7. Epidemiology
• Anorexia nervosa is relatively common among
young women. While the overall incidence rate
remained stable over the past decades, there has
been an increase in the high risk-group of 15-19
year old girls. It is unclear whether this reflects
earlier detection of anorexia nervosa cases or an
earlier age at onset. The occurrence of bulimia
nervosa might have decreased since the early
nineties of the last century. All eating disorders
have an elevated mortality risk; anorexia nervosa
the most striking. Compared with the other eating
disorders, binge eating disorder is more common
among males and older individuals.
8.
9. Eating Disorders Biological
Risk Factors
a. Eating Specific Factors (direct risk factors):
_ Eating specific generic risk
_ Physiognomy and body weight
_ Appetite regulation
_ Energy metabolism
_ Gender
b. Generalized Factors (indirect risk factors):
_ Genetic risk for associated disturbances
_ Temperament
_ Impulsivity
_ Neurobiology
_ Gender
10. Eating Disorders Psychological
Risk Factors
a. Eating Specific Factors (direct risk factors):
_ Poor body image
_ Maladaptive eating attitudes
_ Maladaptive weight beliefs
_ Specific values or meanings assigned to food
and body
_ Overvaluation of appearance
b. Generalized Factors (indirect risk factors):
_ Poor self image
_ Inadequate coping mechanisms
_ Self regulation problems
_ Unresolved conflicts, deficits, posttraumatic
reactions
_ Identity problems
_ Autonomy problems
11. Eating Disorders Developmental
Risk Factors
a. Eating Specific Factors (direct risk factors):
_ Identifications with body concerned
relatives, or
peers
_ Aversive mealtime experience
_ Trauma affecting bodily experience
b. Generalized Factors (indirect risk factors):
_ Overprotection
_ Neglect
_ Felt rejection, criticism
_ Traumata
_ Object relationships (interpersonal
experience)
12. Eating Disorders Social
Risk Factors
a. Eating Specific Factors (direct risk factors):
_ Maladaptive family attitudes to eating and weight
_ Peer group weight concerns
_ Pressures to be thin
_ Body relevant insults and teasing
_ Specific pressures to control weight (through
ballet, athletic,
pursuits)
_ Maladaptive cultural values assigned to body
b. Generalized Factors (indirect risk factors):
_ Family dysfunction
_ Aversive peer experiences
_ Social values detrimental to stable, positive self
image
_ Values assigned to gender
_ Social isolation
_ Poor support network
_ Impediments to means of self definition
38. Social Life
• I don’t have many friends because of my
constant irritability. Also, because of my
appearance, I don’t feel comfortable with
social encounters. Because of my lack of
friends, I sometimes feel depressed.
39.
40.
41.
42.
43.
44.
45. * If the process is allowed to continue without
therapy it can lead to starvation and death
46.
47. How is Anorexia Treated?
• For severe weight loss, intravenous feeding
and tube feeding through the mouth may be
necessary.
• Scheduled eating, decreased physical activity,
and increased social activity are also ways to
regain weight.
48.
49.
50.
51. RationalNursing Intervention
Gastric dilation may occur if refeeding is
too rapid following a period of starvation
dieting. Note: Patient may feel bloated
for 3–6 wk while body adjusts to food
intake.
Provide smaller meals and supplemental
snacks, as appropriate.
Patient who gains confidence in self
and feels in control of environment is
more likely to eat preferred foods.
Make selective menu available, and allow
patient to control choices as much as
possible.
Patient will try to avoid taking in what is
viewed as excessive calories
Be alert to choices of low-calorie foods
and beverages
Moderate exercise helps in maintaining
muscle tone
Monitor exercise program and set limits
on physical activities
54. Binge eating Disorder
• Binge eating is
disorder in which
someone eats a
lot amount of
food at a time
but they don't
vomit.
55. The binge eating disorder as similar as
bulimia disorder .
But the different between there ( the binge
disorder involves obsession over food and
binging, but does not involve purging
afterward as bulimia disorder) but Both
conditions can be very destructive disorders
with serious medical consequences if left
untreated
56.
57.
58.
59.
60.
61.
62.
63.
64. **Prevention aims to promote a healthy development before
the occurrence of eating disorders.
It also intends early identification of an eating disorder before
it is too late to treat.
**Prevention ways :-
1- Discuss emotional eating is to ask children why they might
eat large meals besides being hungry.
2- Body Talk: emphasize the importance of listening to one's
body. That is, eating when you are hungry.
3-Fitness Comes in All Sizes: educate children about the
genetics of body size and the normal changes occurring in the
body.
Discuss their fears and hopes about growing bigger. Focus on
fitness and a balanced diet
67. Bulimia Nervosa
Bulimia Nervosa is an
eating disorder in which
one starts to consume
large amounts of food
at once and then is
followed by purging,
using laxatives, or over
exercising to rid
themselves of the food
they ate.
