Complications of Anorexia Nervosa Following are some of the potentially life-threatening complications of anorexia nervosa: ● Suicide: There is a significant risk of suicide associated with anorexia nervosa. The mortality rate for clients with anorexia nervosa is about 20%. At least 20% of these deaths are suicide (Smith, 2018). ● Malnutrition and near starvation: Lack of proper nutrition can lead to electrolyte imbalances, arrhythmias, and renal failure. If laxative abuse occurs, changes in the bowel can be similar to those in chronic inflammatory bowel disease (Gersch et al., 2016; Videbeck, 2017). Diagnostic Criteria for Anorexia Nervosa The following statements summarize the diagnostic criteria for anorexia nervosa as identified in the DSM-5 (American Psychiatric Association, 2013): ● Restriction of energy intake relative to requirements: This leads to a significantly low weight for age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected. ● Intense fear of gaining weight or becoming overweight or ongoing behaviors that interfere with weight gain. ● Disturbance in the way in which one’s weight or shape is experienced: There is undue influence of body weight or Treatment The major treatment goals of anorexia nervosa are restoring weight lost from severe dieting and purging; treating psychological disturbances associated with body image issues; and achieving either long-term remission and rehabilitation or full recovery (Psychology Today, 2018). A multidisciplinary clinical approach that includes nurses, physicians, social workers, nutritionists, and psychologists is essential for the implementation of a successful treatment program. Client and family involvement in the development, implementation, and evaluation of treatment are also essential if treatment initiatives are to work (Gersch et al., 2016; Videbeck, 2017). Clients with anorexia nervosa often vigorously resist treatment. They deny they have a problem and are often interested only in continuing to lose weight (Gersch et al., 2016; Videbeck, 2017). A variety of treatment settings are available for clients with anorexia nervosa. Regardless of the setting, treatment should be initiated by healthcare professionals who have knowledge of the disorder and expertise in treating it. Hospitalization is needed if the client’s life is in immediate danger, if there is severe malnutrition, if there are medical complications, or if there are severe mental health issues (Mayo Clinic, 2018c; Videbeck, 2017). If clients are agreeable to weight gain, gain weight quickly while hospitalized, and are compliant with the treatment regimen, short hospitalization stays are generally effective. However, longer stays are indicated for clients who are resistant to treatment and gain weight slowly. The length of inpatient hospitalization could be as short as two weeks or as long as several months or even years (Gersch et al., 2016; Videbeck, 2017). The choice of setting depends on the severity of the disorder, such complications as electrolyte imbalance and cardiovascular compromise, and coexisting mental health conditions. The need for immediate hospitalization exists if the client is experiencing severe fluid, metabolic, or electrolyte imbalances; cardiovascular complications; or suicidal ideation (Gersch et al., 2016; Videbeck, 2017). Clients who benefit most from outpatient therapy are those who have been ill for less than six months, do not binge and purge, and have parents and other family members who actively participate in family therapy (Videbeck, 2017).
● Cardiovascular compromise: Possibly fatal cardiovascular complications include a decrease in left ventricular muscle mass and heart muscle mass. Cardiac output may be reduced. ECG may show a prolonged PR interval. Heart failure and sudden death may occur, perhaps because of ventricular arrhythmias (Gersch et al., 2016; Videbeck, 2017) Healthcare consideration : Nurses must be alert to signs and symptoms of complications and promptly report any signs and symptoms that require prompt medical intervention. shape on self-evaluation or ongoing lack of recognition of just how serious the client’s low body weight is. Clients have a disturbance in perception of body image. The DSM-5 identifies two subtypes of anorexia nervosa (American Psychiatric Association, 2013): 1. Restricting type: During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. 2. Binge-eating/purging type: During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior. General Summary of Treatment Initiatives Life-threatening complications must be dealt with immediately. Restoration of fluid and electrolyte balance, treatment of metabolic imbalances, and restoration of effective cardiovascular functioning are imperative (Videbeck, 2017). Clients must be assessed for suicidal ideation. Risk level for suicide is evaluated by obtaining an accurate history of any past suicide attempts; recent expression of suicidal thoughts; and current state of suicidal thoughts, including any plans clients may have made to take their own lives. Gathering information from clients themselves as well as from family, friends, and coworkers as indicated can be helpful. Clients may not always be forthcoming about suicidal ideation. Clients should be monitored for suicide attempts and observed as often as indicated by assessment results. In addition, clients should not have access to sharp objects or other devices that could be used for self-harm. It is also important to ensure that clients actually swallow any medications they are given. Some clients hoard medication for self-harm (Koutek et al., 2016; Videbeck, 2017). After life-threatening complications are dealt with and the possibility of death is no longer imminent, treatment focus shifts to weight restoration and achievement of appropriate self- image. Dietary modifications are implemented to achieve not only weight gain but also normal eating habits. Clients are helped to develop a dietary plan based on age, height, activity level, lifestyle, and personal food and beverage preferences. Usually, access to the bathroom is supervised to prevent purging. This is especially important as clients begin to gain weight. As they notice weight gain, they may become more determined to find ways to purge or to pretend to eat. Mealtimes must be closely supervised to ensure that clients are actually eating and not hiding food in clothing or “pocketing” food inside their mouths to avoid swallowing (Gersch et al., 2016; Videbeck, 2017). Refeeding, nutritional plans, and weight restoration are critical to the treatment of clients. These initiatives are part of the medical stabilization process if recovery is to be achieved. However, refeeding may be accompanied by a potentially fatal complication called refeeding syndrome (Eating Disorder Hope, 2018d).
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