NCM105 7th Eating Disorders
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Transcript of 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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7 Eating Disorders
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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7 Eating Disorders
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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7 Eating Disorders
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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7 Eating Disorders
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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7 Eating Disorders
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.