00:02
So, what do we do for patients
who have these
three types of eating disorders?
Well, there's medical treatments.
00:10
And the first medical treatment
I'm going to talk about
is behavior modification.
00:15
That can be in the hospital,
Milieu treatment
with behavioral reward systems.
00:20
So as we set small goals
for the patient,
as they achieve that goal,
there's some sort of
behavioral reward system,
so that they feel good
about achieving those goals.
00:35
There's also individual therapy.
00:38
You want to make sure that a patient
who has an eating disorder
is with a therapist,
who is specifically trained
to work with patients
who have eating disorders.
00:50
Cognitive behavioral therapy
has been demonstrated
to be very effective
with eating disorders.
00:57
Again, you need to be trained
in cognitive behavioral therapy
in order to conduct
that kind of psychotherapy.
01:07
Group therapy is also used
for patients with eating disorders.
01:14
We want to include the family.
01:18
One of the things with any
psychiatric disorder,
whether it's a
substance use disorder,
an eating disorder,
or a psychiatric disorder.
01:29
It's never one person
who has this disorder.
01:32
We come from our family.
01:34
Our family requires treatment
in order to support recovery.
01:38
So talk to the patient's family,
see if the patient's family is
willing to go into family therapy,
so that the whole environment
starts becoming safe
for that patient to return.
01:53
There's also psychopharmacology.
01:56
There are medications that we
are able to give to the patient.
02:00
So, we want to find out,
what is the underlying
psychiatric problem
that is affecting the patient
to the point where
they will starve themselves,
or will they will binge
until they are sick?
For the most part,
when we commonly see
a medication being prescribed.
02:24
For a person with
an eating disorder,
it's usually Prozac.
Also, it's called fluoxetine.
02:31
One of the things that we know
about antidepressants
is that most of them come with
a 7 to 10 pound weight gain.
02:41
For a person who has
a binging disorder,
the Prozac also works.
02:47
We have to work with them
to make sure
that they don't have the full
10 pounds of weight gain.
02:53
But it helps them
to start gauging their eating
and reducing the binging
which in fact causes weight loss,
despite the fact that they are on
an anti-depressant like Prozac.
03:07
What kind of nursing diagnoses
do we see in eating disorders?
Again, we're going to be listening
and watching our patient.
03:15
Our nursing diagnosis
starts with the patient.
03:20
So we're going to see
a person in front of us
who is either not eating at all,
eating and vomiting,
or unable to stop eating.
03:30
So we know just by their behavior,
our first nursing diagnosis
must be imbalanced nutrition.
03:39
We also know that
these are the patients
who when they look in the mirror,
they don't like what they see
whether they are thin or heavy,
they have a perception
of a disturbed body image.
03:53
And so that could be
another nursing diagnosis
specific to eating disorders.
04:00
As we talk to our patients,
we might find that they say,
"Nobody cares anyway.
Why should I care about myself?
I'm not worth it."
And we start thinking about the fact
that they have low self worth,
and they have low self esteem.
04:17
And so that could be
another nursing diagnosis.
04:22
"I don't have an eating problem.
04:25
I'm very happy
with the way I'm eating.
04:28
It's not a problem.
04:30
I don't know why everyone's making
such a big deal of it." they'll say.
04:34
And what nursing diagnosis is that?
So those of you who said denial,
you're right.
04:44
It is very likely that
the person will deny
that their eating disorder
is a disorder.
04:52
They like who they are.
Leave me alone.
04:56
All of these lead us to the biggest
one, which is risk for injury.
05:03
Because of the loss of calcium,
because of the
orthostatic hypotension,
because of the cholesterolemia.
05:11
Because we have high cholesterol,
increase heart attack,
these are patients who are
at very high risk for injury.
05:20
And so we have to be aware
of that as well.
05:27
What is the first thing that
we must be in looking around us
and making sure that we are doing?
We want to keep our patients safe.
05:37
We want to help them through
to and through recovery.
05:42
We want to make sure
that there is a diet plan
that comes from a dietitian,
who is a specialist in this area
that can provide
the adequate nutrition
and we'll have a realistic plan
for weight gain.
05:59
We also want to make sure
that we are working with
our clients and our patients,
for them to explore their feelings,
for them to look into
what they are afraid of.
06:11
Because that fear,
and those feelings
are part of their disorder.
06:18
And then we want to help them
to develop a positive
relationship with food.
06:25
Right now, while they have
this eating disorder,
food may be their enemy.
06:31
And that is if they are
binging and purging,
or if they are starving themselves,
or their relationship with food
as their priority.
06:42
And the only relationship
that they want
if they are just playing binging.
06:47
So let's help them to develop
a different relationship,
a more positive relationship
with food,
to see it as a way
to feed the body
just enough
so our bodies are healthy.
07:00
That food is not the purpose.
07:03
Our body being healthy
is the purpose.
07:06
And then we have to try
and help them to achieve
a realistic perception
of their own body image.
07:15
We want to encourage their
participation in the program.
07:20
They need to be an
active participant.
07:23
They have to have a capacity
to make independent decisions,
so that we help them learn
how to have a feeling of control
of their environment.
07:34
And what happens next?
We don't want to take over.
07:38
Because oftentimes, when you have
a person with an eating disorder,
control is really the thing
that they are looking to have.
07:47
Total control.
07:48
Whether it is total control
about not eating anything,
or total control,
about eating everything,
and throwing up,
or total control about amassing food
and killing themselves
by eating too much.
08:02
So, let's move them back into
independent decision making
that promote those sense of control
of the environment.
08:11
But without having to have
total control.
08:16
We want to use positive feedback.
08:18
We want to help
these patients understand
that they can control their life,
instead of maladaptive
eating behaviors
to establish some sort of control.
08:31
Although,
there are some similarities
that we see between
substance use disorders
and I hope that you've
been able to see them,
and eating disorders.
08:41
There are really some
important differences
that we have to keep ourselves
well aware of.
08:47
Were both of them
substance and eating disorders
have a main goal
to pursue immediate effects.
08:55
People who have eating disorders
have a long range goal.
09:01
And especially for those
with anorexia nervosa,
that goal is self-starvation.
09:10
Where the drug of choice has
increased the value to the person
who has an STD.
09:15
So, if it's cigarettes,
if it's heroin,
if it's anxiolytic,
that drug is really the thing
that they want more than anything.
09:27
It is the long term effect
of weight loss,
not the denial of eating,
which is the obsession for the
person with the eating disorder.
09:39
Also, when you're looking at someone
who has a substance use disorder,
there's a real negative stigma
attached to it.
09:49
Society does not like a person
who has a substance use disorder.
09:56
But there's a real
positive consequence
for those who are very thin.
10:01
And society actually strives
to make it look better
for people to be thin.
10:08
And to make people who are not thin
feel as though they're overweight.
10:15
If a person is struggling and
trying desperately to recover
from their substance use disorder,
and they want to stop using, or
misusing, or abusing that substance.
10:27
They have a real fear of relapsing.
10:31
They don't,
once they start in recovery,
the idea of going back out
and smoking again
or having that drink,
it's frightening because they know
if I have one, it won't be enough.
10:44
This is a real difference
from those people
who have eating disorders,
because they love being thin.
10:51
And when they start gaining weight,
they often are very ambivalent.
10:56
They can't weigh whether or not
this is a good new look for them.
11:01
And so they are ambivalent
about slipping
and going back
to the eating disorder.