Title: Eating Disorders

Contact Hours: 4

Learning Objectives           

Chapter 1: Eating Disorders

1.      Describe the prevalence of eating disorders in the United States and identify population groups most affected  by them.  

·         90% of those afflicted with eating disorders are adolescents and young adult women.  

2.      Describe the causes of eating disorders in terms of personal, genetic and environmental, biological, psychological, family, social, and trigger factors.               

·         Personalities

·         Genetic and Environmental Factors 

·         Biological factors

·         Psychological factors

·         Family factors

·         Social factors

·         Trigger factors  

3.     Describe the behavioral patterns of someone with an eating disorder in terms of food, appearance, exercise, thinking and emotions.        

·         Food behaviors: skip meals, takes only tiny portions, won’t eat in front of other people, eats in ritualistic ways, mixes strange food combinations.

·         Appearance and body image behaviors: Loses, or tries to lose weight.

·         Exercise behaviors: Exercise excessively and compulsively.

·         Thinking behaviors: thinks in magical, simplistic ways: e.g., “If I’m thinner, I’ll be better, loses the ability to think logically, evaluate reality objectively.

·         Emotional behaviors: trouble talking about her feeling especially anger; denies she is angry.  

4.     Describe the medical complications of eating disorders.  

·         mental disorders

·         damage vital organs such as heart and brain

·         dehydration

·         constipation

·         mild anemia

·         psychiatric illness

·         binge eating can cause stomach to rupture

Chapter 2: Recognizing Eating Disorders  

5.     Describe the etiology of anorexia 15 percent below the individual normal body weight.        

·         Anorexia nervosa is an extreme weight loss–at least nervosa and list its 5 typical signs.                       

5 typical signs:  

·         Person refuses to maintain normal body weight for age and height.

·         Person weighs 85% or less than what is expected for age and height.

·         Her menstrual periods stop (or do not start if she is prepubertal when weight loss begins).

·         She denies the seriousness of her low weight. She is frantically afraid of gaining weight and getting fat even though she may be alarmingly underweight.

·         She reports feeling fat even when very thin.  

6.     Describe bulimia nervosa and list its 5 typical signs.                            

·         Person eats more in one or two hours than most people would consume in a normal meal. Food is often gobbled or stuffed.

·         Person feels out of control while eating, like she cannot stop, especially if binge food is high-fat, high-sugar “forbidden food.”

·         She vomits, abuses laxatives, exercises, or starves to get rid of the calories. She diets when not binging, which makes her hungry and vulnerable to the next episode.

·         Like the anorexic, she believes her worth depends on being thin.

·         Her weight may be normal or near normal unless she is also anorexic.  

7.     List 6 signs of binge eating disorder.        

·         Person binge eats frequently and repeatedly.

·         She feels out of control and unable to stop eating during binges.

·         She may eat rapidly and secretly. She may eat continuously all day.

·         She feels guilty and ashamed and experiences great psychological distress.

·         Person has a history of diet failures.

·         She is often depressed and obese.  

8.     Distinguish between bulimia and binge eating disorders.                     

·         People who have binge eating disorder do not purge like bulimics do. Binge eating disorders frequently eat large amounts of food while feeling loss of control over their eating.  Binge eating disorder usually do not purge afterward by vomiting or using laxatives.

·         Persons with bulimia, regularly purge, fast, or engage in strenuous exercise after an episode of binge eating.

·         Bulimics usually purge meaning vomit or used diuretics or laxatives in greater-than-recommended doses to avoid gaining weight.  

9.     Identify diagnostic characteristics of binge eating disorder.               

·         Frequent episodes of eating what others would  consider an abnormally large amount of food.

·         Frequent feelings of being unable to control what or how much is being eaten.

·         Several of these behaviors or feelings:

        -       Eating much more rapidly than usual.

        -       Eating until uncomfortably full.

        -       Eating large amounts of food, even when not

                physically hungry.

        -       Eating alone out of embarrassment at the quantity of

                food being eaten.

