Eating disorder – This book covers the entire syllabus of “Psychiatric Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.
At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.
Eating disorder
Eating is controlled by several factors like physical health, voluntary control, appetite, habits, family cultural pattern, peer group influence and food availability. Eating disorders are treatable medica illnesses in which certain maladaptive patterns of eating observed and involves serious disturbances in eating behaviour includes extreme and unhealthy reduction of food intake or severe or over eating as well as distress feelings of extreme concern about body shapes, weight and body image.
Many affected individual initially appear to function normally but it can cause significant physical and emotional turmoil. Eating disorders frequently occur with other psychiatric disorders such as depression, substance abuse and anxiety disorders. However, eating disorder includes alteration in eating pattern, dieting (skipping the meals, fasting) perfectionism, etc.
Eating disorders frequently develop during adolescence or early adulthood. Cases were reported even during childhood or later in adulthood also. Females are much likely to develop the eating disorder than males.
Classification (ICD-10; F90309)
1. F500- Anorexia nervosa
2. F50.1- Atypical Anorexia Nervosa
3. Fsez- Bulimia Nervosa
4. F303- Atypical Bulimia Nervosa
5. F504 Overeating associated with other psychological disturbances
6. Fs03- Vomiting associated with other psychological disturbances
7. Fsas- Other eating disorders
8. Fs09- Eating disorder unspecified
Causes
1. Genetic
2. Biological
3. Psychological
4. Socio-cultural factor
5. Altered functioning pattern of an individual
6. Secondary to medical disorders-endocrinal metabolic disturbances, electrolyte imbalances. Specific disorders and its causes, clinical manifestations, investigations, treatments is described accordingly
General treatment modalities of eating disorders Eating disorders are treatable and restoration of weight can be possible. Early diagnosis and prompt treatment has shown good prognosis or better outcomes. Eating disorder requires a comprehensive treatment plan includes monitoring, psychosocial interventions, medical care, nutritional counselling and drug therapy.
At a time of diagnosis, the clinician must determine whether the person requires immediate hospitalization or can overcome difficulty or-can be treated as outpatient cases. People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in hospital for treatment. Family members can be of helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation.
1. Effective communication techniques are used to win the confidence and to establish and maintain effective therapeutic nurse patient relationship
2. Nurses have to provide conducive environment in dealing with the client, always nurses have to be judgmental, non-threatening and non- punitive manner, so that the client will be at ease while communication, Encourage the client to express their views freely without any inhibitions or hesitation.
3. Nurses have to show positive role models to the client
4. Explain the client about treatment plan, orient them to unit staff, policies and procedures to be followed, what the unit expects from them, what they can obtain from the unit.
5. Prepare structured schedules and make a contract with the client about behavioral agreement
6. Provide consistent communication with the client
7. Manipulate the clients’ environment to have desirable behaviour (Milieu therapy)
8. Nutritionist will prepare the ‘specific menu plans and discusses with the client and to the unit staff
9. Encourage the client to keep dietary log noting the type and amount of food consumed associated thoughts and feelings related to food
10. Unit activities includes-community meetings, family therapy, group therapy, stress management, recreational therapy, interpersonal therapy, etc.
11. Privilege systems will be planned and implemented when his condition improves and regains the normal eating pattern. For example, for bulimia nervosa cases-unsupervised bathroom visits, unrestricted activities, unsupervised eating meals, etc.
12. Cognitive approaches (e.g problem solving techniques client education dietary logs, self- monitoring and self-control, assertiveness techniques, etc.) will be used to modify psychopathology; to regulate the feeding pattern, to correct the misbelieves and preconceptions or myth related to body image, body structure and food, etc.
13. Behavioral approaches like role modeling, shaping, reinforcement, etc. techniques will be used to modify the eating pattern or habits
14. Interpersonal therapies will be used to modify the eating pattern or habits
15. Interpersonal therapies will be used to correct the strained interpersonal relationships
16. Individual psychotherapy, in which guidance and counselling services will be provided to the client to alter the thinking processes and to practice healthy eating pattern.
17. Family Therapy
- Family therapist will focusses the family to develop good family interactions and assists the client to adopt to the family environment and resolves the conflicts if any.
18. Group Therapy
- It provides deeper insight into the feelings and behaviour supportive groups or self help groups will be of helpful in providing constructive mocal support and positive feedback.
19. Drug Therapy
- Based on behavioural manifestations, appropriate medications will be used to modify symptomatology and to regain healthy life style.
Nursing management of the client with eating disorders
1. Nursing Diagnosis: Altered nutritional balance related to eating practices and food consumption
Goal. To maintain weight and nutritional status of the client.
Interventions
- Check and record the weight of the chent
- As per nutritionist guidance explain the specific menu, nutrients requirements, benefits, consumption pattern to the chent
- Prepare therapeutic contract and schedule
- Set realistic goals related to weight (either to reduce or to regain)
- Counsel the client on healthy eating habits.
2. Nursing Diagnosis: Anxiety related to body image, structure, myths and pseudo-beliefs associated with it
Goal: Relief from anxiety, participates actively in the treatment regimen
Interventions:
- Encourage the client to develop compensatory behaviour which has to be adopted
- Guidance and counselling services has to be planned for modifying the eating pattern, and to overcome the myths and beliefs associated with it
- Teach factual information to the client related to food practices, exercises, coping strategies and behaviour modification techniques
3. Nursing Diagnosis: Inadequate cooing strategies related to eating behaviour.
Goal: The client will be able to express his feelings overtly. Interventions
✔ Identify the stressors predisposing the altered behavioral pattern
✔ Teach problem solving techniques, strategies to overcome maladaptive eating behaviour
✔ Teach relaxation techniques, diversional activities, activity therapeutic measures, clarify the boundaries and doubts related to it
✔ Encourage the client to develop positive attitude in the eating pattern.
4. Nursing Diagnosis
Altered family thought processes related to clients’ eating habits and alteration in body weight and shape of the child.
Goal: To develop clear understanding in implementation of therapeutic nutritional plans and adopts change in eating practice; attains positive attitude in providing support to the client.
Intervention:
- Guidance and counselling services to the family
- Teach adoptive/coping strategies to be implemented by the family members, accepts the suggestions and follows it for clients’ welfare
- Provide empathetic support and guideline to improve the clients’ condition
(Ref: KP Norraja/Val-2/489-43
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