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Title: Comer, Abnormal Psychology, 5th edition Subject: Chapter 11 Author: alitnik_at_unair Last modified by: User Created Date: 7/24/2001 8:09:29 PM Document ... – PowerPoint PPT presentation

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  • By
  • Ni Ketut Alit A
  • Faculty Of Nursing Airlangga University

  • Black, J.M. Matassarin E, (1997). Medical
    Surgical Nursing Clinical Management for
    continuity of care. J.B.
  • Barbara C.L Wilma J.P. (2006). Essentials of
    Medical Surgical Nursing. Philadelphia
    Lippincott Williams Wilkins.
  • Smeltzer, S.C., Bare, B. (2003). Brunner and
    Suddarth's Textbook of Medical-Surgical Nursing
    (10th ed.). Philadelphia Lippincott Williams
  • Ignativicius Bayne. (2001). Medical and
    Surgical Nursing. Philadelphia W.B. Saunders
  • Luckman Sorensen. (2000). Medical Surgical
    Nursing. Philadelphia W.B. Saunders Company.
  • Journals and article related to..

  • Current Western beauty standards equate thinness
    with health and beauty
  • There has been a rise in eating disorders in the
    past three decades
  • The core issue is a morbid fear of weight gain
  • Two main diagnoses
  • Anorexia nervosa
  • Bulimia nervosa

  • The main symptoms of anorexia nervosa are
  • A refusal to maintain more than 85 of normal
    body weight
  • Intense fears of becoming overweight
  • A distorted view of body weight and shape
  • Amenorrhea

Anorexia Nervosa
  • There are two main subtypes
  • Restricting type
  • Lose weight by restricting bad foods,
    eventually restricting nearly all food
  • Show almost no variability in diet
  • Binge-eating/purging type
  • Lose weight by vomiting after meals, abusing
    laxatives or diuretics, or engaging in excessive
  • Like those with bulimia nervosa, people with this
    subtype may engage in eating binges

Anorexia Nervosa
  • About 9095 of cases occur in females
  • The peak age of onset is between 14 and 18 years
  • Around 0.5 of females in Western countries
    develop the disorder
  • Many more display some symptoms

Anorexia Nervosa
  • The typical case
  • A normal to slightly overweight female has been
    on a diet
  • Escalation to anorexia nervosa may follow a
    stressful event
  • Separation of parents
  • Move or life transition
  • Experience of personal failure
  • Most patients recover
  • However, about 2 to 6 become seriously ill and
    die as a result of medical complications or

Anorexia Nervosa The Clinical Picture
  • The key goal for people with anorexia nervosa is
  • The driving motivation is FEAR
  • Of becoming obese
  • Of losing control of body shape and weight

Anorexia Nervosa The Clinical Picture
  • Despite their dietary restrictions, people with
    anorexia are extremely preoccupied with food
  • This includes thinking and reading about food and
    planning for meals
  • This relationship is not necessarily causal
  • It may be the result of food deprivation, as
    evidenced by the famous.

Anorexia Nervosa The Clinical Picture
  • People with anorexia nervosa also demonstrate
    distorted thinking
  • Often have a low opinion of their body shape
  • Tend to overestimate their actual proportions
  • Adjustable lens assessment technique
    overestimate size by 20
  • Hold maladaptive attitudes and beliefs
  • I must be perfect in every way
  • I will be a better person if I deprive myself
  • I can avoid guilt by not eating

Anorexia Nervosa The Clinical Picture
  • People with anorexia may also display certain
    psychological problems
  • Depression (usually mild)
  • Anxiety
  • Low self-esteem
  • Insomnia or other sleep disturbances
  • Substance abuse
  • Obsessive-compulsive patterns
  • Perfectionism

Anorexia Nervosa Problems
  • Caused by starvation
  • Amenorrhea
  • Low body temperature
  • Low blood pressure
  • Body swelling
  • Reduced bone density
  • Slow heart rate
  • Metabolic and electrolyte imbalance
  • Dry skin, brittle nails
  • Poor circulation
  • Lanugo

  • Bulimia nervosa, also known as binge-purge
    syndrome, is characterized by binges
  • Bouts of uncontrolled overeating during a limited
    period of time
  • Often objectively more than most people
    would/could eat in a similar period

