BY: JOSEPHINE V.

HANRATH

ANOREXIA NERVOSA

ANOREXIA
is actually a misnomer: these clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue; they often believe that if they eat anything, they will not be able to stop eating and will become fat.

ANOREXIA NERVOSA The relentless pursuit of thinness

A life threatening eating disorder characterized by the client s refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem. It is disorder with an insidious onset that often affects adolescents girls (14- 18 yrs of age). Sufferers are typically high achievers, with good grades and described by parents as perfect children. Disorders occurs commonly in upper middle class families. Anorexics uses denial and do not accept that they have problem, thus they are more difficult to treat.

 Clients with anorexia have a body weight that is 85% or less of that expected for their age and height, have experienced amenorrhea for at least three consecutive cycles, and have a preoccupation with food and food related activities. The personality is: perfectionist, introverted, with low self esteem and often has problems with peer relationship. They are good children, hard working, and ideal students. Typically they are people pleasers who seek approval and avoid conflict. Anorexics often started as chubby children or overweight adolescents. The disorder begins when somebody took notice of their being overweight. Because their self esteem are based on the acceptance of others, they go on dieting to lose weight and feel accepted again.

 Clients with anorexia nervosa can be classified into two subgroups depending on how they control their weight. Restricting subtype The binge eating and purging subtype

 Restricters
More often young people in the normal or slightly above normal weight range for height and build before the eating disorder begins.

 Binge-purgers:
Often overweight before the eating disorder begins and their weight tends to fluctuate. Usually young women who are prone to dangerous methods of weight reduction such as induction of vomiting or excessive use of laxative or diuretics.

Signs of Anorexia Nervosa

becomes very thin, frail, or emaciated obsessed with eating, food, and weight control weighs herself or himself repeatedly counts or portions food carefully only eats certain foods, avoiding foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods) exercises excessively feels fat withdraws from social activities, especially meals and celebrations involving food may be depressed, lethargic (lacking in energy), and feel cold a lot

Symptoms of ANOREXIA NERVOSA:

Depressive symptoms such as: depressed mood, irritability, insomnia Inflexible thinking Complaints of constipation and abdominal pain Lethargy Hypotension,hypothermia, and bradycardia Hypertrophy of salivary glands Electrolyte imbalances Elevated liver function test Elevated BUN Leukopenia and mild anemia

Causes:
1. Biological factors: ---Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families. A family history of mood or anxiety disorder and obsessive compulsive disorder places a person at risk for eating disorder. 2. Familiy factors: --- Girls growing up amid family problems and abuse are high risk for both anorexia and bulimia. 3. Sociocultural factors: ---The media fuels the image of the ideal woman as thin.the culture equates beauty, desirability and ultimately, happiness with being thin.

4. Media factors: -- In media, happy and successful people are almost always portrayed by actors and models that are young, toned and thin.
5. Lifestyle and eating disorder: -- A person lifestyle may also place intense demands for thinness.

6. trauma: --Research showed that high % of persons with eating disorders also have histories of physical or sexual abuse. 7. Developmental -- Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity.

Nursing Interventions
Monitor weight 3x a week but weigh with the patient facing away from the weighing scale to help them reduce their focus on weight.
As soon as ideal weight is gained, allow patient to regulate his or her own progression and program.

High protein and high carbohydrate diet, serve food client prefer, small frequent feedings, NGT if client refuses to eat.

 Setting limits to avoid manipulative behavior:

Help patient identify and express feelings-do not be judgmental.

Alexithymia difficulty identifying and expressing feelings

Restrict use of bathroom for 2 hours after eating. Accompany to bathroom to ensure that they will not self-induce vomiting. Stay with client during meals. Do not accept excuses to leave eating the area.

Treatment for Anorexia Nervosa

Psychopharmacology
Antidepressant drugs after electrolyte imbalance is corrected to prevent cardiac arrhythmias due to low potassium levels: Prozac, Elavil, Norpramin, Pamelor. Amitriptyline (Elavil) and the anti-histamine Cyproheptadine (Periactin) in high doses can promote weight gain. Olanzepine (Zyprexa)-used because of its antipsychotic effect (on bizarre body image distortions) and also associated with weight gain. Fluoxetine (Prozac) can show some effectiveness in preventing relapse in clients whose weight has been partially or completely restored.

Psychotherapy
Family therapy Individual therapy

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