EATING
DISORDER
The two most important eating disorder are
1.
Anorexia nervosa
2.
Bulimia nervosa
ANOREXIA
NERVOSA
It is characterized by highly specific behavioral and
psychopathological symptoms and significant somatic sign. Females are suffering
more than male especially in adolescence. As females are having fear of
becoming fat and with the drive of thinness.
Etiology
1.
Genetic cause – among female siblings 6-10%
suffers from the condition compared to the 1-2% found in the general population
of the same age according to Strober
1995
2.
A disturbance in hypothalamic function
3.
Social factors – there is a high prevalence of
anorexia nervosa in students and working females by mass media and beauty
contests
4.
Causes in the family – disturbance in family
relationship also can decrease the interest in food and physical appearance
5.
Individuals psychological factors – disturbance
of body image and traits of low self esteem and perfectionism are often found
Clinical
features
1.
Fear of becoming obese
2.
Body image disturbance
3.
The body weight is 15 below the standard weight
4.
Hormonal disturbance
5.
Vomiting and abuse of laxatives may lead to
electrolyte imbalance
Complication
1.
Increased chance of infections
2.
Malnutrition
3.
Dehydration and nutritional imbalance
4.
Chronic inflammatory bowel disease
5.
Amenorrhea
6.
Dental caries
7.
Cardiovascular problems
Diagnosis
1.
Complete physical examination
2.
Complete blood test
3.
ECG
4.
Different diagnosis to rule out other
psychiatric disorders
Treatment
1.
Psychological
therapies
Ø
Behavioral therapy
Ø
Family therapy
Ø
Cognitive behavior therapy
Ø
Individual psychotherapy
2.
Pharmacotherapy
Ø
Antidepressants
Ø
Appetite stimulants
Ø
Neuroleptics
Nursing
interventions
1.
Maintain
intake and output chart regularly
2.
Monitor skin and oral mucous membrane
3.
Avoid discussion that focus on food
4.
Short term management is focused on ensuring
weight gain
5.
Encourage the person to express feelings of fear
and anxiety
6.
Encourage family to talk nicely to the patient
7.
Check weight regularly
8.
Patient is observed carefully when eating
9.
After eating food patient should not go for
bathroom as they will do vomiting
10.
In extreme cases when total refuse of food is
there gavage feedings should to be
start
BULIMIA NERVOSA
It is characterized by episodes of being eating followed by
feelings of guilt, humiliation, depression and self condemnation.
Etiology
1.
More common in first degree biological relatives
of people with bulimia
2.
Sexual abuse
3.
Family disturbance
4.
Specific area of chromosome 10p linked to
families with history of bulimia
5.
Altered serotonin levels in brain
6.
Society emphasis on appearance and thinness
7.
Struggle for control or self identity
Sign and symptoms
1.
Heart burn and sore throat
2.
Tooth discoloration, loss of dental enamel and
dental carries
3.
Lack of control on eating
4.
Abdominal and epigastric pain
5.
Amenorrhea
6.
Fluid and electrolyte imbalance
7.
Poor impulse control
8.
Frustration
9.
Continue eating like rituals
Complication
1.
Dental caries and gum infection
2.
Chronic irregular bowel movements and
constipation
3.
Dehydration and electrolyte imbalance
4.
Increased risk of suicide
Diagnosis
1.
History collection
2.
Laboratory investigation
3.
Depression history
4.
Medical evaluation to rule out upper
gastrointestinal disorder
Treatment
1.
Psychotherapy
2.
Hospitalization
3.
Group therapy
4.
Family therapy
Nursing intervention
1.
Identify patients like and dislike
2.
Encourage patient to talk about his feelings
3.
Set a time limit for every meal
4.
Encourage the patient to take verity of food
5.
Encourage patient to recognize her/his feelings
of eating
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