MADE BY: ENRIQUEZ, REANNE S.

ATENEO DE ZAMBOANGA UNIVERSITY BSN3-L

PSYCHOOGY: EATING DISORDERS Ilah Enriquez

Eating Disorders Related Disorders

• More than 90% of cases of anorexia nervosa • Binge eating Disorder

and bulimia occur in women o Recurrent episodes of binge eating
• Anorexia—eating too little or starving o No purging or excessive exercise or
themselves abusive of laxatives
• Bulimia--eating chaotically o Guilt, shame, disgust eating behaviors
• Obesity—eating too much o Marked psychological distress
o Over age 35; more often in men
Anorexia Bulimia o Overweight or obese, overweight as
• Earlier age at onset • Later age at onset children, teased about their weight at an
• Below normal body • Near normal body early age
weight weight • Night eating syndrome
• Person fails to • Usually ashamed and o Morning anorexia
recognize eating embarrassed by o Evening hyperphagia—consuming 50%
behavior as a eating behavior
of daily calories after the last evening
problem
meal
o Nighttime awakenings—at least once a
Categories of eating disorders night to consume snacks
o Life stress, low self-esteem, anxiety,
1. Anorexia Nervosa depression, and adverse reactions to
• Life-threatening eating disorder weight loss
• Restriction of nutritional intake • Orthorexia nervosa
• Intense fear of gaining weight or becoming fat o Obsession with proper or healthful
• Significantly disturbed perception size of the eating
body o Not formally recognized in the DSM-IV
• Inability or refusal to acknowledge seriousness o Compulsive checking of ingredients
of problem o Cutting out increasing number of good
• Physical problems of Anorexia Nervosa groups
o Amenorrhea o Unusual interest in what others eat
o Constipation o Hours spent thinking about food, what
o Overly sensitive to cold, lanugo hair on will be served at an event
body o Obsessive involvement in food blogs
o Loss of body fat
o Muscle atrophy Etiology of Eating Disorders
o Hair loss; dry skin; dental caries
o Pedal edema; bradycardia; arrhythmias • Unknown
o Orthostasis; enlarged parotid glands • Biologic Factors:
and hypothermia o Tend to run in families; personality type
o Electrolyte imbalance or susceptibility to psychiatric disorders
• 2 Subgroups o Disruptions of the nuclei of the
o Restricting subtype: lose weight through hypothalamus
dieting, fasting, or excessive exercising o Low norepinephrine levels during
o Binge eating and purging subtype: periods of restricted food
engage in binge eating followed by intake=anorexia
purging o Low levels of serotonin & Monoamine
2. Bulimia Nervosa oxidase in clients with Bulimia and binge
and purge subtype of anorexia nervosa
• Purging, fasting, excessively exercising
• Developmental Factors:
• Binge episode—amount of food consumed
o Struggle to develop autonomy and
much larger; binge eating secretly
identity
• Between binges, may eat low-calories foods or
o Over protective family or enmeshment
fast
(lack of clear role boundaries)—no
• Binging or purging episodes precipitated by
support to members to gain
strong emotions and followed y guilt, remorse,
independence: teen may feel they have
shame, self-contempt
little or no control over their lives and
• Recurrent vomiting destroys tooth enamel
then they begin to control their eating
PSYCHOOGY: EATING DISORDERS Ilah Enriquez
through severe dieting and thus gain Treatment and Prognosis
control over their weight
o Body image=fat, unattractive, Medical Management focus on:
undesirable even when severely • Weight • nutritionally balanced meals and
underweight and malnourished restoration snacks—gradually increase
• Family Influences: • nutritional caloric intake to a normal level for
o Girls growing up amid family problems rehabilitation size, age, and activity
and abuse are at higher risk for both • rehydration • severely malnourished clients—
• correction of TPN, tube feedings,
anorexia and bulimia hyperalimentation
electrolyte
o Disordered eating—common response imbalances • access to a bathroom is
to family supervised to prevent purging
o Patient surrounded with shouting or • weight gain and adequate food
arguments in the dining table tend to intake—criteria for effective ness
of treatment
associate their trauma to their eating
disorder
• Sociocultural Factors: Psychopharmacology
o Media fuels the image of the “ideal
woman” as thin, beauty, and happiness • Amitriptyline (Elavil) and Cyproheptadine
with being thin, toned, and physically fit (Periactin)—promote weight gain
• Olanzapine (Zyprexa)—antipsychotic effect on
ANOREXIA NERVOSA
bizarre body image distortions and associated