        -       Feelings of disgust, depression, or guilt after overeating.  

10.   Describe the complications of binge eating  

·         diabetes

·         high blood pressure

·         high cholesterol levels

·         gallbladder disease

·         heart disease

·         certain types of cancer                

11.   Describe the treatment options for someone with a binge eating  disorder.       

·         Cognitive-behavioral therapy

·         Interpersonal psychotherapy

·         Antidepressants

·         Self-helpgroups  

Chapter 3: Guide to Eating Disorders  

12.   Define six most common eating disorders, provide their characteristics and danger signs and identify the population group affected.

·         Anorexia nervosa

·         Binge eating disorder

·         Bulimia nervosa

·         Exercise resistance

·         Night eating syndrome

·         Restricted eating  

13.   Distinguish between anorexia nervosa and bulimia nervosa.                

·         Anorexia nervosa weight loss to 85% below a minimally normal weight of person’s age and height; intense fear of gaining weight or becoming fat; loss of menstrual cycle.

·         Bulimia nervosa is a recurrent episodes of binge eating, averaging about 5,000 calories per episode, followed by induced vomiting or large doses of laxatives; feeling out of control during binges.  

14.   Provide the diagnostic characteristics and nursing interventions for  each of the six eating disorders.  

·         Anorexia nervosa treatment can include psycho-

·         therapy, behavior modification, nutritional counseling and self-help groups.  Family support is essential.

·         Binge eating disorder Antidepressant and therapy followed by weight-control strategies.

·         Bulimia early intervention and long-term treatment are necessary.  Therapy is similar to that for anorexia,       

·         but antidepressants like Prozac may also be prescribed.

·         Exercise resistance therapy that focuses on underlying psychological issues rather than on weight and fitness.

·         Night Eating Disorder retraining eating habits; consuming a good lunch, midday carbo snack, early dinner. 

·         Engaging in evening activities (like writing letters) to avoid eating.

·         Restricted eating education in nutrition, eating in moderation and regular exercise.  Some food restrictions

·         may be necessary for the obese.  

15.   Identify eating disorders that are officially recognized by the American Psychiatric Association.                              

·         Anorexia nervosa

·         Bulimia nervosa

·         Exercise resistance

·         Restricted eating  

Chapter 4: An Obsession With Being Painfully Thin  

16.   Explain the national  obsession with being thin and the impact advertising beautiful people, so we come to believe that we should look like them                         

·         Nearly every magazine and every televisions commercial we see–and we see a lot of them–shown thin, and entertainment media have on young men and women.                       

17.   Provide at least 4 nursing interventions to a teenager who may be dangerously dieting and exercising to be thin.

 ·         sudden drop in weight

·         an excessive concern and discontent with one’s body

·         distorted body image

·         used of diet pills, laxatives or other drugs to lose weight  

Chapter 5: Treatment of Eating Disorders  

18.   Describe the treatment protocol for eating disorders and present treatment options in terms of hospitalization, medication, and therapy. 

·         hospitalization

·         medication

·         dental work

·         individual psychotherapy

·         group therapy

·         family therapy to change old patterns and create a new

·         nutritional counseling to debunk

·         support groups  

19.   Explain the complex interaction of emotional and  physiological in eating disorders problems  

·         A comprehensive treatment plan, involving a variety of experts and approaches. 

·         The treatment team includes an internist, nutritionist, an individual, psychotherapist, a group of family psychotherapist, and psychopharmacologist.        

20.   Describe the role of individual   psychotherapy,  family therapy and cognitive-behavioral therapy in  the treatment of eating disorders.  

·         A psychiatrist, psychologist, or other mental health professional meets with the patient individually and provides ongoing emotional support, while the patients begins to understand and cope with the illness.    

21.   List four general kinds of antidepressants, provide names of available drugs under each category and their success in the treatment of bulimia nervosa.  

