Chp.32 eating disorders

What are some comorbitites with eating disorders?

• Depression

  • Suicide

• Anxiety

• Substance use disorder (esp. tobacco, caffeine, and alcohol)

• Personality disorders (esp. Borderline, obsessive-compulsive, and avoidant)

What are some warning signs of eating disorders?

• Increasing or decreasing body weight (not caused by other health conditions)

• Intense preoccupation with weight, body image, and/or food. 

• Abnormal eating habits

• Ritualized mealtime behaviors

• Fear of dietary fat (or specific food groups)

• Secretive bingeing or lying about food

• Mood swings 

• Depressed moods

• Irritability 

• Compulsive or excessive exercising

What are some complications with eating disorders?

• Dry skin

• Cardiovascular and pulmonary issues

• Heart failure

• Diabetes mellitus 

• GI and digestive issues

• Kidney failure

• Seizures

• Cardiac arrest

• Osteopenia or osteoporosis 

• Neuroendocrine problems

What are the diagnostic criteria for anorexia nervosa?

• Restriction of food intake

  • Significantly low body weight

• Perfectionism

• Intense fear of gaining weight or becoming overweight

• Disturbance in body shape and weight

  • Distorted body image

What are the 2 subtypes of anorexia nervosa?

• Restricting type: restricting in their diet and also adding exercise. no binging 

• Binge purge type: binge eating and then miss using laxatives.

What are some things experience by patient with Anorexia Nervosa?

• Body image distortion

• Drive for thinness

• Emotional dysregulation: unable to express emotions  

• Perfectionism

• Guilt and anger

What are some Gastrointestinal focused assessment to make in Anorexia Nervosa?

• Gastrointestinal

  • Salivary gland and pancreas, inflammation

  • Esophageal erosion

  • Dysfunctional bowel

What cardiovascular and neuro assessment should be made in anorexia nervosa?

• Cardiovascular 

  • Bradycardia; hypotension; orthostatic hypotension; cardiac arrhythmias 

  • highest mortality rate

• Neuro

  • Rigid thinking, confusion, and even seizures

What are some other physicla assesment to make with anorexia?

• Lanugo

• Bone Density

• Endocrine: amenorrhea 

• Dental

  • Decayed or missing teeth

What are the main treatment for anorexia?

• Refeeding protocol- strict monitoring of intake, 

• Nutritional rehabilitation

• pharamcologic managemnt: fluoxetine and olanzepine

What is refeeding syndrome? S&S, monitoring?

• Dangerous shift of fluids and electrolytes that occurs when calories are reintroduced too quickly

  • Can result in heart failure and even death

• S&S: edema, mental status changes, difficulty breathing, hypertension, fatigue, coma and even death 

• Monitor: Dietary, weight and lab patterns 

What is Bulimia Nervosa?

• recurrent episodes of binge eating and compensatory behaviors.

  • Purging: vomiting or use of laxatives, diuretics, or emetics

  • Nonpurging: fasting or overexercising

• episodes occurring at least once a week for at least 3 months

• no severe weight loss or amenorrhea. weight is maintained.

What are some characteristics of Bulimia nervosa?

• Overwhelmed and overly committed individuals

• Shame, guilt, disgust about binging and eating

  • Binging and purging often done in secret

• Distorted body image and fear of gaining weight

• extrovernted and poor boundaries  

what are some comorbit conditions with bulimia nervosa?

• Anxiety disorder, mood disorders, self-harm, and substance use.

What assessments should be made with bulimia?

• GI

• Laboratory tests:

  • Amylase

  • Electrolytes

  • Kidney Function

• Russell’s sign: callus or leisures on the back on the hand due to vomiting.

• Parotid gland enlargement

• Erosion of tooth enamel 

What treatment is used for bulimia? meds and therapies?

• Stabilization and then normalization of eating

• Restructuring of dysfunctional thoughts or attitudes

• Cognitive-behavioral therapy (CBT)

• Antidepressants: SSRIs

• Nutrition counseling

• Group psychotherapy and support groups

What is Binge eating disorder?

• over eating 

• Distress regarding the binge

• Eating until uncomfortably full

• Feelings of guilt or depression after the binge

What treatment is used for binge eating disorder?

• Psychotherapy

• Pharmacotherapy

• Weight loss treatment