Onset and Clinical Course weight gain
• Fluoxetine (Prozac)—preventing relapse in clients
• Begins between ages of 14-18 years whose weight has been partially or completely
• Early stages—deny having negative body restored (Monitor weight loss as side effect)
image or anxiety regarding appearance
• During initial treatment—unable to identify or Psychotherapy
explain emotions about life events such as • Family therapy may be beneficial for families of
school or relationships with family or friends. clients younger than 18 years.
o A profound sense of emptiness
• Families who demonstrate enmeshment can
• Anorexia begin to resolve this issue and improve
o 30%-50% achieve full recovery communication
o 10%-20% remain chronically ill o Prevent future exacerbation of anorexia
o In dysfunctional family, significant
Medical Complications of Eating Disorders
improvements in family functioning may
• Musculoskeletal—loss of muscle mass, loss of take 2 years or more
fat, osteoporosis, and pathologic fractures Bulimia Nervosa
• Metabolic—hypothyroidism, hypoglycemia, and
decreased insulin sensitivity • Usually begins in late adolescence or early
• Cardiac—bradycardia, hypotension, loss of adulthood: 18-19 years old
cardiac muscle, small heart, cardiac • Frequently begin during or after dieting
arrhythmias, and sudden death • Between binging and purging episodes, clients
• GI—Delayed gastric emptying, bloating, may eat restrictively, choosing salads and other
constipation, abdominal pain, gas, and diarrhea low-calories foods
• Reproductive—amenorrhea and low levels of
luteinizing and follicle-stimulating hormones Treatment and Prognosis
• Dermatologic—dry, cracking skin due to
• Cognitive-Behavioral Therapy—most effective
dehydration, lanugo, edema, and acrocyanosis
treatment
• Hematologic—leukopenia, anemia,
o Strategies design to change client’s
thrombocytopenia, hypercholesterolemia, and
thinking (cognitive) and actions
hypercarotenemia
(behavior) about food focus on
• Neuropsychiatric—abnormal taste sensation,
interrupting the cycle o dieting, binging,
apathetic depression, mild organic mental
and purging and altering dysfunctional
symptoms, and sleep disturbances
thoughts and beliefs about food, weight,
body image, and overall self-concept
PSYCHOOGY: EATING DISORDERS Ilah Enriquez
• Anorexia: paranoid ideas about their family and
• Psychopharmacology health care professionals, believing they are
o Desipramine; Imipramine; Amitriptyline; their “enemies” who are trying to make them fat
Nortriptyline; Phenelzine; Fluoxetine by forcing them to eat
o Antidepressants were more effective
than were the placebos in reducing Nursing Interventions
binge eating • Establish nutritional eating patterns
o Improved mood and reduced • Helping the client identify emotions and
preoccupation with shape and weight develop coping strategies not related to food
but the positive results were short term
• Helping the client deal with body image
o It may be that the primary contribution of
issues
medications is treating the comorbid
• Providing client and family education
disorders frequently seen with Bulimia
• Focus on healthy eating and pleasurable
History of Eating Disorders • Parents must become aware of their own
behavior and attitudes and the way they
• Anorexia Nervosa—perfectionist with above influence the children
average intelligence who are achievement-
oriented, dependable, eager to please, and
seeking approval before onset of condition
• Bulimia—focused on pleasing others and avoid
conflict; often have history of impulsive behavior
such as substance abuse and shoplifting as well
as anxiety, depression, and personality
disorders

General Appearance and Motor Behavior

• Anorexia—slow, lethargic, and fatigued; they

may be emaciated, depending on the amount of
weight loss
o Slow to respond to questions; reluctant
to answer questions
o Wears loose-fitting clothes in layers
o Eye contact may be limited; unwilling to
discuss or enter treatment
• Bulimia—may be underweight or overweight;
appear open and willing to talk

Mood and Affect

• Labile mood corresponds to eating or dieting

behaviors
• Avoiding “bad” or fattening foods gives them a
sense of power and control over their bodies,
while eating, or purging leads to anxiety,
depression, feeling out of control
• Anorexia: seldom smile, laugh, or enjoy any
attempts at humor; somber and serious most of
the time
• Bulimia: initially pleasant and cheerful as though
nothing is wrong; may express intense guilt,
shame, and embarrassment

Thought Processes and Content

• Body image disturbance can be almost

delusional