors

Family lacks emotional support

Parental maltreatment

Cannot deal with conflict

Sociocultural factors

Cultural idea of being thin

Media focus on beauty, thinness,

fitness

Preoccupation with achieving the

ideal body

Symptoms

Fear of gaining weight or becoming fat

even when severely underweight


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Body image disturbance

Depressive symptoms

Preoccupation with thoughts of food

Feelings of ineffectiveness

Inflexible thinking

Strong need to control environment

Limited spontaneity and overly

restrained emotional expression

Amenorrhea for at least 3 consecutive

cycles

Bodyweight that is 85% or less of that

expected for their age and height

Management

For severely malnourished clients, their

medical condition must be stabilized

before psychiatric treatment can begin.

Medical management will focus on

weight restoration, nutritional

rehabilitation, rehydration, and

correction of electrolyte imbalances

Psychopharmacology

Amitriptyline (Elavil) &

cyproheptadine (Periactin)

promote weight gain

Olanzapine (Zyprexa)

antipsychotic effect and weight

gain

Fluoxetine (Prozac) preventrelapse in clients whose weight

has been partially/completely

restored

Family therapy

For families of clients younger than

18 years

For families who demonstrate

enmeshment, unclear boundaries

among members, and difficulty

handling emotions and conflict

Individual therapy

If family cannot participate in family

therapy

If the client is older or separated

from nuclear family

If client has individual issues

requiring psychotherapy

Bulimia Nervosa Often simply called bulimia is a serious

eating disorder in which a person

engages into recurrent binge eating

followed by inappropriate compensatory

behaviors to control ones weight.

A person suffering from bulimia have

episodes of binging and purging.

The amount of food consumed during a

binge episode is much larger than a

person would normally eat.

Clients with bulimia tend to hide their

eating behavior to others.

The weight of the clients with bulimia is

usually normal, although some are

overeight.

Begins in late adolescence or early

adulthood, average age is 18 or 19.

Usually affects people over age 35 andis more frequent in men.

Two types of bulimia

Purging type


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In which the person regularly

engages in self- induced vomiting.

A person may also misuse laxatives,

diuretics likewise enemas.

Non-purging type

The second type of bulimia wherein

one tries to control weight with the

use of fasting and excessive exercise

without purging regularly.

Etiology

Biologic

Developmental

Family Influence

Sociocultural

Predisposing Factors

Early dieting and obesity

Self-perception of being overweight or

fat and being unattractive.

Alterations in the neurotransmitters

Familial influences

Cultural considerations such as when

they link beauty to thinness.

Clinical Manifestation

Recurrent episodes of binge eating.

Self-induced vomiting, misuse of

laxative, diuretics and enemas

Excessive exercise

Depressive and anxiety symptoms

Irregular menstrual periods

Chipped, ragged teeth; loss of dental

enamel

Alterations in fluids and electrolytes

Management

Cognitive-Behavioral Therapy

Strategies designed to change the

clients thinking and action about

food focus on interrupting the

cycle of dieting, binging, purging

and altering dysfunctional

thoughts and belief about food,

weight, body image, and overall

self-concept

Psychopharmacology

Antidepressants more

effective than the placebos in

reducing binge eating. It als

improves mood and reduced

preoccupation with shape and

weight.

Assessment of Clients with

Eating Disorders

Family members often describe clients

with anorexia as perfectionists with

above-average intelligence,

ahievement oriented, dependable,

eager to please, and seeking approval

before their condition began. Parents

describe clients as being good,causing us no trouble until the onset of

anorexia

Clients with bulimia are often focused

on pleasing others avoiding conflict.

They have a history of impulsive

behaviour such as substance abuse


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and shoplifting as well as anxiety,

depression, and personality disorders.

