EATING DISORDERS

Pyschiatric Nursing

EATING
Eating is the ingestion of food to provide for all organism their nutritional needs, particularly for energy and growth. Animals and other heterotrophs must eat in order to survive: carnivores eat other animals, herbivores eat plants, omnivores consume a mixture of both plant and animal matter, and detritivores eat detritus. Fungi digest organic matter outside of their bodies as opposed to animals that digest their food inside their bodies. Eating is an activity of daily living.

Physiologically, eating is generally triggered by hunger, but there are numerous physical and psychological conditions that can affect appetite and disrupt normal eating patterns. These include depression, food allergies, ingestion of certain chemicals, bulimia, anorexia nervosa, pituitary gland malfunction and other endocrine problems, and numerous other illnesses and eating disorders.

Eating Disorder Can be viewed on a continuum with the clients with anorexia eating too little or straving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much. There is much overlap among the eating disorders: 30% to 50% of normal-weight people with bulimia have a history of anorexia nervosa and low body weight and about 50% of people with anorexia nervosa exhibit bulimic behavior .

Clients with bulimia have later age of onset and near-normal body weight. They usually are ashamed and embarrased by the eating behavior. More than 90% of cases of anorexia nervosa and bulimia occur in females. Although fewer men than women suffer from eating disoders, the number of men with anorexia or bulimia may be much higher than previously believed . Men, however, are less likely to seek treatment . The prevalence of both 3% of the general population in the united states.

ANOREXIA NERVOSA
-- also known as simply Anorexia, is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. -- It is often coupled with a distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. --Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. --The average caloric intake of a person with anorexia nervosa is 600800 calories per day, but extreme cases of complete self-starvation are known.

--It is a serious mental illness with a high incidence of comorbidity and the highest mortality rate of any psychiatric disorder. --Anorexia most often has its onset in adolescence and is most prevalent among adolescent girls.However, more recent studies show that the onset age of anorexia decreased from an average of 13 to 17 years of age to 9 to 12. --While it can affect men and women of any age,race , and socioeconomic andcultural background,Anorexia nervosa occurs in females 10 times more than in males.

It is a life threatening eating disorder characterized by the clients's 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 even that one exsists. Clients with anorexia nervosa can be classified into two subgroups depending on how they control their weight.

Clients with the restricting subtype lose weight primarily through dieting, fasting, or excessively excercising. 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.

Purguring- means the compensatory behaviors designed to eliminate food by means of selfinduced vomiting or misuse of laxatives, enemas, and diuretics.

Clients with anorexia do not binge but still engage in purguring behaviors after ingesting small amounts of food. Clients with anorexia become totally absorbed in their quest for weight loss and thinnes. They may also engage in unusual or ritualistic food behaviors such as refusing to eat around others, cutting foods into minute pieces, or not allowing the food they eat to touch their lips. These behavior incresed their sense of control. Excessive excersice is common; it may occupy several hours a day.

AN, typically begins between 14 to 18 years of age. Clients often deny that they have anxiety regarding their appearance or a negative body image. They are very pleased with their ability to control their weight and may express this. They also unable to identify their emotions about life events such as school or relationships with family or friends. A profound sense of emptiness is common. As the illness progress, depression and lability in mood become more apparent.

Clients believe that their jealous of their weight loss and may think that family and health care professionals are trying to make them FAT and UGLY. Study of clients with AN, found that after 21 years, 50% had recoverd fully, 25% had intermediate outcomes, 10% still met all the clients of AN, and 15% had died of anorexiarelated causes. Clients who abuse laxatives are at a greater risk for medical complications.

