psych eating disorders

epidemiological factors

• lifetime prevalence for an episode of anoreia nervose is 0.6% to 0.8%

• men account for one in every 3 of those with an ED

• in undeveloped nations, EDs eist but are not related to body shape. they may be more for religious reasons (fasting) or other reasons not involving fear or gaining weight

epidemiological factors pt. 2

• bulimia nervosa is decr. in recent year, with a lifetime prevalance of 0.28 to 1% among women

• onset of bulimia nervose occurs in late adolescence or early adulthood. more common in females

• it occurs primarily in societies that emphasize thinnes

binge eating disorders

• consists of recurrent episodes of eating significantly more than most people owuld in a similar period of time under similar circumstances

obesity

• has been definsed as a BMI of 30 or greater

  • 41.9% of adults in the U.S. are in the obese range

waist circumference

• abdominal fat is greatly related to cardiometabolic risk

  • male - greater than 40, female-greater than 35

anoreia nervosa

• characterized by a morbid fear or obesity

• distortion in body image is manifested by the indiciduals perception of being fat when he or she is obviously underweight or even ecessively thin

• weight loss is etreme, usually more than 15% of epected weight

• age is usually late adolescene and psychoseual development is often delayed

• amenorrhea is typical and may precede significant weight loss

• may be an obsession with food aniety and depression are common

symptoms of anoreia nervosa

• symptoms include gross distortion of body image, preoccupation with food, and refusal to eat

• hypothermia, bradycardia, hypotension, edema, lanugo, a variet of metabolic changes

what is bulimia nervosa

• episodic, uncontrolled, compulsice rapid ingestion of large quantities of food over a short period (bingeing)

• food consumed during a binge often has a high caloric content

• episode is followed by inappropriate compensatory behaviors to rid the body of ecess calories (self-induced vomiting or the misuse of laatives, diuretics, or enemas)

• fasting or ecessive eercise

• persistent over-concern with personal appearance

• within normal weight range, some slightly under/over weight

• weight fluctuations are common because of alternating binges and fasts

• depression, aniety, and substance abuse are not common

what can bulimia nervosa lead to ?

• ecessive vomiting and laative or diuretic abuse my lead to problems with dehydration and electrolyte imbalances

• erosion of tooth enamel

• gastric or esophgeal tears

• russels sign-calluses on knuckles

what is binge eating disorders

• the DSM5 identified BED as an ED that can lead to obesity

  • binges on large amounts of food, as in bulimia nervosa

  • BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the ecess calories

biological influences of binge eating disorders : genetics

• hereditary predisposition to EDs has been hypothesized

  • Anoreia nervosa is more comon among sisters and mothers of those with the disorder than it is among the general population

  • 56% of the risk for developing anoreia nervosa (seen among twin studies)

biological influences of binge eating disorders : neurenedocrine abnormalities and neruchemical influences

• neuroendo: has been speculation about a primary hypothalamic dysfunction in anoreia nervosa

• neurochem: bulimia nervosa may be associated with the neurotransmitters serotonin and norepinephrine

  • anoreia nervosa may be associated with high levels of endogenous

  • binge ED may be an illness of addiction

family of binge eating disorders

• historically were considered as factors, but not sufficient evidence

• family members should be involved in treatment rather than blamed for issue

• family based approaches have been demonstrated as evidence based treatments

BMI

• A BMI range for normal weight is 20-24.9

• average american woman has a BMI of 26

• fashion models typically have a BMI of 18

• Obesity is defined as a BMI of 30 or greater

• anoreia BMI is 17 or lower, less than 15 in etreme cases

plan and implement: hospitilization

• malnutrition - 20% below epected weight for height are recommended for inpatient treatment, 30% below epected weight for height are recommended for long-term intensive treatment

• dehydration-orthostatic hypotension

• severe electrolyte imbalance-low potassium and phosphate and magnesium teach pt to recognize signs of

• cardiac arrhythmia or severe bradycardia related to electrolyte imbalance. Fatigue, muscle spasm, tingling or numbness, pins and needles

• hypothermia

• hypotension

• suicidal ideation

plan and implement: imbalanced nutrition/deficient fluid volume

• determine appropriate calories to provude adequate nutrition and weight gain

• do not focus on food and eating specifically

• keep a strict record of I&Os

• goals should include: help pt gain an established amt of weight per week, eliminating S/S of malnutrition/dehydration

• interventions: explaining program of behavior modification, assess vitals to eval. bradycardia, sit with client during mealtimes for support

common electrolyte abnormalities can occur when and why?

