Nsg Presentation

8/7/2019 Nsg Presentation

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Signs, Symptoms, & Supports for

Eating Disorders

Presenter:

Cynthia Galloway, MEd (Couns Psych), RD, CCC

Nutrition Therapist / Psychotherapist


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Continuum of Disordered Eating

Unrestrained Eating Milder Forms of Disturbed Eating Clinical Eating

Disorders

Normal Self-conscious Conscientious Obsessive Dieter Binge Bulimic Anorexic

Eater Eater Eater Eater Eater

eats when counts calories rigidly compensatory

hungry expresses body begins follows swings mechanisms refuses

dissatisfaction eliminates eating meal between to eat

stops fats patterns restricting

when full blames good if & bingeing may

problems on begins on diet, B/P

fatness exercising bad if

toU body off diet


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Criteria for Anorexia Nervosa

(DSM-IV)

A. Refusal to maintain a minimally normal body

weight for age and height (body weight less than

85% of that expected)B. Intense fear of gaining weight or becoming fat,

even though underweight

C. Disturbance in perception of body shape & weight

D. Absence of at least three consecutive menstrual

cycles in postmenarcheal females

From the Diagnostic and Statistical Manual of Mental Disorders, Fourth

Edition, Text Revision. 2000 American Psychiatric Association


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Anorexia Nervosa

Specify type:

Restricting Type: the person has not regularly

engaged in binge-eating or purging behaviorBinge-Eating/Purging Type: the person has

regularly engaged in binge-eating or purging

behavior (i.e., self-induced vomiting or the

misuse of laxatives, diuretics, or enemas)


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Criteria for Bulimia Nervosa

(DSM-IV)

Recurrent episodes of binge eating.An episode of

binge eating is characterized by both of the

following:A.eating, in a discrete period of time (e.g., within

any 2-hour period), an amount of food that is

definitely larger than most people would eat

B.a sense of lack of control over eating during the

episode (e.g., a feeling that one cannot stop eating

or control what or how much one is eating)


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Eating Disorder

Not Otherwise Specified

EDNOS category is for disorders of eating that donot meet the criteria for any specific ED

1. For females, all of the criteria forAN are metexcept that the individual has regular menses

2. All of the criteria forAN are met except that,despite significant weight loss, the individual's

current weight is in the normal range3. All of the criteria for BN are met except that the

bingeing and compensatory mechanisms occurless than twice a week or for a duration of lessthan 3 months


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ED NOS

4. The regular use of inappropriate compensatorybehavior by an individual of normal body weightafter eating small amounts of food (e.g. self-

induced vomiting after the consumption of twocookies).

5. Repeatedly chewing and spitting out, but notswallowing, large amounts of food.

6. Binge-eating disorder: recurrent episodes ofbinge eating in the absence of the regular use ofinappropriate compensatory behaviorscharacteristic of Bulimia Nervosa


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Why?

Social and Cultural Pressures

History ofAbuse or Neglect

Mental Illness

Genetic Vulnerabilities

Family pressures


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Family Pressures

Families where there is excessive concern

with weight and appearance

Family conflict

Close family member moving out or dying

Parents have a mental illness or substance

abuse problem


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Social Pressures

Fat prejudice

Being bullied or teased

Early pubertal development

Peer group focused on dieting & body image

Participation in activities that focus on body

weight and sizePressure to be strong, independent, not have needs

Very thin body ideals


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Warning Signs

Significant or unexpected weight loss OR

repeated, large weight fluctuations

Backbone, ribs, collarbones or cheekbones

are sticking out

Stop in growth (25% of adult height gain

occurs during puberty)

Loss of or irregular menstrual periods


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Other Signs

Yellow or orange-tinged skin

Thinning or brittle hair

Downy hair on back, stomach, or face

Conjunctival hemorrhages

Swollen parotid glands (chipmunk cheeks)

Calluses on the back of the hand


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Eating Behaviours

Dieting

Skipping meals

Changes in types of food eaten

Eating only low-fat or non-fat foods

Eating significantly fewer caloriesCounting calories or fat grams,measuring portions


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Eating Behaviours

Unusual eating practices

E.g. pushing food around the plate

cutting food into very small pieces

hiding food

Preoccupation with food-related activitiesEating alone


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Eating Behaviours

Disappearing to the washroom

immediately after meals

Claiming to have eaten already or not

being hungry

Food missing from the kitchen, ornumerous empty food containers in the

garbage or persons bedroom


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Behavioural Changes

Weighing self daily or more than once

per day

Extreme concern with appearance

Distorted body image

Low self-esteemInflexibility and resistance to change


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Behavioural Changes

Excessive exercise

Standing during activities usually donesitting or constantly moving legs whilesitting

Anxiety if misses routine exercise

Irritability, personality change

Change in school performance


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Medical Complications

Extremely low body weight

Very low heart rate

Low blood pressure

Low body temperature

Irregular heart rhythms

Electrolyte abnormalities (qK, o orq Na,qCa, qP)

Fainting, seizures


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Medical Complications

Arrested growth and development

Low bone density

Changes in brain function and structure

Slowing of the digestive system

Heart failure

Kidney failure


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Why dont you just eat?

