Mental Health Mental Health Nursing IINursing II

NURS 2310NURS 2310

Unit 9Unit 9

Eating DisordersEating Disorders

Anorexia Nervosa

DefinitionProlonged loss of appetite; self-starvation

with a disruption in metabolism due to inadequate calorie intake.

Incidence & Population Affected Increased in the past 30 years Affects approximately 1% of young

women– Occurs predominantly in females aged

twelve to thirty– Less than 10 percent of cases are males

Etiology & Characteristics Morbid fear of obesity Gross distortion of body image; sees self as

“fat” when obviously underweight Preoccupation/obsession with food

– hoarding or concealing food– preparing elaborate meals for others while

severely restricting self Refusal to eat; marked weight loss May include extensive exercising Physiological symptoms include amenorrhea,

hypothermia, bradycardia, hypotension, edema, lanugo, and metabolic changes

Diagnostic Criteria Refusal to maintain body weight at or

above a minimally normal weight for age and height

Intense fear of gaining weight or becoming fat, even though underweight

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

Amenorrhea

Bulimia Nervosa

DefinitionExcessive, insatiable appetite;

episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time,

followed by inappropriate compensatory behaviors to rid the

body of the excess calories.

Incidence & Population Affected

More prevalent than anorexia nervosa Affects approximately 4% of young

women– Onset occurs in late adolescence or early

adulthood– Occurs mainly in populations with an

abundant availability of food, and in which the ideal of beauty is thinness

Etiology & Characteristics Persistent overconcern with personal

appearance Weight fluctuations common due to

alternating binges and fasts Excessive vomiting and laxative/diuretic

abuse may lead to problems with dehydration and electrolyte imbalances

Gastric acid in vomitus contributes to the erosion of tooth enamel

Individual may experience tears in the gastric or esophageal mucosa

Diagnostic Criteria Recurrent episodes of binge eating Recurrent inappropriate compensatory

behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise

The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months

Self-evaluation is unduly influenced by body shape and weight

Obesity

DefinitionChronic disease defined by having a Body

Mass Index (BMI) of more than 30.

Incidence & Population Affected 61% of the U.S. population age 20 or

older are overweight; 27% are obese; 4.7% are morbidly obese

Affects black women more than white women, and white men more than black men

6 times more prevalent among lower socioeconomic classes

Etiology & Characteristics May have a genetic component Lifestyle factors; lack of physical

activity Leads to problems with hyperlipidemia,

hyperglycemia, diabetes mellitus, osteoarthritis due to trauma to weight-bearing joints, angina and respiratory insufficiency due to increased workload of the heart and lungs

Food is considered a social outlet Depression/low self-esteem May involve binge-eating disorder

Diagnostic Criteria(Binge-Eating Disorder)

Recurrent episodes of binge eating in which one does not feel in control of what/how much is being consumed

Binge-eating episodes are associated with– eating much more rapidly than normal– eating until feeling uncomfortably full– eating alone because of being

embarrassed by how much one is eating– feeling depressed or guilty after overeating

Marked distress regarding binge eating The binge eating occurs, on average, at least

2 days a week for 6 months

Nutritional Deficits

Electrolyte imbalances

Nutrient deficits

Malnutrition

Poor glucose control

Deficiency in vital fats

Vitamin deficiencies

Treatment Modalities

Education– Learning healthy eating patterns

Weight management– Nutrition education– Exercise program– Surgery

Individual therapy– Cognitive-behavioral therapy (CBT)– Coping with thoughts and feelings

Family therapy Psychopharmacology

– Antidepressants– Anxiolytics

Milieu Therapy*Focuses on behavior modification Changing maladaptive eating behaviors Empowering client to take control of treatment Contract for privileges based on weight gain or

weight maintenance Goals of therapy agreed upon by client and staff System of rewards and privileges can be earned

by client, who is given ultimate control– Client chooses whether or not to abide by the

contract– Client is made accountable for choices and

behaviors