• due to disorder or during refeeding

  • hypokalemia more common develops by ecessive loss of potassium through emesis (vomit), stool, or urine without adequate replacement, but it can also happen during the refeeding process. hypokalemia is the most common, but may also get hyponatremia, hypernatremia, and low magnesium

signs of hypokalemia

• constipation

• N/V

• fatigue

• heart palpitations.arrhythmias

• muscle weakness, twitches, or cramps

• tingling or numbness

• rhabdo (muscle breakdown)

• polyuria

• poly dipsia

plan and implement: denial

• establish trusting relationship

• avoid arguing or bragaining with the client

plan and implement: obesity

• encourage diary of food intake

• provide instructions about meds

• goals: understanding correlations btwn. emotionoal issues and eating behaviors, coping with emotional issues in a more adaptive manner

• interventions should include acknowledging the clients anger at feelings of loss of control and encouraging the client to verbalize feelings

plan and implement: disturbed body image/low self esteem

• for client with anoreia nervosa or bulimia

  • promote feelings of control

  • help client realize perfection is unrealistic

• for client with BED

  • help identify positive attributes

  • refer client to a support or therapy group

Client/Family Education: Nature of the illness

• symptoms of anoreia/bulimia nervosa

• what constitutes obesity

• causes of ED

• effects of the illness or condition on the body

Client/Family Education: management of the illness

• principles of nutrition

• ways client may feel in control of life

• importance of epressing fears and feelings, rather than holding them inside

• alternative coping strategies

• correct administration of prescribed meds

• indication for, and side f of, prescribed meds

• relaation techniques

• problem solving skills

Client/Family Education: for obese client

• how to

  • plan a reduced calories, nutritious diet

  • read food content labels

  • establish a realisitic weight loss plan

  • establish a planned program of physical activiry

  • support servives

  • weight watchers international

  • overeaters anonymous

  • national association of anorecia nervosa and associated disorders

  • national ED assocation

evaluation of client

• requires reassessment of the behaviors for which the client sought treatment

• behavioral change will be required by the client and family members

evaluation of anorecia or bulimia nervosa

• is client willing to discuss real issues concerning family roles, seuality, dependence/independence, need for achievement

evaluation for client with binge eating

• does client verbalize a relapse prevention plan to avoid triggers and abstain from binging? does client verbalize positive self-attributes not associated with body size or appearance?

• for client with anoreia, bulimia, or binge eating disorder and associated obesity

  • has client developed adaptive coping strategies to deal with stress without resorting to maladaptive eating behaviors

treatment modalities: behavior modification

• issues of control are central to the etiologu of these disorders

• for the prohram to be successful, client must perciebe that he or she has a say in the treatment

treatment modalities: behavioral modification - successes

• successes have been observed when the client:

  • is allowed to contract for privileges based on weight gain

  • has input into the care plan

  • clearly sees what the treatment choices are

  • client has control over eating

  • client has control over eercise

  • client has control over purgin g

• staff and client agee about goals, system of rewards

treatment modalities: therapy

• individual

  • helped when underluingn psychological problems are contributing to maladpative behaviors

• family therapy

  • involved education the family about disorder

  • assess familys impact on maintaining the disorder

  • assits in methods to promote adaptive functioning by the client

maudsley approach

• few EB treatment approaches for treatment of teens with anoreia nervosa. Approach actively involved fmaily in each step. 90%showed improvement compared to 36% of those in individual therapies

• 3 phases -

  • first phase: parents have control and refeed teen with anoreia

  • second: parents help teen to take more control over their eating

  • third: initiated when adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated. healthy teenage autonomy is the focus

treatment modalities: psychopharmaoclogy

• no meds are specifically indicated for EDs

• various meds have been prescribed for associated symptoms:

  • aniety

  • depression

  • meds that have been tried with some success for anoreia includes prozac after weight has stabilized

med for bulimia nervosa

• fluoetine (prozac) - SSRI

• imipramine (tofranil) - tricyclic first-gen anti-depressant

• desipramine (norpramine) imipramine (tofranil) - tricyclic

• amitriptyline (elavil) - tricyclic

• nortiptyline (aventyl) - tricyclic

• phenelzinne (nardil) - MAOI

med for binge eating disorders

• lisdeamfetamine (vyvanse) - ADHD stimulant

• prozac

• looking at the GP-1

• bariactic surgery is still the gold standard

• topriamate (topama) - anticonvulsant

med for obesity

• phentermine and topiramate (qysmia)

• naltreone and bupropion (contrave)