1 EATING DISORDERS (ESCALANTE-SAAC)

EATING D/OS
1. Anorexia nervosa

Most simple term, self starvation

Anorexia nervosa

Feels theres disturbance in the way they feel about food, wt and body image

Anorexia nervosa

Stubborn

3.7%

Incidence: _ in women; less common than bulimia

W
hite upper and middle class

Most common in_

Dancers, gymnasts, models, skaters

Common in

Anorexia nervosa

Food and eating dominate life

Bpdy wt and shape

Becomes the measure of self worth

CAUSES:
1. Cultural pressure

Being extremely thin is the standard of beauty for women and represents success, happiness, and self
control

Cultural pressure

Women are bombarded w/ msgs

Cultural pressure

Wt and shape are very important

Computer graphics

Makes thin models thinner

2. Psychological issues

Includes:
Low self esteem
Feelings of ineffectiveness
Poor body image
Depression
Difficulty expressing feelings
Rigid thinking patterns
Need for control
Perfectionism
Physical/sexual abuse

3. Family environment

Families maybe:
*Overprotective
*rigid
*suffocating in their closeness
-develops struggle for independence and individuality
*overwhelming appearance and thinness
*critisizing childs wt and shape

4. Genetics

Occurs 8 times more often in people who have relatives of genetic d/o

5. Life transitions

Often trigger anorexia in someone whos vulnerable

Examples

Adolescence
break up
failing in school/work
death of loved one

6. Perpetuating factors

Factors:
sx of starvation
others people reaxn to w t loss
feelings of self control
emotional needs filed by _

DSM-IV CRITERIA
*Refusal to maintain normal wt,
*Intense fear of aging even if underwt
*Body image disturbances
*In female adults, absence of at least 3 consecutive menstrual cycles
Restring and binge/purging
Fear of losing control
Low sex drive
Feeling of helplesness
OCD
Major depression
Substance abuse
Personality d/os

TYPES:
MENTAL HEALTH PROBS ASSOC W/ ANOREXIA

FOOD- RELATED BEHAVIORS IN ANOREXIA

Restricting intake, fasting
Hoarding food
Highly avoidant of certain foods
Preoccupations w/ calories, meals and recipes
Preparing/serving elaborate meals for others
Rituals before and during eating
METABOLIC CONSEQUENCES
Lanugo
loss of bone mass
body temp drops

2 EATING DISORDERS (ESCALANTE-SAAC)

skin dry and scaly
constipation
hair is brittle and fall out
slow thyroid function
Dec BP
Hand and ft cold
Breathing and HR slows
Ammenorhea, dec dvpt of sec sex char,
MORE CONSEQUENCES
osteopenia/osteoporosis, weakness and fatigue
Heart failure,
Cardiac ventricular dilation
Dec oxygenation
*Refeeding syndrome

COMPLICATIONS

Complications of treatment
Severe fluid shift from too rapid re-introduction of food
-Extracellular-intracellular

*Cardiovascular, neuro and hematologic

2. Bulimia nervosa

Episodes of binge-eating followed inappropriate method of wt control

Bulimia nervosa

Vomiting, fasting, enemas, excessive laxatives, diuretics is used

Binge

Episode where individual eats much larger amnt of food than most people would do in similar
situation

Binge

Response to repression, stress, self-esteem issues

Individual experience loss of control

BINGE EATING

*Lack of control
*Often done in secret
*Hi cal-hi carb
*Consumed less than 2 hrs feeding
*Addicted to high experienced when eating

PURGING

Compensatory behavior for BINGE EATING

PURGING

Manual stimulation, axatives, emetics

Self induced vomiting, occurs w/ minimal stimulation
Post purging: sense of relief, calm

Bulimia

Begins in adolescent, in women, sx overlap anorexia

Biology
culture
personal feelings
stressful events
families

BULIMIA CAUSES

SX
Underwt, overwt, normal wt
makes it harder to know if someone has the d/o
Signs:
*Extreme measures to lose wt
*Uses diet pills
*Goes to bathrm all the time after she eats(throws up)
*exercise a lot
*Signs of throwing up
*swelling of cheeks or jaw area
*cuts and callusses @ back of hands and knuckles
Russels sign

CUTS AND KNUCKLES

Sx:
Erosion of dental enamel
sore throat
weakness, exhauting blood shot eyes
Hide eating d/o
CHARACTERISTICS
Lack of wt loss
Coexisting mental d/o: depression, personality d/os
Mood d/o
Substance abuse
Conflict
Disorganized

FAMILY CHARACTERISTICS

MGT: ANOREXIA

Inc wt to 90% of average BW

Inc self esteem
Dec need for perfection

MGT: BULIMIA

Stabilize wt without purging

BOTH MGT

*In pt treatment for medical stabilization and dietary mgt

*Long term outpt tx. Adressess psychosocial issues

MGT: STARVATION PHASE

Assess labs
I&O
Assess cardio, neuro compication

3 EATING DISORDERS (ESCALANTE-SAAC)

Refeed slowly
IV lines and feeedings
IN ANOREXIA

Pt is forced to eat
Treatment means los of control
Nurse is enemy

IN BULIMIA

More likely want help

Wants to enter treatment of their on volition
Hide degree of prob
Tendency to manipulate

SSRI
Anxiolytics
Psychoterapy:
*Antidepressants

For bulimia
When refeeding

MILLIEU MGT
*Orientation
*Warm nurturing environment
*Nonjudgmental orientation
*CONSISTENCY
*Encourage pt to talk to staff when wanting to purge

PSYCHOPHARMACOLOGY