·         MAOIs Example: Nardil

·         Tricyclics Example: Elavil, and Tofranil

·         SSRIs  Example: Prozac and Zoloft

·         Desyrel; Wallbutrin 1  

22.   Explain the popularity of prozac as an antidepressant drugs.                               

·         Prozac is the no. 1 antidepressant in this county for many reasons it safe, effective, simple, compliance.  

23.   Describe the role of antidepressants in the treatment of anorexia nervosa and depressed.  

·         Anorexic patients do have a history of depression, and healthy people who are starved also become  compulsive overeating.                     

Chapter 6: Helping the Person With An Eating Disorder  

24.   Provide help–in terms of referrals, resources and understanding to an eating disorder patient.    

·         hospital emergency room

·         call crisis hotline

·         find the number in the yellow pages under Crisis Intervention

·         Ask your family doctor for an evaluation and referral

·         Check with the school counseling center if you are a student

·         Community service agencies in the Counselors section  

25.   List 8 things to do and 9 things not to do while helping the patient.   

·         Provide information. Give her this book.

·         Be supportive. The greatest gift you can give is a listening ear with no strings attached.

·         Encourage professional help, but be prepared for denial, resistance, and stubborn, sullen hostility.

·         Do what you can to persuade her that a normal life is   worth the hard work she will have to do to recover.

·         Realize that recovery is her responsibility, not yours.

·         Realize that she won’t change until she wants to, until she finally accepts that being thin will not get her the happiness and power she wants, and until she finds some other way of dealing with problems.

·         If she refuses treatment, you get help for your fears and anxiety. Show her how healthy people use professional resources to help solve problems.

·         Be kind to yourself. You are doing the best you can.

·         No one, not even you, should expect more than that.  

Some Things Not to Do  

·         Don’t give advice unless you are asked for it. Even if she does ask, don’t expect her to act on it.

·         Don’t tell her she has lost weight and is too thin. She will be pleased, and you will reinforce the problem.

·         Don’t congratulate her on gaining weight. She will think, “I’ve gotten too fat. Now I’m not special. I’ve lost, and they have won.”

·         Don’t let her run your family: e.g., decide what, where, and when you will eat.

·         Don’t ignore stolen food and bathrooms stained with evidence of  purging.  Make her replace the food and

·         clean  up her messes.

·         Don’t overestimate what you can accomplish. You can provide support and encouragement, but you can’t make her recover if she does not want to recover.  

26.   Formulate questions to ask of a potential therapist.               

·         How did you get involved in treating eating disorders?

·         How long have you been working in this area?

·         What is your training ( psychiatrist, psychologist, social worker, nurse,  etc.)

·         Are you affiliated with any hospital and/or organizations important in this field?

·         What percentage of the people you see have eating disorders?

·         Are there any former or current patients I might be able to talk to?

·         How much time will be spent focusing on food, weight and diet issues?

·         Will you restrict any of my behavior in order for me to see you? ( i.e., can I come to therapy if I throw up, exercise, do drugs, etc.)

·         Do you believe people can get better for life, or will I always have this disease?

·         What is your attitude towards self-help groups ( OA, ACOA, AA)?

·         What is important for me to know about you? Why should I see you?

·         Do you think you would want to work with someone like me?  

Process of change  

·         What can I expect during a session? How interactive are you?

·         Will you monitor my weight?

·         When, if ever, do you hospitalize?

·         Will you involve my family?

·         What role, if any, will medication play? What percentage of people who see you take medication? Which ones?

·         How would you describe your approach?

·         What would you see as a healthy recovery for me?

·         What goals would we set for change?  

Nuts and Bolts  

·         How often should we meet? For what length of time?

·         How long is a session?

·         How difficult will it be for me to schedule meetings at a convenient time to me? Do you have after work or early morning appointments?

·         Do you charge for cancellations?

·         Do you accept insurance assignments? Are you reimbursable by insurance?

·         How and when do you request payment?

·         Are you available for telephone calls during the week.  Is there a charge for telephone consultations?

