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Mental health eating disorders

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Mental health eating disorders

  1. 1. Mental Health Nursing: EatingDisordersBy Mary B. Knutson, RN, MS, FCP
  2. 2. Maladaptive Eating Food may be used to satisfy unmet emotional needs, to moderate stress, and to provide rewards or punishments People can have unrealistic images of their ideal body size and desired body weight
  3. 3. Continuum of Eating RegulationResponses Adaptive responses: Balanced eating patterns, appropriate caloric intake, and healthy body weight  Occasional overeating or skipping meals  Overeating or fasting under stress  Maladaptive responses:  Frequent bingeing, fasting, night eating, or severe dieting  Anorexia, Bulimia, Binge eating disorder, or Night eating syndrome
  4. 4. Maladaptive Eating Illnesses  Inability to regulate eating habits and the frequent tendency to overuse or underuse food Sociocultural  Interferes with norms may biological, result in a distorted body psychological, and image sociocultural integrity
  5. 5. Scope of the Problem Eating disorders can cause biological changes that include altered metabolic rates, profound malnutrition, and possibly death Obsessions about eating can cause psychological problems like depression, isolation, and emotional lability
  6. 6. Eating Disorders Anorexia nervosa occurs in approximately 0.5% to 1% of females About 5% to 10% with anorexia are male Usual onset between 13 and 20, but can occur in any age Although hungry, a person with anorexia refuses to eat because of distorted self- perception of fatness Starvation ensues Can become a chronic illness Estimated mortality from anorexia nervosa is 5% of those with the disorder
  7. 7. Eating Disorders (continued) Bulimia nervosa is more common,  Estimated to occur in 1% to 4% of population, mostly in females  4% to 15% of female high school and college students Onset usually at 15 to 18 years old Uncontrolled binge eating alternating with vomiting or dieting Bulimia and anorexia both may be present in the same patient Bulimia usually occurs in people of normal weight, but may be in obese or thin people
  8. 8. What is Purging? Behaviors may include: Excessive exercise Forced vomiting Over-the-counter or prescription diuretics, diet pills, laxatives, or steroids Laxative abuse is common, but it is an inefficient way to lose calories
  9. 9. More Eating Disorders Binge Eating Disorder is consuming large amounts of calories in a contained amount of time Differs from bulimia because they do not attempt to prevent wt gain by purging behaviors  Prevalence is approximately 2% to 4% of population
  10. 10.  Night eating syndrome includes pattern of awakening during the night that is associated with food intake  It is not yet listed as a separate eating disorder in DSM-IV-TR  Prevalence is estimated to be 1.5% in general population and 27% among severely obese population seeking surgical tx
  11. 11. Medical Complications of EatingDisorders CNS- Fatigue, seizures, weakness Renal- Hematuria, proteinuria, and renal calculi Hematological- Anemia, leukopenia GI- Dental caries and erosion, esophagitis, gastric dilatation, pancreatitis, high cholesterol Metabolic- Acidosis, dehydration, starvation, potassium depletion or hypokalemia, osteoporosis, alkalosis Endocrine- Amenorrhea, irregular menses CV- Bradycardia, postural hypotension, dysrhythmia (sudden death)
  12. 12. Predisposing Factors Psychological- rigidity, perfectionism Environmental- illnesses, sexual abuse, drug abuse, media influences Familial- risk increases in female relatives Biological- probable relationship to serotonin and dopamine levels (regulated in hypothalamus) Precipitating stressors include peer pressure, daily solitude, interpersonal rejection or loss of a significant other
  13. 13. Psychiatric Complications Many people with eating disorders also have depression, anxiety, and substance abuse Bulimia may also be associated with posttraumatic stress disorder People with antisocial personality disorders are more likely to have bulimia
  14. 14. Alleviating Factors Important coping resource is motivation to change behavior Includes intrapersonal, interpersonal, cultural, and social factors
  15. 15. Medical Diagnosis Anorexia nervosa  Includes intense fear of gaining wt, and disturbed body image  >15% below minimum normal wt for age/ht  Can be restrictive type or binge-eating/purge type Binge eating disorder Bulimia nervosaDiagnoses as listed in Diagnostic and statistical manual ofmental disorders, ed 4, text revision, Washington DC,2000, American Psychiatric Association.
  16. 16. Examples: NursingDiagnosis Anxiety related to fear of weight gain, e/b rituals associated with food preparation and eating Disturbed body image related to fear of weight gain, e/b verbalization of being “fat” while being 30% below ideal weight Powerlessness r/t perceived lack of control over eating behaviors, e/b inability to stop binge eating and avoidance of food-related settings Imbalanced nutrition: more than body requirements e/b 40% over IBW, and sleep apnea
  17. 17. Nursing Diagnoses (continued) Imbalanced nutrition: less than body requirements e/b being 25% below body IBW, and weakness r/t malnutrition and anemia Chronic low self esteem r/t to feelings of low self-worth e/b verbalization of sole standard of success being r/t physical attractiveness Risk for self-mutilation r/t feelings of inadequacy e/b injuries caused by excessive exercise and self-induced vomiting
  18. 18. Nursing Care  Assess subjective and objective responses  Recognize defense mechanisms  Denial, avoidance, intellectualization, isolation of affect  Choose outpatient or inpatient tx setting  Utilize nurse-patient contracts
  19. 19. Implementation Stabilize nutritional status  Refeeding interventions such as NG tube feeding or total parenteral nutrition (TPN) are rarely used Monitor activity Promote family involvement Utilize group therapies Administer medication, if ordered  No drugs have been completely effective for anorexia, but antidepressants may be helpful
  20. 20. Interventions (continued) Utilize cognitive behavioral intervention to help pts become aware of their cognitive distortions Teach alternative eating regulation responses to assist in problem solving and making healthier decisions Include body image intervention Explain consequences of maladaptive eating responses Set realistic goals together
  21. 21. Evaluation Patient Outcome/Goal  Patient will restore healthy eating patterns and normalize physiological parameters related to body weight and nutrition Nursing Evaluation  Was nursing care adequate, effective, appropriate, efficient, and flexible?
  22. 22. References  Stuart, G. & Laraia, M. (2005). Principles & practice of psychiatric nursing (8th Ed.). St. Louis: Elsevier Mosby

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