Bulimia Nervosa
  • The disorder is also characterized by
    compensatory behaviors, which mark the subtype of
    the condition
  • Purging-type bulimia nervosa
  • Vomiting
  • Misusing laxatives, diuretics, or enemas
  • Nonpurging-type bulimia nervosa
  • Fasting
  • Exercising excessively

Bulimia Nervosa
  • Like anorexia nervosa, about 9095 of bulimia
    nervosa cases occur in females
  • The peak age of onset is between 15 and 21 years
  • Symptoms may last for several years with periodic

Bulimia Nervosa
  • Patients are generally of normal weight
  • May be slightly overweight
  • Often experience weight fluctuations
  • Binge-eating disorder may be a related
  • Symptoms include a pattern of binge eating with
    NO compensatory behaviors (such as vomiting)
  • This condition is not yet listed in the DSM

Bulimia Nervosa
  • Teens and young adults have frequently attempted
    binge-purge patterns as a means of weight loss,
    often after hearing accounts of bulimia from
    friends or the media
  • In one study
  • 50 of college students reported periodic binges
  • 6 tried vomiting
  • 8 experimented with laxatives at least once

Bulimia Nervosa Binges
  • For people with bulimia nervosa, the number of
    binges per week can range from 2 to 40
  • Average 10 per week
  • Binges are often carried out in secret
  • Binges involve eating massive amounts of food
    rapidly with little chewing
  • Binge-eaters commonly consume more than 1500
    calories (often more than 3000 calories) per
    binge episode

Bulimia Nervosa Binges
  • Binges are usually preceded by feelings of
    tension and/or powerlessness
  • Although the binge itself may be pleasurable, it
    is usually followed by feelings of extreme
    self-blame, guilt, depression, and fears of
    weight gain and discovery

Bulimia Nervosa Compensatory Behaviors
  • After a binge, people with bulimia nervosa try to
    compensate for and undo the caloric effects
  • The most common compensatory behaviors
  • Vomiting
  • Affects ability to feel satiated ? greater hunger
    and bingeing
  • Laxatives and diuretics
  • Almost completely fail to reduce the number of
    calories consumed

Bulimia Nervosa Compensatory Behaviors
  • Compensatory behaviors may temporarily relieve
    the negative feelings attached to binge eating
  • Over time, however, a cycle develops in which
    purging ? bingeing ? purging

Bulimia Nervosa
  • The typical case
  • A normal to slightly overweight female has been
    on an intense diet
  • Research suggests that even among normal
    subjects, bingeing often occurs after strict
  • For example, a study of binge-eating behavior in
    a low-calorie weight loss program found that 62
    of patients reported binge-eating episodes during

Bulimia Nervosa vs. Anorexia Nervosa
  • Similarities
  • Onset after a period of dieting
  • Fear of becoming obese
  • Drive to become thin
  • Preoccupation with food, weight, appearance
  • Elevated risk of self-harm or attempts at suicide
  • Feelings of anxiety, depression, perfectionism
  • Substance abuse
  • Disturbed attitudes toward eating

Bulimia Nervosa vs. Anorexia Nervosa
  • Differences
  • People with bulimia are more worried about
    pleasing others, being attractive to others, and
    having intimate relationships
  • People with bulimia tend to be more sexually
  • People with bulimia display fewer of the
    obsessive qualities that drive restricting-type
  • People with bulimia are more likely to have
    histories of mood swings, low frustration
    tolerance, and poor coping

Bulimia Nervosa vs. Anorexia Nervosa
  • Differences
  • People with bulimia tend to be controlled by
    emotion may change friendships easily
  • People with bulimia are more likely to display
    characteristics of a personality disorder
  • Different medical complications
  • Only half of women with bulimia experience
    amenorrhea vs. almost all women with anorexia
  • People with bulimia suffer damage caused by
    purging, especially from vomiting and laxatives

Causes Eating Disorders
  • Most theorists subscribe to a multidimensional
    risk perspective
  • Several key factors place individuals at risk
  • More factors greater risk
  • Leading factors
  • Sociocultural conditions (societal and family
  • Psychological problems (ego, cognitive, and mood
  • Biological factors

Causes Eating Disorders Societal Pressures
  • Many theorists argue that current Western
    standards of female attractiveness have
    contributed to the rise of eating disorders
  • Standards have changed throughout history toward
    a thinner ideal

