Helping Those With Eating Disorders
Dr. Samson Omotosho, PhD, APRN/PMHN
Definition: An eating disorder is a maladaptive response due to inability to regulate eating habits and the tendency to overuse or under use food. It is more common in females. The problem may be characterized by an imbalance in the eating pattern, an excessive or inadequate caloric intake or an inappropriate body weight for the individual's age and height. Types of Eating Disorders: Bulimia Nervosa, Anorexia Nervosa, Binge Eating Disorder, and Night Eating Syndrome.
Bulimia Nervosa: This is an eating disorder characterized by uncontrollable binge eating, alternating with vomiting or dieting. Most (90%) of bulimia nervosa is found in females. It occurs in 2.5% of the population. The age of onset is 15-18 years. About 72% of patients recover. Early detection and treatment of the illness improves chances of recovery. It is mostly found in normal weight persons. The patient may, in addition, have anorexia nervosa.
Anorexia Nervosa: This is an eating disorder in which the person experiences hunger but refuses to eat because of a distorted body image and false perception of fatness, leading to starvation. It occurs in about 1% of the population. The onset may be at any age, mostly 13-20 years. Mostly (90%) occurs in females. About 72% of patients recover and about 5% die. Alcohol use increases mortality from anorexia nervosa.
Binge Eating Disorder (BED):This is an eating disorder in which the person rapidly consumes large quantities of food without any attempt to control weight gain. It is found in about 3% of the population. About 30% of obese persons have this disorder. Therefore, clinicians want to assess obese persons for BED.
Night Eating Syndrome (NES):This is a severe eating problem in which the person experiences anorexia in the morning, depression in the evening, insomnia at night and multiple awakenings to eat at night. About 1.5% of the population has NES. 8% of obese persons have NES.
Possible Factors: There has been a genetic link to eating disorders. Other factors include disorder in the appetite regulation center in the brain (hypothalamus); low serotonin and high dopamine levels in the brain; the individual's psychological makeup such as being a perfectionist, impulsive, or rigidity; early separation problems; low self esteem; high sense of shame and guilt; compulsion and obsession; environmental factors; multiple childhood illnesses or surgeries; parental separation; deaths in the family; parental overemphasis on athletics and slimness; parental disapproval of overweight persons in the presence of the child; skipping meals; preoccupation with wanting to be a model, poor nutritional habits; societal value of thinness; school's emphasis on weight and size; occupations such as dancing, acting, modeling, and fashion that emphasize body weight and size; mass media reinforcement of the thinness culture;
What to look for: Look for any of the factors listed above. Do or suggest a full physical assessment. Check for the individuals' satisfaction with their eating pattern; if they ever eat in secret; actual weight versus desired weight; food avoidances, including restrictions, dieting, and fasting; use of laxatives, diuretics, diet pills, and purging; compulsive exercise patterns; frequency, timing, and preferences about eating. Assessment for Binging: Check for consumption of hundreds or thousands of calories in one sitting; excessive intake and loss of control in eating; secretive consumption of food; eating accompanied with sense of shame; history of unsuccessful dieting in the past. Binging may range form occasional to more than ten times per day. Assessment for Anorexia Nervosa: Look for fasting and restriction of calorie intake to 200-700/day while patient yet perceives her intake as adequate; the design of limited unbalanced diet for self; insistence on particular choice of food repeatedly; insistence on a particular eating time, order, and pattern; bizarre food preferences; avoidance of fatty foods; prolonged fasting; obsession with food, cooking, and food-related jobs. Assessment for Bulimia: Look for forced vomiting, excessive exercise, and the use of diet pills, diuretics, laxatives, steroids, insulin, cocaine, heroine, thyroid hormones, nicotine, hallucinogens, antidepressants, benzodiazepines, and analgesics.
Complications: For Anorexia nervosa: starvation, scanty menstruation, osteoporosis, cold intolerance, fast heartbeat, low blood pressure, constipation, electrolyte imbalance, and leg edema (swelling). Bulimia Nervosa: low blood potassium, muscle weakness, irregular heartbeat, stomach and intestinal problems, dental enamel erosion, and parotid enlargement. Binging - obesity, hypertension, diabetes mellitus. For any form of eating disorder, there may also be accompanying depression, anxiety, substance abuse, and personality disorders.
Other Considerations: Persons with eating disorders are very susceptible to life stressors. Anorexia nervosa is thought to be as a result of the individual's difficulty in controlling some aspects of the individual's life or fears (aspects such as maturity, independence, failure, sexuality, and parental demand). Individuals with anorexia are usually angry about concern from others and frequently use denial as a defense mechanism. Bulimia patients use avoidance, isolation of affect and intellectualization mostly.
Help and Treatment: Success in helping actually depends on the patient's motivation. So, assess the level of motivation of the individual for help and treatment. Ask her to rate her desire for help and treatment on a scale of 1 to 10. Formulate a helper-patient contract and help protocol and gain patient's commitment. The protocol should specify patient and expectations and responsibilities about meals, weighing, timing of meals, amount of drinking water, vital signs, bathroom privileges, close observation, diet foods, and food substitutions. Graduate the patient's independence over meal selection and scheduling. Stabilize patient's nutritional status. Motivate anorexic and bulimic patient to stop trying to lose weight. Motivate her to gain weight. Contract with her to gain at least 1lb per week. Counsel her about healthy eating patterns. Help her to graduate her exercise and focus on fitness. Provide cognitive behavioral therapy (CBT). The CBT should train her in cue avoidance and response change; challenging faulty thoughts, feelings, and assumptions, and finding alternative problem-solving and decision-making responses in high-risk situations. Reinforce her compliance with the contract. Use dance, movement therapy, imagery, relaxation, working with mirrors and depicting the self through art to help her with body image distortion. With patient's consent, involve chosen family members in planning and intervention. Help family to respect patient's individuality. Motivate them to serve as support system to the patient. Use group therapy for reality testing, support, peer communication, social alliance, and expression of feelings. Medications are not usually very useful for eating disorders. Antipsychotics, antidepressant and mood stabilizers provide very little benefit.
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Dr. Samson Omotosho
CEO, Futurefocus Wealth Builders.
References:
Copstead, L. C., & Banasik, J. L. (2005).Pathophysiology(3rd ed.). St. Louis, MO: Elsevier Saunders.
Stuart, G. W. & Laraia, M. T. (2005).Principles and practice of psychiatric nursing(8th ed.). St. Louis, MO: Elsevier Mosby.
Varcarolis, E. (2006).Foundations of psychiatric mental health nursing: A clinical approach(5th ed.). Philadelphia: W.B. Saunders.
Williams, P. M., Goodie, J., & Motsinger, C. (2008). Treating eating disorders in primary care.American Family Physician 77(2), 187-195.