68. Bulimia Nervosa: Warning Signs
Wrappers/containers indicating consumption
of large amounts of food
Frequent trips to bathroom after meals
Signs of vomiting e.g. staining of teeth, calluses on hands
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives
69. Health Risks with Bulimia
• Dental problems
• Stomach rupture
• Menstruation
irregularities
70. Is an eating disorder refer to frequent
episodes of binge eating and purging ,
People with bulimia, known as bulimics who
consume large amounts of food (binge) and
then try to rid themselves of the food and
calories (purge)
Bulimia typically is seen . in
adolescence or early adult life and
predominantly in girls .
71. Methods of eliminating the food eaten in
order to avoid weight gain :-
A. Vomiting
B. Laxatives
C. Diuretics
D. Enemas
E. Excessive exercise/fasting
72. • Electrolyte imbalances can lead to
irregular heartbeat, heart failure and
death.
• Inflammation and possible rupture of
esophagus from frequent vomiting.
• Tooth decay and staining from
stomach acids released during
vomiting.
• Chronic irregular bowel movements
and constipation as result of laxative
abuse.
• Gastric rupture is possible.
74. **Eat three meals and two snacks a day and avoid
unhealthy diets. Provide education regarding
healthy nutrition and eating patterns.
**Reduce concern about your body weight and
shape.
**Understand and reduce triggers of binge eating
by examining your relationships and emotions and
establishing trust and effective communication
and help to resolve any interpersonal issue
75. Develop a plan to learn proper coping
skills to prevent future relapses
Medication such as antidepressants
treatment any complication of the bulimia
nervosa
Treat associated psychiatric conditions
and psychological difficulties, including
deficits in mood and impulse regulation,
and factors contributing to poor self-
esteem
81. Deficient Fluid Volume
**Nursing Diagnosis:
Fluid Volume actual or risk for deficient
May be related to
Inadequate intake of food and liquids
Consistent self-induced vomiting
Chronic/excessive laxative/diuretic use
Possibly evidenced by (actual)
Dry skin and mucous membranes, decreased skin turgor
Increased pulse rate, body temperature, decreased BP
Output greater than input (diuretic use); concentrated urine/decreased
urine output (dehydration)
Weakness
Change in mental state
Hemoconcentration, altered electrolyte balance
Desired Outcomes
Maintain/demonstrate improved fluid balance, as evidenced by adequate
urine output, stable vital signs, moist mucous membranes, good skin
turgor.
Verbalize understanding of causative factors and behaviors necessary
to correct fluid deficit.
82. Nursing Interventions Rationale
Monitor and record vital signs, capillary
refill, status of mucous membranes, skin
turgor.
Indicators of adequacy of circulating
volume. Orthostatic hypotension may occur
with risk of falls and injury following
sudden changes in position.
Note amount and types of fluid intake.
Measure urine output accurately.
Patient may abstain from all intake, with
resulting dehydration; or substitute fluids
for caloric intake, disturbing electrolyte
balance.
Discuss strategies to stop vomiting and
laxative and diuretic use.
Helping patient deal with the feelings that
lead to vomiting and laxative or diuretic use
will prevent continued fluid
loss. Note: Patient with bulimia has learned
that vomiting provides a release of anxiety.
Identify actions necessary to regain or
maintain optimal fluid balance (specific fluid
intake schedule).
Involving patient in plan to correct fluid
imbalances improves chances for success.
Review electrolyte and renal function test
results.
Fluid, electrolyte shifts, decreased renal
function can adversely affect patient’s
recovery or prognosis and may require
additional intervention.
Administer and monitor IV, TPN; electrolyte
supplements, as indicated.
Used as an emergency measure to correct
fluid and electrolyte imbalance and prevent
83. Disturbed Thought Process
Nursing Diagnosis
Thought Processes, disturbed
May be related to
Severe malnutrition/electrolyte imbalance
Psychological conflicts, e.g., sense of low self-worth, perceived lack of
control
Possibly evidenced by
Impaired ability to make decisions, problem-solve
Non–reality-based verbalizations
Ideas of reference
Altered sleep patterns, e.g., may go to bed late (stay up to binge/purge)
and get up early
Altered attention span/distractibility
Perceptual disturbances with failure to recognize hunger; fatigue,
anxiety, and depression
Desired Outcomes
Verbalize understanding of causative factors and awareness of
impairment.
Demonstrate behaviors to change/prevent malnutrition.
Display improved ability to make decisions, problem-solve
84. Nursing Interventions Rationale
Be mindful of patient’s distorted
thinking ability.
Allows caregiver to have more realistic
expectations of patient and provide
appropriate information and support.
Listen to or avoid challenging
irrational, illogical thinking. Present
reality concisely and briefly.
It is difficult to responds logically
when thinking ability is physiologically
impaired. Patient needs to hear
reality, but challenging patient leads to
distrust and frustration. Note: Even
though patient may gain weight, she or
he may continue to struggle with
attitudes or behaviors typical of eating
disorders, major depression, or alcohol
dependence for a number of years.
Adhere strictly to nutritional regimen. Improved nutrition is essential to
improved brain functioning.
