EATING DISORDERS Anorexia Nervosa is a disorder characterized by compulsive resistance to eat and maintain body weight common in adolescent

nt and young adult 12-18 years of age with a mortality rate of 18-20% majority of cases are females clients usually dies of severe malnutrition refusal to maintain a normal body weight an intense dear of gaining weight a body image disturbance: a clients perception of being overweight perfectionist type of personality Assessment Parameters: o A menorrhea o N o other organic factor accounts for weight loss o O bviously thin but feels fat o R efusal to maintain body weight o E pigastric discomforts o X Symptoms like hiding foods, collecting recipes o I ntense fear of gaining weight o A lways thinking about food portrays an image of perfectionism high achievers DIETERS normal weight eat less avoid social situations isolation competitive and obsessive rigid exercise VOMITERS/PURGERS overweight induction of vomiting or excessive use of laxatives denies concerns about weight eat normally in social events binge eating

2. control of ones identity 3. sectoral demands for perfection and control 4. ambivalent feelings toward mother and independence etiology: o biological factors: increased serotonin level o socio-cultural: ideal woman o family factors: emotional restraint, enmeshed relationships, rigidity in the organization of the family, avoidance of conflict o cognitive and behavioral: reinforced idea about rejecting food and losing weight Anorexia Food = control Food = fat NERVOSA Fear Food = love Bulimia Insatiable appetite Food = love GUILT

What is purging? the compensatory behavior designed to eliminate food by means if self-induced vomiting Binge eating and purging frequently begins during or after dieting may eat low calorie foods restrictive eating effectively sets them up for the next episode of binging and purging and the cycle continues Bulimia is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain usually begins in late adolescents or late adulthood: 18/19 yrs is the typical age at onset binging or purging episodes are often precipitated by strong emotions and followed by guilt, remorse or selfcontempt very sociable usually is in the normal range of weight some are overweight or underweight has pathologic eating behavior hidden from others 10 years after treatment, 30% continued to engage such behavior, 38% to 47% were fully recovered but relapse may occur, 3% or less dies etiology: o Biologic familial psychiatric d/o o Developmental/environmental autonomy and unique identity (self-environment) o Socio-cultural things that are being taught o Cognitive and behavioral low self-esteem o Psychodynamics the feeling of ambivalence

Physiologic changes: o hypotension, bradycardia and hypothermia o dehydration leading to renal failure o constipation o dry skin, lanugo o prolonged amenorrhea: osteoporosis Emotional changes: o fear of losing control over the amount of food they eat and of becoming fat o feeling of helplessness may be triggered by adolescent crisis, unconscious fear of growing up and obsessive concern with obesity Possible etiologies: 1. phobic avoidance of adulthood

Assessment: o B inge eating o U nderstrict dieting or vigorous exercise o L ack of control over eating binges o I nduced vomiting o M inimum of two binge-eating episodes in a week for a period of 3 months o I ncreased or persistent concern over body size and shape o A buse of laxatives and diuretics Signs and symptoms: o depressive and anxiety symptoms o loss of dental enamel o menstrual irregularities o esophageal tears r/t purging, vomiting o dependence on laxatives o F & E abnormalities Anorexia Early onset Very low weight Amenorrhea Hormonal imbalance Constipation if not using laxative Bulimia Later onset More normal weight Menstrual irregularities No amenorrhea F & E imbalance Constipation if not using laxative

o expresses self-disgust after overeating o obesity Health consequences: o BP o cholesterol o diabetes o obesity o gallbladder disease o heart disease

Management Psychotherapy Milieu - must be placed in a room without CR, must not be included in a room with a person dx with eating d/o, should be near the nurse station Cognitive behavioral therapy decatastrophizing removing the trauma by frequently talking to someone reframing restructuring thoughts by saying that eating is a healthy way to live life positive self-talk Kaya ko to Psychopharmacology anxiolytics for anxiety atypical antipsychotics (Olanzapine [Zyprexa]) to promote weight gain for anorexics SSRIs in bulimia, reducing bingeing, purging and depression

Binge-Eating Disorder Warning signs: o frequently eats large amounts of food o eats rapidly o often eats alone