Anorexia Nervosa

Definition
  • Anorexia Nervosa is a disorder with an insidious onset that often affects adolescent girls.
  • Sufferers are typically high achievers, with good grades and described by parents as perfect children. Disorder occurs commonly in upper middle class families. Usually the youngest child is affected.
  • Unlike bulimics, anorexics uses denial and do not accept that they have a problem, thus, they are more difficult to treat.
  • 10-20 % of anorexics die and half of these deaths are due to suicide.
  • They are often not recognized  because they eat normally in social situations but after eating they retreat to the nearest bathroom and purge themselves.
  • In order to prevent themselves from eating and to help maintain their very restrictive dietary program, they avoid socializations such as parties, even family meals, thus becoming increasingly socially isolated.
  • They often start as chubby children or overweight adolescents. The disorder begins with somebody took notice of their being overweight. Because the self-esteem of this person is based on the acceptance of others, they go on dieting to lose weight and feel accepted again.
  • The personality is perfectionist, introverted, with low self-esteem and often has problems with peer relationships. They are good children who are conscientious, hard working, and ideal students. Typically they are people pleasers who seek approval and avoid conflict.
  • The person may have low tolerance to change and do not adjust well to new situations. Often they are overly engaged with or dependent on parents or family. Dieting may represent avoidance or, or ineffective attempts to cope with, the demands of a new life stage such as adolescence.
  • They may fear growing up and assuming adult responsibilities including an adult lifestyle. The symptoms of anorexia are thought to be a kind of symbolic language that expresses: ” I’m not ready to grow up yet,” or ” I’m starving for attention”.
  • Another factor is that this individual may have felt worthless and helpless. They try to combat these feelings by taking over those parts of their life that they can control, that is, their weight and the food that they eat.
Types:
  1. Restricting – weight loss by dieting, fasting and excessive exercise.
  2. Binge eating or purging – uses self induced vomiting, abuses laxatives, diuretics or enema.

Assessment
  • Behaviors directed toward weight loss like dieting, exercise and purging.
  • Withdrawn and socially isolated, refuses to eat with family on the table.
  • Distorted body image, they see themselves as fat despite being emaciated.
  • Intense fear of becoming fat.
  • Due to misconception that food can make them obese and look ugly, their life is dominated by behavior directed at avoiding food intake and weight loss. They then become preoccupied with food and engage in bizarre behaviors such as peculiar way on handling food, hoarding food, collecting recipes, rearranging food on plate repeatedly, dawdling, reading multiple materials about food to the point of thinking that they have superior knowledge
  • Depressed, sleep disturbances, suicidal tendencies and crying spells.
  • Compulsive rituals.
  • In women, amenorrhea for at least four months and lack of interest in sexual activity due to lack of nourishment, menstruation can occur only if a woman is able to maintain at least 17% of body fat.
  • In men, level of sex hormones drop. Males develop eating disorders too. About 10% of patient with eating disorders are male.
  • Physical symptoms include bradycardia, hypothermia, dehydration, dependent edema, hypotension due to decreased metabolic rate as a compensatory mechanism of the body to low food intake.
  • Induce vomiting, uses enema, diet pills, excessive exercise, diuretics and laxatives.
  • As disease progresses, becomes deceitful, stubborn, hostile, and manipulative.

Nursing Interventions
  1. Cognitive and Behavioral therapy to positive and negative reinforcement: focus is on client’s responsibility to gain weight.
    • Privileges are gained with weight gain.
    • Privileges are lost with weight loss.
  2. Increase self-esteem by acceptance and non-judgmental approach so the patient will realize that they do not need to artificial perfection they believe thinness provides. Assist to find other positive qualities about self.
  3. Teach about the disorder. The more information they receive that validates their problem, the less likely they will deny it.
  4. Monitor weight three times a week but weigh with the patient facing away from the weighing scale to help them reduce their focus on weight. Make sure the patient is not hiding heavy objects under her clothing.
  5. As soon as the ideal weight is gained, allow patient to regulate his or her own progression and program.
  6. High protein and high carbohydrate diet, serve foods the patient prefer in small frequent feedings. NGT if the patient refuses to eat.
  7. Setting limits to avoid manipulative behavior:
    • Restrict use of bathroom for 2 hour after eating.
    • Accompany to the bathroom to ensure that they will not self induce vomiting.
    • Stay with client during meals.
    • Do not accept excuses to leave eating area.
  8. Help the patient identify and express feelings. Avoid being judgmental. People with eating disorders are thought to be afraid of expressing strong emotions; they express their feelings unconsciously by vomiting, starvation, and purging.
  9. Help the patient to identify and express other bodily concerns such as hairstyle, clothing. Typically anorectic patients have little bodily awareness other than a distorted perception of their size.
  10. Identify the patients non-weight related interests. This could help reduce anxiety, become creative outlet for energy, raise self-esteem and divert attention from eating and weight.
  11. Avoid being confrontational and engaging in long discussions or explanations about food or body.
  12. Ignore manipulative behaviors.
  13. Refer to self-help groups.

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