Eating disorders ( Anorexia nervosa and Bulimia nervosa)

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape.

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated.

1. Presented by
Mr.KalyankumarMsc(N)

2. Introduction
Eatingispartofeverydaylife.Itisnecessaryfor
survivalandpartofmanyhappyoccasions.People
gooutfordinner,invitefriendsandfamilyformealsin
theirhomes,andcelebratespecialeventssuchas
marriages,holidaysandbirthdayswithfood.

3. Overview of eating disorders
Morethan90%ofcasesofanorexianervosaand
bulimianervosaoccurinfemales.30%to35%of
normal-weightpeoplewithbulimiahaveahistoryof
anorexianervosaandlowbodyweightandabout
50%ofpeoplewithanorexianervosaexhibit
bulimicBehaviour.

4. Anorexia nervosa
Itisalife-threateningeatingdisordercharacterized
bytheclient’srefusalorinabilitytomaintaina
minimallynormalbodyweight,intensefearof
gainingweightorbecomingfat,significantly
disturbedperceptionoftheshapeorsizeofthebody.

5. Etiology
Aspecificcauseforeatingdisordersisunknown.
Initiallydietingmaybethestimulusthatleadstotheir
development.Biologicvulnerability,developmental
Problemsandfamilyandsocialinfluencescanturn
dietingintoaneatingdisorder.
Disturbanceinhypothalamus
Manyneurochemicalchangesaccompanyeating
disorders,butitisdifficulttotellwhethertheycauseor
resultfromeatingdisorders.

6. Clinical features
Body image disturbance
Compensatory behaviour such as self-induced vomiting,
misuse of laxatives
Sensitivity to cold
Delayed gastric emptying
Constipation
Low blood pressure

7. Bradycardia
Hypothermia
Amenorrhea
Electrolyte disturbances (Hypokalemia)

8. Diagnostic findings
History collection
Physical examination
Complete blood count
Liver profile
Electrolytes
Blood glucose levels
ECG

9. Complications
Increasedsusceptibilitytoinfection
Hypoalbuminemia
Chronicinflammatoryboweldisease
Esophagealerosion,ulcers,bleeding,dentalcaries
(duetofrequentvomiting)
Cardiovascularissues
Amenorrhea

10. Medical management
Medical management focuses on weight restoration,
nutritional rehabilitation and correction of
electrolyte imbalances.
Pharmacotherapy
❖Neuroleptics
❖Appetite stimulants
❖Anti depressants

11. Psychologicaltherapies
❖Individualpsychotherapy
❖Behavioraltherapy
❖cognitivebehaviortherapy
❖Familytherapy

12. Nursing interventions
Maintain strict intake and output chart
Monitor status of skin and oral mucous membranes
Short term management is focused on ensuring weight
gain and correcting nutritional deficiencies.
Eating must be supervised by the nurse and a balanced
diet of at least 3000 calories should be provided in 24
hours
Monitor electrolyte levels.

13. Weightshouldbecheckedregularly
Controlvomitingbymakingthebathroom
inaccessibleforatleast2hoursafterfood.
Inextremecaseswhenpatientrefusestoeatand
complywiththetreatment,gavagefeedingsmay
needtobeinstituted.
Encouragefamilytoparticipateineducation
regardingconnectionbetweenfamilyprocessandthe
patientsdisorder.

14. BULIMIA NERVOSA
Bulimianervosaischaracterizedbyepisodesofbinge
eatingfollowedbyfeelingsofguilt,humiliationandself-
condemnation.
Clientswithbulimianervosareportdissatisfactionwith
theirbodies,aswellastheybeliefthat,theyarefat,
unattractiveandundesirable.

15. Etiology
Familyhistoryofmoodoranxietydisorders(e.g,
obsessive-compulsivedisorder)placesapersonatrisk
foraneatingdisorder.
Alteredserotoninlevelsinbrain
Society'semphasisonappearanceandthinness
Sexualabuse
Struggleforcontrolorself-identity
Learnedmaladaptivebehavior

16. Clinical features
Heartburn
Persistent sore throat
Callused or scarring on back of hands and knuckles.
Tooth staining or discoloration
Loss of dental enamel
Increased dental caries
Normal or slightly overweight appearance.

17. Epigastricorabdominalpain
Amenorrhea
Fluidandelectrolyteimbalance
Poorimpulsecontrol
Lowtoleranceforfrustration
Excessiveexerciseregimen
Withdrawalfromfriends.

18. Diagnostic findings
Historycollection
Physicalexamination
Psychologicalevaluationandbeckdepressioninventory
Bloodinvestigations(Electrolytes,bloodglucose)
ECG
MedicalevaluationtoruleoutGastrointestinaldisorder.

19. Psychotherapy
SSRIs
Cognitivebehavioraltherapy
Mostclientswithbulimiaaretreatedonanout
patientbasis.Hospitaladmissionisindicatedif
bingingandpurgingbehavioursareoutofcontrol
andtheclient’smedicalstatusiscompromised.
Medical management

20. Complications
Dehydrationorelectrolyteimbalances
Chronic,irregularbowelmovements
Constipation
Increasedriskofsuicide
Gastricruptureduringperiodsofbingeeating
Dentalcariesandguminfections.

21. Nursing care
Encouragepatienttorecognizeandverbalizeher
feelingsabouthereatingbehavior
Provideassertivenesstraining
Explainrisksofemetic,laxativeanddiureticabuse
Setatimelimitforeachmeal.

22. KEY POINTS
Anorexianervosaisalife-threateningeatingdisorder
characterizedbybodyweightlessthan85%ofnormal,
anintensefearofbeingfatandrefusaltoeatorbinge
eatingandpurging.
Bulimianervosaisaneatingdisorderthatinvolves
recurrentepisodesofbingeeatingandcompensatory
behavioursuchaspurging,useoflaxativesanddiuretics
orexcessiveexercise.
Severelymalnourishedclientswithanorexia
nervosamayrequireintensivemedicaltreatmentto
restorehomeostasisbeforepsychiatrictreatmentcan
begin.

23. Familytherapyiseffectiveforclientswithanorexia;
cognitive-behaviouraltherapyismosteffectivefor
clientswithbulimianervosa.
Focusonhealthyeating.

24. SUMMARY
CONCLUSION