Eating DisordersEating Disorders

TopicsTopics

CoveredCovered

AnorexiaAnorexia

BulimiaBulimia

Not CoveredNot Covered OvereatingOvereating ObesityObesity Bariatric SurgeryBariatric Surgery

Anorexia NervosaAnorexia Nervosa

Affects 3.7% of Affects 3.7% of womenwomen

Less common than Less common than bulimiabulimia

6 to 20% die as a 6 to 20% die as a result of the illnessresult of the illness

Higher death rate Higher death rate than any other than any other psychiatric disorderpsychiatric disorder

Cultural BackgroundCultural Background

Weight and Shape are Weight and Shape are very importantvery important

Computer Graphics: Computer Graphics: make thin models even make thin models even thinnerthinner

Preoccupation with Preoccupation with food, eating, fitnessfood, eating, fitness

Unrealistic IdealsUnrealistic Ideals Eating Disorders: Eating Disorders:

Primarily Women (90%)Primarily Women (90%)

Onset of Anorexia NervosaOnset of Anorexia Nervosa

PersonalityPersonality AdolescentAdolescent FemaleFemale PerfectionistPerfectionist IntrovertedIntroverted Self-esteem and peer relationship problemsSelf-esteem and peer relationship problems Active in school activitiesActive in school activities Rules and regulations for everythingRules and regulations for everything

Anxiety over breaking the rulesAnxiety over breaking the rules Regain control by tightening rules and punishing selfRegain control by tightening rules and punishing self

Deliberate Weight lossDeliberate Weight loss

Objective SignsObjective Signs

RestrictorsRestrictors Eat Less Eat Less Avoid social situationsAvoid social situations CompetitiveCompetitive Compulsive and obsessive about activitiesCompulsive and obsessive about activities Rigid exercise programRigid exercise program Hyperactive unable to relaxHyperactive unable to relax AnxiousAnxious

Objective SignsObjective Signs

Hoarding foodHoarding food

Preparing elaborate meals for othersPreparing elaborate meals for others

Rituals before and during eating Rituals before and during eating become a compulsionbecome a compulsion

AnorexiaAnorexia

Purgers and vommittersPurgers and vommitters Eat normally in a social situationEat normally in a social situation The amount of food eaten is not The amount of food eaten is not

excessiveexcessive Purge if unsuccessful with severe Purge if unsuccessful with severe

dietary restrictionsdietary restrictions

ConsequencesConsequences

Low metabolic rateLow metabolic rate HypotensionHypotension BradycardiaBradycardia SkinSkin

Dry and lanugo may appearDry and lanugo may appear Delayed gastric emptyingDelayed gastric emptying

Feel full much longerFeel full much longer ConstipationConstipation

Overuse of LaxativesOveruse of Laxatives DehydrationDehydration

RENAL FAILURERENAL FAILURE

Other Consequences of Other Consequences of AnorexiaAnorexia

Osteopenia or OsteoporosisOsteopenia or Osteoporosis Bone mass loss may be irreversibleBone mass loss may be irreversible

Cardiac ventricular dilationCardiac ventricular dilation Decrease thickness of the ventricular Decrease thickness of the ventricular

wall wall Decrease oxygenation of the cardiac Decrease oxygenation of the cardiac

musclemuscle

Metabolic ConsequencesMetabolic Consequences

Med Surg ReviewMed Surg Review

Electrolyte Electrolyte imbalanceimbalance PotassiumPotassium

HypokalemiaHypokalemia

CalciumCalcium hypocalcemiahypocalcemia

Metabolic Metabolic imbalanceimbalance Metabolic AcidosisMetabolic Acidosis

Metabolic AlkalosisMetabolic Alkalosis

Re-feeding SyndromeRe-feeding Syndrome

Severe Fluid ShiftsSevere Fluid Shifts Extracellular to intracellularExtracellular to intracellular Cardiovascular, neurological and Cardiovascular, neurological and

hematologic complicationshematologic complications Refeed slowlyRefeed slowly Close supervisionClose supervision

Mental Health Problems and Mental Health Problems and AnorexiaAnorexia

Fear of losing controlFear of losing control Low sex drive; amenorrhea; decreases Low sex drive; amenorrhea; decreases

development of secondary sex characteristicsdevelopment of secondary sex characteristics Feelings of helplessnessFeelings of helplessness

Feel abandoned or inadequateFeel abandoned or inadequate Combat by controlling what they eatCombat by controlling what they eat

Obsessive-compulsive disorderObsessive-compulsive disorder Major-depression Major-depression

(only after weight is established)(only after weight is established)

Substance abuseSubstance abuse Personality disordersPersonality disorders

Etiology of AnorexiaEtiology of Anorexia

High levels of serotoninHigh levels of serotonin SSRIs are not effectiveSSRIs are not effective If used should not be If used should not be

started until weight started until weight

restoration is establishedrestoration is established

Anorexia and the FamilyAnorexia and the Family

Emotional restraintEmotional restraint Enmeshed relationshipsEnmeshed relationships Rigid organizationRigid organization Tight controlTight control

Drive for thinness is a way to seek controlDrive for thinness is a way to seek control Avoidance of conflictAvoidance of conflict