Causes Eating Disorders Societal Pressures
  • Certain groups are at greater risk from these
  • Models, actors, dancers, and certain athletes
  • Of college athletes surveyed, 9 met full
    criteria for an eating disorder while another 50
    had symptoms
  • 20 of surveyed gymnasts met full criteria for an
    eating disorder

Causes Eating DisordersSocietal Pressures
  • The socially-accepted prejudice against
    overweight people may also add to the fear and
    preoccupation about weight
  • About 50 of elementary and 61 of middle school
    girls are currently dieting

Causes Eating Disorders Family Environment
  • Families may play a critical role in the
    development of eating disorders
  • As many as half of the families of those with
    eating disorders have a long history of
    emphasizing thinness, appearance, and dieting
  • Mothers of those with eating disorders are more
    likely to be dieters and perfectionistic

Causes Eating Disorders Family Environment
  • Abnormal family interactions and forms of
    communication within a family may also set the
    stage for an eating disorder
  • Minuchin cites enmeshed family patterns as
    causal factors of eating disorders
  • These patterns include overinvolvement in, and
    overconcern about, family members lives
  • Such families can be affectionate and loyal but
    can also foster clinginess and dependency
  • Children are allowed little room for
    individuality and independence

Causes Eating Disorders Ego Deficiencies and
Cognitive Disturbances
  • Bruch eating disorders are the result of
    disturbed motherchild interactions which lead to
    serious ego deficiencies in the child and to
    severe cognitive disturbances

Causes Eating Disorders Ego Deficiencies and
Cognitive Disturbances
  • Bruch parents may respond to their children
    either effectively or ineffectively
  • Effective parents accurately attend to a childs
    biological and emotional needs
  • Ineffective parents fail to attend to childs
    internal needs they feed when the child is
    anxious, comfort when the child is tired, etc.
  • Children who receive such parenting may grow up
    confused and unaware of their own internal needs
    they are unable to identify their own emotions

Causes Eating Disorders Ego Deficiencies and
Cognitive Disturbances
  • There is some empirical support for Bruchs
    theory from clinical sources
  • People with bulimia eat in response to emotions
    many mistakenly think they are also hungry
  • People with eating disorders rely excessively on
    the opinions, wishes, and views of others
  • They are more likely to worry about how they are
    viewed, to seek approval, to be conforming, and
    to feel a lack of life control

Causes Eating Disorders Mood Disorders
  • Many people with eating disorders, particularly
    those with bulimia nervosa, experience symptoms
    of depression
  • Theorists believe mood disorders may set the
    stage for eating disorders

Causes Eating Disorders Mood Disorders
  • There is some empirical support for the claim
    that mood disorders set the stage for eating
  • Many more people with an eating disorder qualify
    for a clinical diagnosis of major depressive
    disorder than do people in the general population
  • Close relatives of those with eating disorders
    seem to have higher rates of mood disorders
  • People with eating disorders, especially those
    with bulimia nervosa, have low levels of
  • Symptoms of eating disorders are helped by
    antidepressant medications

Causes Eating Disorders Biological Factors
  • Biological theorists suspect that some people
    inherit a genetic tendency to develop an eating
  • Consistent with this model
  • Relatives of people with eating disorders are 6
    times more likely to develop the disorder
  • These findings may be related to low serotonin

Causes Eating Disorders Biological Factors
  • Other theorists believe that eating disorders may
    be related to dysfunction of the hypothalamus
  • Researchers have identified two separate areas
    that control eating
  • Lateral hypothalamus (LH)
  • Ventromedial hypothalamus (VMH)

Causes Eating Disorders Biological Factors
  • Some theorists believe that the LH and VMH are
    responsible for weight set point a weight
    thermostat of sorts
  • Set by genetic inheritance and early eating
    practices, this mechanism is responsible for
    keeping an individual at a particular weight
  • If weight falls below set point ? hunger, ?
    metabolism ? binges
  • If weight rises above set point ? hunger, ?
  • Dieters end up in a fight against themselves to
    lose weight

Treatments for Eating Disorders
  • Eating disorder treatments have two main goals
  • Correct abnormal eating patterns
  • Address broader psychological and situational
    factors that have led to and are maintaining the
    eating problem
  • This often requires the participation of family
    and friends