Signs and symptoms A person with anorexia nervosa may exhibit a number of signs and symptoms, some of which are listed below. The type and severity vary in each case and may be present but not readily apparent. Anorexia nervosa and the associated malnutrition that results from self-imposed starvation , can cause severe complicationsin every major organ system in the body
.

obvious, rapid, dramatic weight loss

obsessionwithcaloriesand facontent
preoccupation with food , recipes , or cooking ; may cook elaborate dinners for others but not eat themselves dietingdespite being thin or dangerously underweight fearof gaining weight or becoming overweight rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food purging: uses laxatives , diet pills , ipecac syrup , or water pills ; may engage in self-induced vomiting ; may run to the bathroom after eating in order to vomit and quickly get rid of the calories .

may engage in frequent, strenuous perception : perceives self to be overweight despite being told by others they are too thin becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure; body temperature lowers (hypothermia ) in effort to conserve energy depression : may frequently be in a sad, lethargicstate solitude : may avoid friends and family; becomes withdrawn and secretive

clothing: some may wear baggy, loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it, while others will wear baggy clothing to hide what they see as an unattractive and overweight body. Cheeksmay become swollen due to enlargement of the salivary glandscaused by excessive vomiting swollen joints [citation needed ] abdominal distension[citation needed ] bad breath[citation needed ] Missing three of the menstruation cycle

Binge eating-is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is sometimes as a symptom of binge eating disorder . During such binges, a person rapidly consumes an excessive amount of food. Most people who have eating binges try to hide this behaviour from others, and often feel ashamed about being overweight or depressed about their overeating. Although people who do not have any eating disorder may occasionally experience episodes of overeating, frequent binge eating is often a symptom of an eating disorder . A 2009 study of female rats concluded that binge eating of sweet-fat food alters opioid receptors in the nucleus of the solitary tract .

Purging means the compensatory behaviors designed to eliminate food by means of self induced vomiting or misuse of laxatives.

BULIMIA NERVOSA- often simply called bulimia, is an eating disorder characterized by recurrent episodes og binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or excessively excercising. Binging or Purguring episodes are often precipitatedby strong emotions and followed by guilt,remorse, shame, or self-contempt.

BN usually begins in late adolescence or early adulthood: 18-19 years in the typical age of onset. Binge eating frequently begins during or after dieting, clienta may eat restrictively, choosing salads and other low-calorie foods. Clients w/ bulimia are aware that their eating behavior is pathologic and go to great lengths to hide it from others.

Related disorder Eating disorder usually first diagnosed in infancy and childhood include rumination disorder, pica, and feeding disorder. Binge eating disorder is listed as a research category in DM-IV-TR,2000; it is being investigated to determine its classification as a mental disorder. Night eating syndrome(NES)- is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and night time awakening to consume snacks.

Etiology A specific cause for eating disorder is unknown. Initially dieting may be the stimulus that leads to their development. Biologic vulnerabitlity, developmental problems, and family and social influences can turn dieting into an eating disorder. Psychological and psychologic reinforcement of maladaptive eating behavior sustains the cycle.

BIOLOGIC FACTORS
Studies of anorexia and bulimia have shown that these disorder tend to run in families. Found a genetic susceptibility for anorexia and bulimia on chromosone Two setsof nuclei are particularly important in many aspects of hunger and satiety(satisfaction of the appetite)

Developmantal factors BULIMIA NERVOSA Bulimia nervosa is a serious and sometimes lifethreatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives. The behavior often serves to reduce stress and relieve anxiety. Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression, it is also considered a psychiatric illness.

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa, an eating disorder that leads to excessive weight loss.

FAMILY INFLUENCES Girls growing up amid family problems and abuse are at higher risk for both anorexia and bulimia. Mazzeo and espelage found that response to family conflict and problems was strongly associated with disordered eating.childhood adversity has been identified as a significant risk factoor in the development of problems with eating or weight in adolescene or early adulthood.

Sociocultural factors the cultures equates beauty, desirability , and ultimately happiness with being very thin, perfectly toned, and physically fit. Adoloscene often idealize actressess and models as having the perfect LOOK or body even though many of these celebrities are underweight or use special effects to appear thinner than they are. Books, magazines,dietary supplements, exercise equipment, plastic surgery advertisements, weight loss program abound.

The culture considers being overweight a sign laziness, lack of self-control, or indifference; it equates pursuit of the perfect body with the beauty, desirability, success, and will power. Being good when they stick to their diet and bad when they eat desserts or snacks. Pressure from others also may contribute eating disorder.

