Psych Exam 3 Eating D/O

  1. Discuss Steps from Normal Eating to Needing Treatment
    • Normal eating
    • Dev of RF
    • Partial-Syndrome Eating D/o
    • Full-Syndrome Eating D/o
    • Tx
  2. Define Anorexia Nervosa
    A life–threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming fat, a severely distorted body image, and the refusal to acknowledge the seriousness of weight loss.
  3. Define Restricting Type of Anorexia Nervosa
    describes those individuals that do not regularly engage in binge eating or purging(calorie counters and excessive exercise)
  4. Define Binge Eating and Purging Type of Anorexia Nervosa
    refers to those who regularly engage in binge eating or purging behavior(self-induces vomiting or misuse of laxatives, diuretics, or enemas)
  5. Discuss Clinical Course of Anorexia Nervosa
    • onset in early adolescence
    • chronic condition with relapses characterized by significant weight loss
    • it can be cured!
    • often continue to be preoccupied with food
    • 10% to 25% go on to develop bulimia nervosa
    • poor outcome related to initial lower minimum weight, presence of purging, and later age of onset
  6. Discuss Diagnostic Criteria: Anorexia Nervosa
    • *weight loss of 25 pounds and the absence of menses for at least 3 consecutive months or periods*
    • refusal to maintain body weight at or above a minimally normal weight for age & height
    • intense fear of gaining weight or becoming fat, even though underweight
    • disturbance in body image
    • perfectionism
    • restricting and/or purging
  7. Discuss Body Image Distortion r/t Anorexia Nervosa
    occurs when the individual perceives his or her body disparately from how the world or society views it
  8. Discuss Drive for Thinness r/t Anorexia
    an intense physical and emotional process that overrides all physiologic body clues, such as hunger and weakness
  9. Discuss Interoceptive Awareness r/t Anorexia
    describes the sensory response to emotional and visceral cues, such as hunger
  10. Discuss Etiology of Anorexia: Biologic Theories
    Changes in the brain may create a vulnerability to the development of eating d/o. However, research in this area is in its infancy
  11. Discuss Etiology of Anorexia: Psychological Theories
    • This theory postulates that separation-individuation and autonomy are interrupted
    • Sexuality fears are underlying
  12. Discuss Etiology of Anorexia: Social Theories
    • More than with any other psychiatric condition, society plays a significant role in the development of eating disorders!
    • Theories about social norms and expectations explain some of the causes of eating disorders
    • media
    • family responses
  13. List Risk Factors for Anorexia
    • dieting
    • over exercising
    • low self-esteem
    • body dissatisfaction
    • lack of assertiveness
    • other eating disorders
    • sexual abuse
    • comorbid conditions
    • distorted body image
    • media
    • fashion industry
    • being an athlete
  14. Discuss Interdisciplinary Tx
    • Nutritional rehab
    • Body image
    • Inc coping
    • SSRIs not effective in acute, but after wt gain
  15. List Criteria for Hospitalization in Anorexia
    • weight loss, <75% below ideal
    • heart rate, <40 beats/min; children <20 beats/min
    • temperature, <36 C (96.8 F)
    • blood pressure, <90/60,; children <80/50
    • glucose, <60
    • serum potassium <3
    • severe dehydration
    • electrolyte imbalance
    • risk for suicide
    • severe depression
    • failure to comply with treatment
    • inadequate response to treatment
  16. List Priority Care Issues of Anorexia
    • mortality is high, 7%-10%
    • long duration of illness
    • bingeing and purging
    • comorbid illnesses
    • substance abuse
  17. List Nsg Management of Anorexia
    • therapeutic relationship; this may be hard due to mistrust, paranoia, impatience and irritability, believe people want to “make them fat”
    • use firm, accepting, and patient approach
    • provide a rationale for all interventions provides trust
    • avoid power struggles over eating
  18. Discuss Nsg Interventions: Biological Domain (Anorexia)
    • refeeding; most important and most challenging! Protocol typically starts with 1,500 calories/day and increased slowly until the patient is consuming 3,500/day Weight gain of 1-2 pounds/week
    • strict monitoring and recording of intake
    • weight-increasing protocols (usually a behavioral plan with positive and negative reinforcements)
    • structured, healthy sleep routine
    • exercise is generally not permitted during refeeding
    • any exercise needs to be monitored
  19. Discuss Nsg Interventions: Psychological Domain (Anorexia)
    • Inability to experience visceral cues and emotions
    • Understanding feelings
    • Interpersonal therapy (ITP)
    • Pt Education
  20. List Evaluation and Tx Outcomes (Anorexia)
    • particularly long duration of symptoms and low weight when treatment begins predict poor outcomes
    • later onset
    • family support and involvement generally improves outcome
    • comorbid conditions and their severity will influence outcome
    • intense outpatient therapy will improve outcome
  21. List Prevention Strategies for Parents (anorexia)
    • real vs. ideal weight
    • influence of attitudes, behaviors, teasing
    • ways to increase self-esteem
    • role of media
    • signs & symptoms
    • intervention for obesity
    • boys at risk also
    • observe for rituals
    • supervision of eating & exercising
  22. List Prevention Strategies for Children (anorexia)
    • peer pressure regarding eating, weight
    • menses, puberty, normal weight gain
    • strategies for obesity
    • ways to develop or improve self-esteem
    • body image traps: media, retail clothing
    • adapting and coping with problems
    • reporting friends with signs of eating disorders
  23. Define Bulimia Nervosa
    an eating disorder in which the individual engages in recurrent episodes of binge eating and compensatory behavior to avoid weight gain through purging methods such as self-induced vomiting, use of laxatives, diuretics, enema, emetics, or through nonpurging methods such as fasting or excessive exercise.