Treatments for Anorexia Nervosa
  • The initial aims of treatment for anorexia
    nervosa are to
  • Restore proper weight
  • Recover from malnourishment
  • Restore proper eating

Treatments for Anorexia Nervosa
  • In the past, treatment took place in a hospital
    setting it is now often offered in an outpatient
  • In life-threatening cases, clinicians may force
    tube and intravenous feeding
  • This may breed distrust in the patient and create
    a power struggle
  • Most common technique now is the use of
    supportive nursing care and high calorie diets

Treatments for Anorexia Nervosa
  • Therapists use a mixture of therapy and education
    to achieve this broader goal
  • One focus of treatment is building autonomy and
  • Therapists help patients recognize their need for
    independence and control
  • Therapists help patients recognize and trust
    their internal feelings

Treatments for Anorexia Nervosa
  • Another focus of treatment is correcting
    disturbed cognitions, especially client
    misperceptions and attitudes about eating and
  • Using cognitive approaches, therapists correct
    disturbed cognitions and educate about body

Treatments for Anorexia Nervosa
  • Another focus of treatment is changing family
  • Family therapy is important for anorexia
  • The main issues are often separation and

Treatments for Anorexia Nervosa
  • The use of combined treatment approaches has
    greatly improved the outlook for people with
    anorexia nervosa
  • But even with combined treatment, recovery is
  • The course and outcome of the disorder vary from
    person to person

Treatments for Anorexia Nervosa
  • Positives of treatment
  • Weight gain is often quickly restored
  • 83 of patients still showed improvements after
    several years
  • Menstruation often returns with return to normal

Treatments for Anorexia Nervosa
  • Negatives of treatment
  • Close to 20 of patients remain troubled for
  • Even when it occurs, recovery is not always
  • Relapses are usually triggered by stress
  • Many patients still express concerns about body
    shape and weight

Treatments for Bulimia Nervosa
  • Treatment programs are relatively new but have
    risen in popularity
  • Treatment is frequently offered in specialized
    eating disorder clinics

Treatments for Bulimia Nervosa
  • The initial aims of treatment for bulimia nervosa
    are to
  • Eliminate binge-purge patterns
  • Establish good eating habits
  • Eliminate the underlying cause of bulimic
  • Programs emphasize education as much as therapy

Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Individual insight therapy
  • The insight approach receiving the most attention
    is cognitive therapy, which helps clients
    recognize and change their maladaptive attitudes
    toward food, eating, weight, and shape
  • As many as 65 stop their binge-purge cycle
  • If cognitive therapy isnt effective,
    interpersonal therapy (IPT), a treatment that
    seeks to improve interpersonal functioning, may
    be tried
  • A number of clinicians also suggest self-help
    groups or self-care manuals

Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Behavioral therapy
  • Behavioral techniques are often included in
    treatment as a supplement to cognitive therapy
  • Diaries are often a useful component of treatment
  • Exposure and response prevention (ERP) is used to
    break the binge-purge cycle

Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Antidepressant medications
  • During the past decade, antidepressant drugs have
    been used in bulimia treatment
  • Most common is fluoxetine (Prozac), an SSRI
  • Drugs help 25 to 40 of patients
  • Medications are best when used in combination
    with other forms of therapy

Treatments for Bulimia Nervosa
  • Several treatment strategies
  • Group therapy
  • Provides an opportunity for patients to express
    their thoughts, concerns, and experiences with
    one another
  • Helpful in as many as 75 of cases, especially
    when combined with individual insight therapy

Treatments for Bulimia Nervosa
  • Left untreated, bulimia can last for years
  • Treatment provides immediate, significant
    improvement in about 40 of cases
  • An additional 40 show moderate improvement
  • Follow-up studies suggest that 10 years after
    treatment, about 90 of patients have fully or
    partially recovered

Treatments for Bulimia Nervosa
  • Relapse can be a significant problem, even among
    those who respond successfully to treatment
  • Relapses are usually triggered by stress
  • Relapses are more likely among persons who
  • Had a longer history of symptoms
  • Vomited frequently
  • Had histories of substance use
  • Have lingering interpersonal problems
  • Finally, treatment may also help improve overall
    psychological and social functioning

The Best Wishes