General appearance and motor

behaviour

Anorexia

Appear slow, lethargic, fatigued,

emaciated, depending on the

amount of weight loss

May be slow to respond to

questions and have difficulty

deciding what to say

Often reluctant to answer questions

fully because they do not want to

acknowledge any problem

Often wear loose-fitting clothes in

layers, regardless of the weather

Eye contact may be limited

Bulimia

May be underweight or overweight

but are generally close to expected

body weight for age and size

Appear open and willing to talk

General appearance is not unusual

Mood and affect

Anorexia

Labile mood

Often seem sad, anxious, and

worried

Seldom smile, laugh or enjoy any

attempts at humor; somber and

serious most of the time

Bulimia

Clients are initially pleasant and

cheerful as though nothing is wrong.

Thought process and content

Spend most of the time thinking

about dieting, food, and food-related

behavior

Preoccupied with attempts to avoid

eating or eating bad or wrong

foods

Anorexia

Body image disturbance

May have paranoid ideas about theirfamily and health care

professionals, believing they are

their enemies who are trying to

make them fat by forcing them to

eat

Bulimia

Eating, binging, or purging leads to

anxiety, depression, and feeling out

of control.

Sensorium and intellectual processes

They generally are alert and

oriented.

Anorexic clients who are severely

malnourished show signs of

starvation such as mild confusion,

slowed mental processes, and

difficulty with concentration adattention.

Judgment and insight

Anorexia


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Very limited insight and poor

judgment about health status

Do not believe they have a problem

Believe others are trying to interfere

with their ability to lose weight

Continue to restrict food intake

despite negative effect on health

Bulimia

Ashamed of their behaviors (binge

eating and purging)

Feel out of controland unable to

change

Self-concept

Low self-esteem

See themselves only in terms of their

ability to control food intake and weight.

Overlook/ignore other personal

characteristics or achievements

Roles and relationships

Anorexia

May begin to fail at school, which is in

sharp contrast to previously

successful academic performance.

Withdraw from peers and pay little

attention to friendships.

Believe others will not understand orfear they will begin-out-of-control

eating with others.

Bulimia

Bulimic clients feel great shame about

their behaviors

Tend to lead secret lives.

Time spent buying and eating food

and then purging can interfere with

role performance at home and at

work.

Psychologic and self-care

considerations

Excessive exercise, almost to the point

of exhaustion

Sleep disturbances such as insomnia,

reduced sleep time, and early-morning

wakening

Dental problems, such as loss of tooth

enamel, chipped and ragged teeth, and

dental caries

Possible Nursing Diagnosis

Imbalanced Nutrition: Less than/More

than Body Requirements

Ineffective Coping

Disturbed Body Image

Interventions for Clients with

Eating Disorders

Establishing Nutritional Eating

Patterns

Total parenteral nutrition or enteral -

when a clients health status is

severely compromised.

Diet of 1, 200 1, 500 cal/day, with

gradual increases in calories.

Monitor meals and snacks.


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Discourage client from performing

food rituals, e.g. cutting food into

tiny pieces

Be alert for attempts to hide or to

discard food.

For bulimic patients are often

treated on outpatient basis,

encourage to them eat along with

friends and families.

Encourage client to always sit in a

designated eating area.

Remind client to avoid buying foods

that are frequently consumed during

binge eating.

Self-Monitoring

Encourage a client to keep a diary

of the foods consumed throughout

the day including binge and moods.

Teach client relaxation techniques

to control emotions.

Body Image Issues

Help clients view themselves in

terms other than weight and sizelikewise satisfaction with body

image

Identify clients strengths and

interest that is not related to size

and weight.

Maintain a positive attitude.

Client and Family Education

Provide education to help clients

take control of nutritional

requirements independently.

Extensive teaching about basic

nutritional needs and the effects of

restrictive eating, dieting, and the

binge and purge cycle.

Encourage client to set realistic

goals.

For clients who purge, teaching

should include information about

harmful effects of purging by

vomiting and laxative abuse.

Teach techniques of distraction and

delay.

Explain to family and friends that

they can be most helpful by

providing emotional support, love,

and attention.

NCM105 7th Eating Disorders

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