  24. Discuss Bulimia versus Anorexia
    • more prevalent
    • older at onset (mean onset 18)
    • typically of normal weight
    • generally not life-threatening
    • treatment is usually outpatient
    • outcomes better
    • mortality rates lower
    • medications are effective
  25. Discuss Diagnostic Criteria for Restricting type Bulimia
    • Similar to anorexia nervosa
    • Restricting is followed by binge eating, which is then followed by another period of restricting
  26. Discuss Diagnostic Criteria for Purging type Bulimia
    Recurrent episodes of binge eating and compensatory purging in the form of vomiting or using laxatives, diuretics, or emetics, fasting or over exercising in order to avoid weight gain. In anorexia the goal is severe weight loss
  27. State Major Diagnostic Criteria for Bulimia
    These episodes must occur at least twice a week for a period of at least 3 months; binge and purge may occur several times a day
  28. Define Binge eating
    • rapid, episodic, impulsive, and uncontrollable ingestion of large amounts of food over a short period of time (1 to 2 hours)
    • eating followed by guilt, remorse, self-contempt, and severe dieting, leading to purging
  29. Discuss Dietary Restraint (bulimia)
    • restricting intake is believed to explain the relationship between dieting and binge behavior
    • restrictions are viewed as rules, each binge imposes stricter rules leading to more frequent binges
    • treatment is focused on addressing these dietary restraint; when the dietary restraints are resolved binge eating & purging decrease
    • restraining intake is predictive of overeating
  30. List Sx of Bulimia Nervosa
    • usually within normal weight range, possible overweight or underweight
    • restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived to be fattening or likely to trigger a binge
    • increased frequency of depressive symptoms and anxiety symptoms
    • possible substance abuse or dependence involving alcohol or stimulants
  31. Discuss Etiology of Bulimia
    • -Biologic theories
    • Neuropathologic; changes in the brain my be due to eating dysregulation
    • Genetic and familial predispositions; ? Gene connection
    • Biochemical: ? Lower brain serotonin
    • -Psychological and social theories
    • Cognitive theory: distorted thinking
    • Family: chaotic with few rules and unclear boundaries
  32. List Tx Goals for Bulimia
    • stabilizing and normalizing eating, stop the binge-purge cycle
    • restructuring dysfunctional thoughts and attitudes about eating, weight, & shape
    • teaching healthy boundary setting
    • resolving conflicts about separation-individuation
    • treatment is usually on an outpatient bases unless the individual is suicidal or past outpatient treatments have failed
  33. Discuss Tx for Bulimia
    • Cognitive behavioral therapy, CBT (focus on changing problematic behavior & dysfunctional thinking)
    • IPT
    • SSRIs
    • Behavioral techniques such as using a diary to record binges and purges and precipitating emotions and environmental cues
    • Nutrition counseling
    • Group psychotherapy & support groups
  34. List Priority Care Issues for Bulimia
    • co-morbid depression and suicide
    • risk for self-mutilation
    • impulsive behavior ; shoplifting, overspending, financial and legal problems , etc
  35. List Nsg Interventions for Bulimia
    • CBT/ IPT
    • Behavioral Techniques
    • Psychoeducation
    • Group Therapy
  36. Discuss/ Define Binge Eating Disorder (BED)
    • consists of binge eating which includes both ingestion of large amounts of food in a short time and a sense of loss of control; distress over binge; eating until uncomfortably full; feelings of guilt or depression following binge; and purging does not occur(this differentiates it from BN)
    • Individuals have lower dietary restraint and are higher in weight
    • 10-30% of obese individuals have BED
Card Set
Psych Exam 3 Eating D/O
Eating Disorders