MHM103.pdf

11/16/23, 11:17 AM Realizeit for Student Anorexia Nervosa Onset and Clinical Course Anorexia nervosa typically begins between the ages of 14 and 18 years. In the early stages, clients often deny having a negative body image or anxiety regarding their appearance. They are pleased with their ability...

11/16/23, 11:17 AM Realizeit for Student Anorexia Nervosa Onset and Clinical Course Anorexia nervosa typically begins between the ages of 14 and 18 years. In the early stages, clients often deny having a negative body image or anxiety regarding their appearance. They are pleased with their ability to control their weight and may express this. When they initially come for treatment, they may be unable to identify or to explain their emotions about life events such as school or relationships with family or friends. A profound sense of emptiness is common. As the illness progresses, depression and lability in mood become more apparent. As dieting and compulsive behaviors increase, clients isolate themselves. This social isolation can lead to a basic mistrust of others and even paranoia. Clients may believe their peers are jealous of their weight loss and may believe that family and health care professionals are trying to make them “fat and ugly.” For clients with anorexia, about 30% to 50% achieve full recovery, while 10% to 20% remain chronically ill. Compared to the general population, clients with anorexia are six times more likely to die from medical complications or suicide. Clients with the lowest body weights and longest durations of illness tended to relapse most often and have the poorest outcomes. Clients who abuse laxatives are at a higher risk for medical complications. Table 20.2 lists common medical complications of eating disorders. TABLE 20.2 Medical Complications of Eating Disorders Body System Symptoms Related to Weight Loss Musculoskeletal Metabolic Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures Hypothyroidism (symptoms include lack of energy, weakness, intolerance to cold, and bradycardia), hypoglycemia, and decreased insulin sensitivity https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/4 11/16/23, 11:17 AM Realizeit for Student Bradycardia, hypotension, loss of cardiac muscle, small heart, cardiac Cardiac arrhythmias (including atrial and ventricular premature contractions, prolonged QT interval, ventricular tachycardia), and sudden death Gastrointestinal Reproductive Dermatologic Hematologic Neuropsychiatric Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea Amenorrhea and low levels of luteinizing and follicle-stimulating hormones Dry, cracking skin due to dehydration, lanugo (i.e., fine, baby-like hair over body), edema, and acrocyanosis (i.e., blue hands and feet) Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, and hypercarotenemia Abnormal taste sensation, apathetic depression, mild organic mental symptoms, and sleep disturbances Related to Purging (Vomiting and Laxative Abuse) Metabolic Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, hypomagnesemia, and elevated blood urea nitrogen Salivary gland and pancreas inflammation and enlargement with an increase in Gastrointestinal serum amylase, esophageal and gastric erosion or rupture, dysfunctional bowel, and superior mesenteric artery syndrome Dental Neuropsychiatric Erosion of dental enamel (perimyolysis), particularly front teeth Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies, fatigue, weakness, and mild organic mental symptoms https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/4 11/16/23, 11:17 AM Realizeit for Student Adapted from Call, C. C., Attia, E., & Walsh, B. T. (2017). Feeding and eating disorders. In B. J. Sadock, V. A. Sadock, & P. Ruiz (Eds.), Comprehensive textbook of psychiatry (10th ed., Vol. 1, pp. 2065–2982). Philadelphia, PA: Lippincott Williams & Wilkins. Treatment and Prognosis Clients with anorexia nervosa can be difficult to treat because they are often resistant, appear uninterested, and deny their problems. Treatment settings include inpatient specialty eating disorder units, partial hospitalization or day treatment programs, and outpatient therapy. The choice of setting depends on the severity of the illness, such as weight loss, physical symptoms, duration of binging and purging, drive for thinness, body dissatisfaction, and comorbid psychiatric conditions. Major lifethreatening complications that indicate the need for hospital admission include severe fluid, electrolyte, and metabolic imbalances; cardiovascular complications; severe weight loss and its consequences; and risk for suicide. Short hospital stays are most effective for clients who are amenable to weight gain and who gain weight rapidly while hospitalized. Longer inpatient stays are required for those who gain weight more slowly and are more resistant to gaining additional weight. Outpatient therapy has the best success with clients who have been ill for fewer than 6 months, are not binging and purging, and have parents likely to participate effectively in family therapy. Cognitive– behavioral therapy (CBT) can also be effective in preventing relapse and improving overall outcomes (Costa & Melnik, 2016). Medical Management Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances. Clients receive nutritionally balanced meals and snacks that gradually increase caloric intake to a normal level for size, age, and activity. Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Generally, access to a bathroom is supervised to prevent purging as clients begin to eat more food. Weight gain and adequate food intake are most often the criteria for determining the effectiveness of treatment. Psychotherapy Family therapy may be beneficial for families of clients younger than 18 years. Families who demonstrate enmeshment, unclear boundaries among members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication. Family therapy is also useful to help members be effective participants in the client’s treatment. Family-based early intervention can prevent future exacerbation of anorexia when families are able to participate in an effective manner. However, in a dysfunctional family, significant improvements in family functioning may take 2 years or more. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 3/4 11/16/23, 11:17 AM Realizeit for Student Individual therapy for clients with anorexia nervosa may be indicated in some circumstances; for example, if the family cannot participate in family therapy, if the client is older or separated from the nuclear family, or if the client has individual issues requiring psychotherapy. Therapy that focuses on the client’s particular issues and circumstances, such as coping skills, self-esteem, self-acceptance, interpersonal relationships, and assertiveness, can improve overall functioning and life satisfaction. CBT, long used with clients with bulimia, has been adapted for adolescents with anorexia nervosa and used successfully for initial treatment as well as relapse prevention. Enhanced cognitive– behavioral therapy (CBT-E) has been even more successful than CBT. In addition to addressing the body image disturbance and dissatisfaction, CBT-E addresses perfectionism, mood intolerance, low self-esteem, and interpersonal difficulties (Calugi, El Ghoch, & Dalle Grave, 2017). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 4/4