Odd eating habitsOdd eating habits Emphasis on appearanceEmphasis on appearance

Bulimia NervosaBulimia Nervosa

BulimiaBulimia

Means to have an insatiable Means to have an insatiable appetitiveappetitive

Begins in adolescentsBegins in adolescents Primarily in womenPrimarily in women 4% of young adults4% of young adults Overlap with Anorexia making Overlap with Anorexia making

diagnosis difficultdiagnosis difficult

BulimiaBulimia

Hide their eating-disordered behaviorsHide their eating-disordered behaviors Lack of weight lossLack of weight loss Major DepressionMajor Depression Personality disorder Personality disorder Post traumatic Stress DisorderPost traumatic Stress Disorder Purging develops as a way to compensate Purging develops as a way to compensate

for massive amounts of food eatenfor massive amounts of food eaten Restrictive eating….then purging….cycleRestrictive eating….then purging….cycle

Binge EpisodeBinge EpisodeMassive Amounts of FoodMassive Amounts of Food

BingeBinge

Feelings of lack of controlFeelings of lack of control Secretive about behaviorSecretive about behavior High calorie High carbohydrateHigh calorie High carbohydrate Consumed in less than 2 hoursConsumed in less than 2 hours Several different fast food restaurantsSeveral different fast food restaurants During the evening or at nightDuring the evening or at night Eat rapidlyEat rapidly Addicted to the high experienced when Addicted to the high experienced when

eatingeating Resume usual scheduledResume usual scheduled

Self Induced Vomiting or Self Induced Vomiting or Laxative AbuseLaxative Abuse

Electrolyte imbalances Electrolyte imbalances Metabolic AcidosisMetabolic Acidosis Metabolic AlkalosisMetabolic Alkalosis CardiomyopathyCardiomyopathy Enlarged salivary glandsEnlarged salivary glands Erosion of dental enammelErosion of dental enammel Russell’s sign Russell’s sign PancreatitisPancreatitis

Etiology: Differences in Etiology: Differences in BulimiaBulimia

Lowered serotonin activityLowered serotonin activity Binge eating raises levels of Binge eating raises levels of

serotoninserotonin Treatment with SRRI particularly Treatment with SRRI particularly

fluoxetine (Prozac)fluoxetine (Prozac) Depression; shame; hide their eatingDepression; shame; hide their eating

Family Family

Mood disordersMood disorders Substance abuseSubstance abuse ConflictConflict DisorganizedDisorganized Lacking nurturanceLacking nurturance Evidence Bulimia is a response to chaosEvidence Bulimia is a response to chaos Food is a symbolic form of nurturingFood is a symbolic form of nurturing

ManagementManagement

AnorexiaAnorexia Increase weight to Increase weight to

90% of average 90% of average body weight for body weight for heightheight

Increase self-Increase self-esteemesteem

Decrease need for Decrease need for perfection (provided perfection (provided by thinness)by thinness)

BulimiaBulimia Stabilize weight Stabilize weight

without purgingwithout purging

Starvation Phase of Starvation Phase of AnorexiaAnorexia

Severe Fluid ShiftsSevere Fluid Shifts Extracellular to intracellularExtracellular to intracellular Cardiovascular, neurological and Cardiovascular, neurological and

hematological complicationshematological complications Refeed slowlyRefeed slowly Close supervisionClose supervision Intravenous lines and feeding tubes if Intravenous lines and feeding tubes if

client refuses foodclient refuses food

Nurse Patient RelationshipNurse Patient Relationship

Anorectic Anorectic Forced into Forced into

treatmenttreatment Loss of control over Loss of control over

eatingeating Nurse is the enemyNurse is the enemy Keep in mind these Keep in mind these

clients may also clients may also have a Personality have a Personality disorderdisorder

BulimicBulimic More likely to want More likely to want

helphelp More likely to enter More likely to enter

treatment of their treatment of their on volitionon volition

Tendency to Tendency to manipulatemanipulate

Hide the degree of Hide the degree of the problemthe problem

The Nurse Patient The Nurse Patient RelationshipRelationship

Convey empathy and Convey empathy and listenlisten

Deny the problem but Deny the problem but will admit loneliness will admit loneliness and tired of trying for and tired of trying for perfectionperfection

HonestyHonesty CollaborateCollaborate TEACHTEACH patient about patient about

their disordertheir disorder Assist to identify Assist to identify

positive qualitiespositive qualities

WeighingWeighing Set appropriate limitsSet appropriate limits Behavior modificationsBehavior modifications

Patient inputPatient input Rewards for weight gain Rewards for weight gain

or lack of purgingor lack of purging Once a safe weight is Once a safe weight is

attainedattained Control is given to Control is given to

patientpatient As long as there is no As long as there is no

backslidebackslide

PsychopharmacologyPsychopharmacology

Anxiolytics when re-feeding is Anxiolytics when re-feeding is occurringoccurring

SSRI for BulimiaSSRI for Bulimia Equally effective for depressed and non-Equally effective for depressed and non-

depressed patientsdepressed patients Psychotherapy for AnorexiaPsychotherapy for Anorexia

Use antidepressant for co morbid severe Use antidepressant for co morbid severe depressiondepression

Milieu ManagementMilieu Management

OrientationOrientation Warm nurturing environmentWarm nurturing environment

Convey an understanding of their fearsConvey an understanding of their fears Close observationClose observation

Do we let these patient go to the rest room alone?Do we let these patient go to the rest room alone? Should we let them go to their room right after a meal?Should we let them go to their room right after a meal? Nonjudgmental confrontationNonjudgmental confrontation CONSISTENCYCONSISTENCY

Encourage the patient to talk to staff when they feel the Encourage the patient to talk to staff when they feel the need to purgeneed to purge

Family TherapyFamily Therapy Group TherapyGroup Therapy DietitianDietitian Follow-up Therapy (outpatient)Follow-up Therapy (outpatient)