Not a conscious choiceunconscious

protection from emotional pain

Eating disorder behaviours are the

symptoms, not the problem

Safer to be angry with your body than

someone you care about


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Are eating disorders addictions?

12 Steps ofAA have been modified to fit eatingdisorders, resulting in Overeaters Anonymous

Addictive substances = sugar &/or refined flourSubstances alter mood, help one manage feelings

The bodys response to the substance results in

eating disorder behavioursGet rid of the substance, you get rid of theaddiction


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Amandas Story

Family expected her to act & feel certain

ways & punished if she did not

Perfectionist, always trying to please others

Left home for college & gained the

freshman 15

Boyfriend with whom she had had her firstsexual experience rejected her


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Amanda

Decided her life would be better if she

lost weight

Started by restricting intake, then

began purging when she ate more than

planned

Lost 25 lbs in 4 months


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Amanda

Initially received positive feedback for

her weight loss

Preoccupation with food & weight

enabled her not to think about her

actual troubles

Physiological stress protected her from

feeling


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Amanda

Concern of possible pregnancy due

to missed periods led her to see adoctor

Physician suspected an ED and

referred her to a specialist


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Amandas Treatment

Specialist helped her to

Feel safe enough to work on emotional

issues

Understand how emotional issues and

eating behaviours are connected


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Emotions

Specialist helped Amanda identify: Thoughts & feelings never validated as a

child Learned to equate parental approval with

love

Never learned how to express feelings orresolve conflicts in a healthy way

Learn how to express intense emotions & askfor support


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Nutrition Therapy: Normalization

of Eating &Weight

Establish collaborative relationship

Collect relevant information

Separate eating behaviours from emotional

issues

Determine setpoint or ideal body weight

Provide nutrition education


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Nutrition Therapy

Nutrition education about

symptoms of starvation

metabolic rate

hunger & fullness cues

healthy weight range

minimum food intake to stabilize weight

optimal food intake for health


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Nutrition Therapy

Challenge distorted beliefs re: food, weight

& body image

Devise experiments that help the person todemonstrate to herself the truth or falseness

of her beliefs

Gradually restore weight to healthy levelResolve the social eating dilemma


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Refeeding Syndrome

Generalized fluid & electrolyte imbalance

in patients refed after severe weight loss

Severe q P, q K, q Mg

Glucose intolerance & fluid intolerance

Result in complications in variety of organ

systems including cardiac, gastrointestinal,neuromuscular, renal & pulmonary


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Preventing Refeeding Syndrome

Start slowly, e.g. 50% of calculated needs

Restrict total glucose to 150-200 g/d

Restrict fluid & Na, e.g. net fluid not to

exceed 800 ml/d during the 1st week

Weight gain should not exceed 1 kg/wk

Daily monitoring of serum electrolytes with

supplementation as needed


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Recovery

Therapy needs to continue beyond cessation

of eating disorder behaviours to:

prevent resumption of behaviours

address any remain psychological issues

Recovery = cessation of behaviours +

development of life skills


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Myth

Once you have an eating disorder,you always have an eating disorder


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Family & Friends

Focus on behaviours that you have witnessed &express your resulting feelings

Be prepared for the person to deny she itAvoid talking about weight & appearance, even ifyou think they are compliments

Dont try to force the person to eatlet her make

her own decisions about when & what to eatTalk about things other than the eating disorder,e.g. the days happenings, special interests, oraccomplishments


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Where to go for help?

No publicly funded treatment programs for

adults > 18 y.o. in London, Ontario

Extended healthcare benefits may cover

residential treatment at Homewood Health

Centre in Guelph

Eating Disorders Program at Victoria Hospital

for adolescents


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Hospital-Sponsored Eating

Disorder Programs in Ontario

Toronto Toronto General Hospital

Waterloo Grand River Hospital

Ottawa Childrens Hospital ofEastern Ontario

Newmarket Southlake Regional Health

Centre

Port Colborne Niagara Eating DisorderOutpatient Program

Sudbury Sudbury General Hospital


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379 Dundas St, Suite 210 Ph: 434-7721

Support & resource centre for people witheating disorders and their loved ones

Non-clinical programs offered in a safe,

non-threatening environment

Opened in November 2002, modelled after

Sheenas Place in Toronto


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NEDIC is a Toronto-based, non-profitorganization, established in 1985 to

provide information and resources oneating disorders and weight preoccupation

The National Eating Disorder Information CentreES 7-421, 200 Elizabeth Street, M5G 2C4

Telephone 416-340-4156 Fax 416-340-4736

Toll-Free 1-866-NEDIC-20 (1-866-63342-20)

Email: [email protected]

The National Eating Disorder

Information Centre


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Questions?

Email questions to:

[email protected]

Or call Cynthia Galloway

777-1906

Or visit website coming soonwww.hopecounsellingcentre.ca

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