·         What other services do you provide ( groups, lectures, sessions, etc.)?  

27.   List resources and sources of infor mation to help an eating disorder patient.                  

·         National Association of Anorexia Nervosa and Associated Disorders (ANAD)

·         Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED)

·         American Anorexia/Bulimia Association, Inc. (AABA)

·         Center for the Study of Anorexia and Bulimia

·         National Anorexic Aid Society (NAAS)

·         Foundation for Education about Eating Disorders (FEED)

·         Bulimia Anorexia Self Help, Inc. (BASH)

·         Overeaters Anonymous  

Chapter 7: What Should I Do?  

27.   Formulate an action plan with specific guidelines for friends and relatives of people with eating disorders.               

·         When we care about someone with an eating disorder, our natural tendency is to see the eating disorder as problem and to try to help the person get rid of that problem.

·         It is important in life not to take responsibility for things over which we have no power and to recognize those over which we do.

·         When we express our concern, we are wise to speak of our own experiences rather than to assume that we know what is true or best for the other person. That is, we are wise to use “I” statements rather than “you” statements. When we speak in “I” statements, we take responsibility for our response. When we speak in “you” statements, we tend to make judgments about the person which leave her feeling that she has to take a defensive position. We end up locked in a battle of wills that leads nowhere.   

·         We need to remain true to ourselves, authentic.

·         Don’t focus on eating and weight

·         We sometimes work with the mistaken belief that there is a right thing to do with someone who has an eating disorder and that if we did that right thing, then the person would be helped and we would not feel enough.

·         It is a fact that we are ultimately helpless over making another person feel some other way or be some other way.

·         Human company and empathy matter.

·         People who have recovered acknowledge the importanceof being loved and being believed in.

·         People with eating disorders often experience great shame about their eating behavior and great shame

·         about their imperfections as human beings. They fear that if anyone really knew them, really saw who they were, that people would reject them. They yearn to know that someone could both know the worst about them and love them and care about them anyway.               

·         Get support for yourself.  

28.   Write and say several examples of “I” and “You” statements that may help or hurt the patient.   

·         “I’ve heard you throwing up in the bathroom. I’m concerned. Let’s get some help.”

·         “I feel afraid that you’re hurting yourself. I’m concerned that your health could be in danger or that you could die. Let’s get some help.”

·         “Look, I think we’re both at risk for getting caught up

·         on some sort of denial here. I know I’ve been avoiding talking to you about how concerned I am. I don’t like it when we act as if nothing is wrong, because my sense is that something is very wrong. It’s too much for us to handle alone. Let’s get some help.”

·         “I look at you and I see the light going out of your eyes and I feel like I’m losing you. I miss you. I’m afraid I really will lose you. And I’m scared for you.”

·         “I want more for you than this life of obsession and guilt and self-control and self-contempt. There’s so much more to life – and to you for that matter.”

·         “I want to say, ‘Stop, don’t do it!’ But I know it’s not that simple.”

·         “I’m sorry, but I’m not going to work out with you anymore because I feel like I’m helping you abuse yourself.”  

Chapter 8: Methods for Voluntary Weight Loss and Control      

29.   Define various population groups who are trying to lose weight.       

·         33 percent to 40 percent of adult women and 20 percent

·         to 24 percent of men are currently trying to lose weight.  

30.   List 5 reasons for which Americans try to lose weight.          

·         seek to improve their self-images

·         physical or emotional health problems caused by their weight

·         severely overweight by current medical standards and attempt to lose weight reduction to improve their perception of their health.

·         society’s discrimination against overweight individuals

·         attempt weight reduction to gain greater acceptance         

31.   List 7 commons methods used for weight loss.       

·         diet

·         exercise

·         vitamins

·         meal replacements

·         over-the-counter products

·         participation if a weight loss program

·         diet supplements  

32.   Discuss various weight loss methods with respect to their effectiveness in facilitating weight loss.           

·         Person loses weight while participating in such programs but, after completing the programs, tend to regain the weight overtime.

