Page 171 - Encyclopedia of Nursing Research

138 n EATiNG DiSORDERS

with anorexia nervosa. These women usu- seek treatment for anxiety or depression,
ally fear obesity and see themselves as over- only one third were asked if they suffered
E weight even when they are not (Cyr, 2008). from an eating disorder; however, if ques-
They have a preoccupation with eating and tioned, half of the women reported they
restrict the amount of food eaten (some- would not disclose their eating disorder to
times to the point of starvation) or regularly the health care provider (Mond et al., 2010).
engage in binge eating or self-induced vomit- Substance abuse is closely aligned to eat-
ing (Robert-McComb, 2001). Bulimia involves ing disorders, and 18% of older women with
eating excessive amounts of food followed by eating disorders admit to a substance abuse
multiple episodes of self-induced vomiting problem (Carr & Kaplan, 2010). Detection of
(Cyr, 2008) as well as the misuse of laxatives, eating disorders is difficult in that it tends to
diuretics, or enemas. Bulimia affects 1% to be hidden by the patient, but compounding
3% of the U.S. population, which is most this problem is that nurses and other health
likely an underestimation (Broussard, 2005). professionals often lack the knowledge and
Similarly, calorie restriction is controlled by insight necessary to detect and treat eating
excessive exercise. A woman may lose 50% disorders (Mond et al., 2010).
of her ideal body weight; however, women When an eating disorder is detected,
with bulimia already tend to be below, at, health care providers must identify con-
or exceed ideal body weight. Complications cerns regarding follow-up intervention par-
include dehydration, fluid and electrolyte ticularly in the 25% of older women who
imbalance, renal failure, metabolic acido- do not respond to current therapies for rea-
sis, arrhythmias, sudden death, endocrine sons yet unknown (Carr & Kaplan, 2010).
abnormalities, and neurological dysfunction Problematic is the disconnect in perceived
(Robert-McComb, 2001). recovery from eating disorders between the
Anorexia nervosa was first recognized as medical perspective and that of the patient.
a disorder in the nineteenth century and was Medical recovery has been based on the
thought to be on the rise in the twentieth cen- patient’s decreased obsession with body
tury. Treatment consisted of neuroleptics in the weight, return of a regular menstrual cycle,
1950s and 1960s and later shifted to individual and weight maintenance. Patients, however,
psychotherapy. in the 1970s, family therapy describe recovery as developing a sense of
was emphasized, and by the late twentieth control over their lives and of achieving a
century, medications were used as an adjunct renewed sense of self (Patching & Lawler,
to psychotherapy (Steinhausen, 2002). 2009). Therefore, not only is there a need for
The cost of treating an eating disorder in consensus about what constitutes recovery
the United States ranges from $500 to $2,000 but also for innovative approaches to treat-
per day. Many patients require in-patient ment as well as tailored protocols (Johnston,
treatment for at least 3 to 6 months costing Fornai, Cabrini, & Kendrick, 2007). Future
$30,000 per month or $90,000 to $180,000 research needs to focus on exploring and
for the total length of stay (Agras, 2001). understanding these disorders from the
Unfortunately, many insurance companies women’s standpoint rather than placing
do not cover the cost of treating eating disor- these women into a predetermined medical
ders (South Carolina Department of Mental treatment template which tend to be unsuc-
Health, 2010). cessful (Patching & Lawler, 2009).
Eating disorders are closely connected Women living with eating disorders
with impaired psychosocial functioning, but feel isolated and ashamed and are not able
less than 40% of those suffering from these to effectively verbalize their difficulties.
disorders have obtained treatment from a One approach that addresses these feelings
health care provider. Of the 80% who did is to increase allocation of funding directed