Clients must be encouraged not to deviate from dietary plans or to skip therapy sessions. The importance of family participation in therapy must be emphasized. ● Encourage clients to keep a food journal, as appropriate. This would include the types of food eaten, how often they eat, and the feelings associated with eating and exercise. ● Some dietary plans include vitamin and mineral supplements. It is important that clients keep their healthcare providers informed of any medications and supplements they take, including prescription and over-the-counter medications, vitamins, minerals, and herbal supplements. No medications or other supplements should be added to the diet without the knowledge and approval of the clients’ healthcare providers. Such medications and supplements can interact with each other and adversely affect treatment outcomes. Clients and families (and even some healthcare professionals) might not be aware that over-the-counter and herbal preparations and vitamins and minerals can cause harmful side effects. ● Help clients to establish a target weight and support them as they work to achieve this goal. ● Monitor clients for suicidal ideation, especially those clients with depression or on an SSRI ● Be aware that clients may try to isolate themselves from family members, friends, work colleagues, and healthcare professionals who genuinely want to help them. Clients may view other people, even family members, as enemies who want them to gain weight and be fat. Help all persons involved in the clients’ plans of care to be on guard for isolation tendencies. Clients need emotional support to reach and maintain a state of health and wellness. Everyone involved in the clients’ treatment initiatives should be aware that clients sometimes have the urge to weigh themselves or check their appearance in a mirror quite frequently. These kinds of behaviors only increase anxiety and can lead to a relapse of unhealthy behaviors. ● Remember that treatment of anorexia nervosa is generally a lifelong process. Some experts refer to it as a chronic illness. This is not easy for clients and their loved ones to accept. Some clients who regain a normal weight and discontinue unhealthy behaviors that are linked to anorexia nervosa see themselves as completely cured. Caution clients, families, and professional colleagues that ongoing monitoring and therapy may be necessary, particularly during periods of anxiety or stress-provoking events such as the death of a loved one, job loss, or divorce. Healthcare professionals have an obligation to promote quality care that facilitates desired client outcomes and a duty to correct false perceptions about eating disorders that are prevalent in society today. Clients can receive mixed messages about eating disorders and being thin. Some of them even hear people (even friends and family) joke about weight loss, making comments such as, “I wish
I could have anorexia for a little while so that I could be thin, too” (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017). Such comments only exacerbate feelings of anxiety and possibly resentment of those who are promoting weight gain. Television, magazines, movies, and social media all promote, to some extent, the ideal view of a woman’s body as ultrathin. Celebrities are interviewed about weight loss, and so-called supermodels talk about how they stay thin. Some of them even joke about purging via self-induced vomiting and abusing laxatives and diuretics. Clients may feel that they are bombarded by a society that equates being very thin with being attractive and successful (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017). Healthcare professionals can help to promote wellness by taking the following actions (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017): ● Promoting positive role models: Contact media sites that endorse unrealistic presentations of women’s (and men’s) bodies. Remind clients and families that models or actors do not necessarily represent a healthy lifestyle just because they are thin or muscular. Also remind them that photographs and other images are often altered to make them appear much thinner or more muscular than they actually are. ● Working to expose websites that promote unhealthy eating (or failure to eat) lifestyles: The internet is a source of a wide variety of “proanorexia” websites. These sites are easily accessed by clients and families. The information on these sites generally reinforces beliefs that anorexia nervosa is a lifestyle choice, not a disease. ● Reminding healthcare professionals, as well as the general public, what a healthy weight actually is: There are so many extremes represented in the media that many people can no longer recognize what is healthy and what is not. ● Helping clients and families realize that they are not always the best judges of whether the client is at a healthy weight. This may be especially true if there is a family history of eating disorders. ● Helping clients and families to recognize situations that are likely to prolong recovery or to trigger relapses after a healthy weight is achieved: Healthcare professionals must also be taught to recognize such situations and help clients and families to know when to seek help if such situations occur. Clients must be taught how to access help when they encounter life events that can lead to unhealthy behaviors. In summary, anorexia nervosa is a serious, potentially life- threatening illness that could need lifelong monitoring and treatment. In addition to their local network of healthcare professionals, clients and families might find it helpful to join an eating disorder support group or to access organizations devoted to eating disorder recovery such as the National Association of Anorexia Nervosa and Associated Disorders (http://www.anad.org/; 630-577-1330).
BULIMIA NERVOSA
Evelyn is a 30-year-old management consultant for a prestigious consulting firm. She is married and is the mother of a 2-year-old girl. Evelyn is intelligent, slim, and attractive and is the envy of many people who know her. Her family, friends, and colleagues describe her as “having it all”: a successful career, a wonderful marriage, and a beautiful little girl. What they do not know is that Evelyn, in an attempt to fulfill her image of having the perfect life, including the perfect physical appearance, has been binging and purging since she was 20 years old. Evelyn suffers from bulimia nervosa, a psychological life- threatening eating disorder (Eating Disorder Hope, 2018a). The disorder is characterized by eating over a discrete period (generally within 2 hours) a very large amount of food. Eating in this manner is referred to as binge eating. The amount of food eaten is greater than what most persons would consume in a
similar period and under similar circumstances (Gersch et al., 2016). During binge-eating episodes, the client has no control over the amount of food being eaten and cannot stop eating. Binge- eating episodes can occur up to several times a day and are usually followed by feelings of guilt, humiliation, depression, and self-condemnation (Gersch et al., 2016). Bulimia nervosa can be classified in two ways (Eating Disorder Hope, 2018b): 1. Purging bulimia: Clients regularly self-induce vomiting or abuse laxatives, diuretics, or enemas after binging. Most clients with bulimia nervosa have purging bulimia. 2. Nonpurging bulimia: Clients use other methods to prevent weight gain after eating such as fasting or excessive exercise.
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