Review electrolyte and renal function
tests.
Imbalances negatively affect cerebral
functioning and may require correction
before therapeutic interventions can
begin.
85. Disturbed Body Image
Nursing Diagnosis
Body image, disturbed/Self-Esteem, chronic low
May be related to
Morbid fear of obesity; perceived loss of control in some aspect of life
Personal vulnerability; unmet dependency needs
Dysfunctional family system
Continual negative evaluation of self
Possibly evidenced by
Distorted body image (views self as fat even in the presence of normal
body weight or severe emaciation)
Expresses little concern, uses denial as a defense mechanism, and feels
powerless to prevent/make changes
Expressions of shame/guilt
Overly conforming, dependent on others’ opinions
Desired Outcomes
Establish a more realistic body image.
Acknowledge self as an individual.
Accept responsibility for own actions.
86. Nursing Interventions Rationale
Allow the patient to draw picture of self. Provides opportunity to discuss patient’s
perception of self and body image and
realities of individual situation.
Encourage personal development program,
preferably in a group setting. Provide
information about proper application of
makeup and grooming.
Learning about methods to enhance
personal appearance may be helpful to
long-range sense of self-esteem and
image. Feedback from others can promote
feelings of self-worth.
Suggest disposing of “thin” clothes as
weight gain occurs. Recommend
consultation with an image consultant.
Provides incentive to at least maintain and
not lose weight. Removes visual reminder
of thinner self. Positive image enhances
sense of self-esteem.
Assist patient to confront changes
associated with puberty and sexual fears.
Provide sex education as necessary.
Major physical and psychological changes
in adolescence can contribute to
development of eating disorders. Feelings
of powerlessness and loss of control of
feelings (in particular sexual sensations)
lead to an unconscious desire to
desexualize self. Patient often believes
that these fears can be overcome by
taking control of bodily appearance,
development, and function.
Establish a therapeutic nurse-patient Within a helping relationship, patient can
87. Knowledge Deficit
Nursing Diagnosis
Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment,
self-care and discharge needs
May be related to
Lack of exposure to/unfamiliarity with information about condition
Learned maladaptive coping skills
Possibly evidenced by
Verbalization of misconception of relationship of current situation and behaviors
Preoccupation with extreme fear of obesity and distortion of own body image
Refusal to eat; binging and purging; abuse of laxatives and diuretics; excessive
exercising
Verbalization of need for new information
Expressions of desire to learn more adaptive ways of coping with stressors
Desired Outcomes
Verbalize awareness of and plan for lifestyle changes to maintain normal weight.
Identify relationship of signs/symptoms (weight loss, tooth decay) to behaviors
of not eating/binging-purging.
Assume responsibility for own learning.
Seek out sources/resources to assist with making identified changes.
88. Nursing Interventions Rationale
Determine level of knowledge and readiness to
learn.
Learning is easier when it begins where the
learner is.
Note blocks to learning (physical,
intellectual,emotional).
Malnutrition, family problems, drug abuse,
affective disorders, and obsessive-compulsive
symptoms can be blocks to learning requiring
resolution before effective learning can occur.
Provide written information for patient and SO(s). Helpful as reminder of and reinforcement for
learning.
Discuss consequences of behavior. Sudden death can occur because of electrolyte
imbalances; suppression of the immune system and
liver damage may result from protein deficiency;
or gastric rupture may follow binge-eating and
vomiting.
Review dietary needs, answering questions as
indicated. Encourage inclusion of high-fiber foods
and adequate fluid intake.
Patient and family may need assistance with
planning for new way of eating. Constipation may
occur when laxative use is curtailed.
Encourage the use of relaxation and other stress-
management techniques (visualization, guided
imagery, biofeedback).
New ways of coping with feelings of anxiety and
fear help patient manage these feelings in more
effective ways, assisting in giving up maladaptive
behaviors of not eating and binging-purging.
Assist with establishing a sensible exercise
program. Caution regarding overexercise.
Exercise can assist with developing a positive body
image and combats depression (release of
endorphins in the brain enhances sense of well-
being). However, patient may use excessive
exercise as a way to control weight.
92. • Now, we know the definition and types of eating
disorders and their effect on health.
• We noticed that most people feed their children
more than they can handle, thinking that they’re
keeping them healthy.
• The effect of parents level of knowledge about
eating disorders, is connected closely to their
children’s eating pattern.
• People with lower self esteem and depression
have more tendency to eating disturbances.
• We can stop the prognosis of eating disorders if
we detect the signs early.
93. Recommendations
• We should educate people more about eating
disorders.
• Instruct parents to observe their child eating habits
closely.
• Instruct adolescents about the influence of eating
disturbances on their health.
• Instruct parents not to feed their child whenever he
asks, only when he’s truly hungry.
• Instruct parents to encourage their child to eat
healthy, and limit sweets and fast food as possible.
94. • Thank you for listening;
• Prepared by:
• Maha al joureshe.
• Isra’a sayyaleh.
• Ruba Sbaih.
• Isra’a al deek.