CULTURAL CONSIDERATIONS Both anorexia nervosa and bulimia nervosa are far more prevalent in industrialized societies, where food is abundant and beauty is linked with thinness. Eating disordered are most common in the different countries, like USA, canada, europe, australia, japan, new zealand, and south africa. Immigrants from cultures in which eating disordered are rare may develop eating disorders as they assimilate the thin-body ideal.

Eating disorders appear equally common among hispanic and white women and less common among african american and asian women. Minority women who are younger, bettre educated, and more closely identified risk for developing an eating disorder. Have shown a straggering increase among all U.S social classes and ethic groups. With today's technology, the entire world is exposed to the western ideal, which equates thinness with beauty and desirability. As this ideal becomes widespread to non-Western cultures, anorexia and bulimia will likely increase there as well.

Treatment Treatment settings include inpatient especially eating disorder units. Partial hospitalization or day treatment programs, and outpatient therapy. The choice of setting depends on the severity of the illness, such as weight loss, physical symptoms, duration of binging and purging, drive for thinness, body dissatisfaction, and comorbid psychiatric conditons.

Medical management Focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances. Clients receive nutritionally balanced meals and snacks that gradually increase caloric intake to a normal level for size,age,and activity.

Bulimia nervosa
Most clients with bulimia are treated on an outpatient basis. Hospital admission is indicated if binging and purging behaviors are out of control and the client's medical status is compromised. Most clients with bulimia have near-normal weight, which reduces the concern about severe malnutrition-a factor in clients nervosa.

Application of the nursing process Although anorexia and bulimia have several differences, many similarities are found in assessing, planning, implementing, and evaluating nursing care for clients with these disorders. Thus this section adresses both eating disorders and highlights differnces where they exists.

Assessment

Several specialized tests have been developed for eating disorders. An assessment tool such as the eating attitudes test often is used in studies of anorexia and bulimia. This test also can be used at the end of treatment to evaluateoutcomes because it is sensitive to clinical changes.

History

Family members often desscribe clients with anorexia nervosa as perfectionist with aboveaverage intelligence, achievement-oriented, dependable, eager to please , and seeking approval before their condition began.

Mood and affect

Clients with eating disorders have labile moods that usually corresponds to their eating or dieting behaviors. Avoiding 'bad or fattening foods gives them a sense of power and control over their bodies, whereas eating, binging, purging leads to anxiety, depression, snd feeling out of control

Thought processes and content

Clients with eating disorder spend most of the time thinking about dieting food, and foodrelated behavior. Clients with anorexia who are severely underweight may have paranoid ideas about their family and health care professionals, believing that they are 'enemies who are trying to make them fat by forcing them to eat.

Sensorium and intellectual process

Generally clients with eating disorders are alert and oriented; their intellectual fuctions are intact. The exception is clients with anorexia who are severly malnourished and showing signs of starvation such as mild confusion, slowed mental processes, and difficulty with concentration and attention.

Judgement and insight

Client with anorexia have very limited insight and poor judgement about their health statu. They do not believe that they have problem; rather they think that others are trying to interfere with their ability to lose weight and to achieve the desired body image.

Self concept

Low self-esteem is prominent in clients with eating disorder. They see themselves only in terms of their ability to control their foood intake and weight.

They tend to judge themselve harshly and see themselves as bad if they eat certain foods or fail to lose weight.

Roles and characteristics

Eating disorders interfere with the ability to fulfill roles and to havesatisfying relationships. Clients with anorexia may begin to fail at school, which is in sharp contrast to previouslysuccessful academic performance.

Evalution

The nurse can use assessment tools such as the eating attitudes test to detect improvement for clients with eating disorders. Both anorexia and bulimia are chronic for many clients. Residual symptoms such as dieting, compulsive excercising, and discomfort eating in a social setting are common.

Treatment is considered successful if the client maintains a body weight within 5% to 10% of normal with no medical complications from starvation or purging.

Mental health promotion

Nurse can educate parents, children, and young people about strategies to prevent eating disorders. Important aspects include realizing that the ideal figures portrayed in advertisement and magazines are unrealistics, developing realistics ideas about body size, and shape, resisting peer pressure to diet, improving self esteem, and learning coping strategies for dealing with emotions and lifr issues.

T.H.A.N.K .Y.O.U =))))))) XOXO