Anorexia/Bulimia

Anorexia/Bulimia

Signs and Symptoms
1. Hard skin on knuckles
2. Menstrual cycle stops (amenorrhea)
3. Excessive weight loss
4. Lying to others about food consumption and weight loss
5. Find it difficult to think about anything else other than food
6. Engagement in lots of high impact activites and over exercising
7. Tooth decay and bad breath
8. Growth of fine hair on body and face
9. Thinning and loss of hair
10. Pain in abdomen
11. Swelling in feet and hands
12. Intolerance to cold
13. Light headed or dizzy
Causes
1. Biological Factors
  1. Malnutrition
  2. Brain becoming sensitive to the amino acid tryptophan
2. Psychological Factors
  1. Tendency/prone to toward anxiety and/or depression
  2. Poor or weak reaction to stress
  3. Excessive restraint or control in other areas of life
3. Enviromental Factors
  1. Going through puberty
  2. Living in a culture where thinness is sdesierable/media related/social pressure to be thin
  3. Abuse
Potential Impacts
1. Physical
  1. Hormone imbalance due to menstrual cycle stopping (amenorrhea)
  2. Lack of energy due to lack of nutrience
  3. Anemia
2. Interlectual
  1. Lack of concentration at school or work
3. Emotional
  1. Striving for perfection and needing to have control so may feel frustrated
  2. Depression due to a build up of anxiety
  3. Anxiety
  4. Obsessive attitude
  5. Cycle of guilt
4. Social
  1. Social phobia
  2. Secrecy about the condition between patient and friends and family may lead to isolating themselves and losing interest with other people
5. Financial
  1. Time off work due to illness
Treatments and Managment
1. Cognitive Analytical Therapy (CAT)
  1. Three-stage process
    1. Reformulation - looking for past events that may explain why the unhealthy patterns developed
    2. Recognition - helping people see how these patterns are contributing towards the anorexia
    3. Revision - identifying changes that can break these unhealthy patterns
2. Cognitive Behavioural Therapy (CBT)
  1. CBT is based on the theory that how we think about a situation affects how we act and that, in turn, our actions can affect how we think and feel.
    1. "putting on weight is the single worst thing that can happen in my life"
    2. "everyone I know secretly thinks I am fat"
    3. "if I finish the whole meal then people I am eating with will think I am greedy and worthless"
3. Focal Psychodynamic Therapy (FPT)
  1. FPT is based on the theory that mental health conditions may be associated with unresolved conflicts that occurred in the past, usually in childhood.
    1. The therapy encourages people with anorexia to think about how early childhood experiences may have affected them. The aim is to find more successful ways of coping with stressful situations and negative thoughts and emotions.
4. Interpersonal Therapy (IPT)
  1. IPT is based on the theory that relationships with other people and the outside world in general have a powerful effect on mental health.
    1. During IPT, the therapist will explore negative issues associated with your interpersonal relationships and how these issues can be resolved.
Patient Care Pathway
1. Anorexia nervosa is a serious mental health condition. It is an eating disorder in which people keep their body weight as low as possible.
2. Bulimia nervosa is a serious mental health condition. It is an eating disorder in which people binge eat but then make themselves sick or take laxatives so the food they have eaten does not digest
3. Read the question: how they got to the treatment - old or new diagnosis?
  1. Old - patient already involved with a Community Mental Health Team
  2. New - after being diagnosed, care professionals will help the patient with their treatment and management and get the patient involved with a Community Mental Health Team
4. Professional involved within the treatment would be: GP, practice nurse, pharmacist (administer of the drugs/medical intervention) and social workers
5. Social workers may be involved in the care, supporting regarding housing, employment and support for the care of children who's parent are not in work due to the medical condition.
6. Steps and Milestones
  1. Initial visit to medical services : GP, accident and emergency
  2. History of illness is taken by medical profession working with the patient. This could be the medical nurse, GP, doctor in the hosptal
  3. Risks assessment will be taken by medical professional working with the patient. This could be the medical nurse, GP, doctor in the hospital
  4. Education about the treatment process for the condition will be done by the psychologist who I caring for the patient
  5. Psychological support given to the patient is important for the mental wellbeing of the patient. Anti depressants e.g. Prozac may be given alongside counselling, CBT and IPT
Patient Centred Approach
1. Put at the centre of the care process
2. Thoes involved in the patients care will try to recognise ways in which the patient can take responsibility for their owen health and wellbeing
3. The patient will need help to make appropriate health and lifestyle changes to mmanage the anorexia/bulimia
4. Involved in the decision making as an equal partner (when appropriate - reference to age and/or mental health. Possible links to parents and/pr medical staff making the decisions)
5. Family/medical staff may need to make decisions for the patient
6. Patient will be treated with dignoty and respect. This will also help the patient be more engaging and involved in their own care (e.g. decisions about increasing food consumption, dietairy choices, exercise)
7. Practitioners will show understanding and compassion as the patient will feel vulnerable (reference to metal health)
Diagnosing
1. The patient is not likely to self diagnose themselves and so it would be someone else who tells them to go see their GP but in most cases, the condition progresses so far, medical intervention needs to be immediately taken in a hospital. Some people will go to their GP when their periods stop and then will be diagnosed with anorexia
  1. GP
    1. The GP will usually check you weight. If someone has anorexia nervosa, their weight is generally at least 15% below average for their age, sex and height.
    2. The GP will also calculate you body mass index (BMI) A healthy BMI for adults is 18.5 to 24.9, although in some cases doctors may be concerned if you have a BMI below 20. Adults with anorexia generally have a BMI below 17.5.
    3. Your GP may also ask you to carry out some simple physical exercises, such as moving between sitting, squatting and standing, to assess your muscle strength.

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	Created by Katie Inwood over 9 years ago

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