·         Dietary change has a short-term success for some of this method.

·         Exercise has beneficial effects independent of weight loss, it can be an important adjunct to other strategies

·         and can, if continued, diminish the tendency for rapid postprogram weight gain.

·         Behavior modification  when use alone for 18 weeks can generate a 1-to 15 pound/week weight loss.  One-third of this weight will be regained at the end of 1-year and most regained by 5 years.

·         Drug treatment has been effective in producing weight loss.

·         Combination therapies can lead to greater short-term weight loss.  

33.   Discuss short- and long-term benefits and adverse effects of weight loss.     

·         Diet and exercise weight program lead to weight loss can prevent the onset of hypertension and that the same may be true for diabetes mellitus

·         Patients report fatigue, hair loss, dizziness, and other symptoms.

·         Increased risk for gallstones and acute gallbladder disease.

·         Weight cycling appears to affect energy metabolism and may result in faster regaining of weight, and cycling has longer term negative effects on physiological and physical health needs.  

34.   Discuss fundamental principles that should be used to select a personal weight loss and control strategy.   

·         lifelong commitment to a change in lifestyle, behavioral responses, and dietary practices.

·         the decision to lose weight should take into account the difficulty of the task as well as the potential  adverse physical and pscyhological effects of weight loss regimens.

·         Modest goals and a slow course will maximize the probability of both losing the weight and keeping it off.  

35.   List four factors that should be method program.                   

·         considered in evaluating a weight loss           

·         personal food preferences desire for structure in the program

·         degree of support in the home, workplace, or a chosen group.

·         consider include time; money, and transportation

 36.   Specify and discuss at least 6 major areas for future research on weight loss and control.  

·         More data with which to answer the questions  about voluntary weight loss and control methods

·         An appropriate research base must span the entire spectrum of health research from genetic, biochemical, physiologic, and neurophysiologic to individual, community, and populations investigations.

·         Physiologic research in helping define weight loss mechanisms that may be useful in therapy.

·         The paucity of well-designed, long-term clinical trials evaluating  various methods for voluntary weight loss is disturbing.

·         Analysis of existing data sets and survival studies of persons losing weight voluntarily are urgently needed.

·         Populations studies are needed to determine better the range of healthy weights by age, gender, and ethnicity.  

Chapter 9: The Pressure To Be Perfect                

37.   Discuss the impact of group pressure in the development of eating disorders among young women.                       

·         In an environment with such social pressure to conform, there’s an operative ethic that says,

·         ‘If you need to eat, need to give in to the food, you have failed in some way.  Eating is immoral and you demonstrate your excellence by not giving in.  

Chapter 10: The Pressure to Lose Weight  

38.   Distinguish between the pattern of eating disorders between men and women.              

·         eating behavior is likely to go awry at key points of separation from family or reaching a new, adult stage in life, going away to college or graduate school, or starting a new job appear to be trigger, anorexia develop in late adolescent sometimes signals confusion over sexual orientation.  

39.   Identify the causes and characteristics of eating disorders among men.  

·         ferocious fear of fatness

·         skipping meals

·         vomiting

·         using laxatives  

Chapter 11: “I Am An Exercise Addict”

  40.   Describe the behavioral pattern of an exercise addict.                           

·         the exercise addict is very close to the profile of many bulimics and anorexics.               

41.   Identify the similarities between the profile of an exercise addict and that of   a bulimic or an anorexic.               

·         the truly addicted exercises, it’s like being an alcoholic –you never lose the urge.

 42.   List 5 telltale signs of exercise   a rigid daily schedule of exercise addiction.     

·         domination of exercise over other activities

·         an overwhelming need to increase exercise activities

·         when the same quantity no longer delivers the desired results

·         withdrawal symptoms such as anxiety or mood swings

·         when exercise is curtailed and relief from those feelings

·         when exercise is resumed a rational understanding that exercise has become a destructive compulsion counterbalance by a deeper feeling that it is nonetheless a necessity.