Thus many women speak of being “good” when they
stick to their diet and “bad” when they eat desserts
or snacks.
Pressure from others also may contribute eat-
ing disorders. Sherwood, Neumark-Sztainer, Story,
Beuhring & Resnick (2002) noted that pressure from
coaches, parents, and peers and the emphasis placed
on body form in sports such as gymnastics, ballet, and
wrestling can promote eating disorders in athletes.
Parental concern over a girl’s weight and teasing
from parents or peers reinforces a girl’s body dis-
satisfaction and her need to diet or control eating in
some way.
CULTURAL CONSIDERATIONS
Both anorexia nervosa and bulimia nervosa are far
more prevalent in industrialized societies, where
food is abundant and beauty is linked with thinness
(Patel et al., 1998). For example, before 1995 there
was little television on the Island of Fiji. Eating dis-
orders were almost nonexistent and being “plump”
was considered the ideal shape for girls and women.
In the 5 years following the widespread introduction
of television, the number of eating disorders in Fiji
skyrocketed (Sorgen, 2002).
Eating disorders are most common in the United
States, Canada, Europe, Australia, Japan, New
Zealand, and South Africa. Immigrants from cultures
in which eating disorders are rare may develop eat-
ing disorders as they assimilate the thin-body ideal
(APA, 2000).
Eating disorders appear equally common among
Hispanic and white women and less common among
African American and Asian women (Halmi, 2000).
Minority women who are younger, better educated,
and more closely identified with white, middle-class
values are at increased risk for developing an eating
disorder.
Over the past several years, eating disorders
have shown a staggering increase among all U.S. so-
cial classes and ethnic groups (Jacob, 2001). With
today’s technology, the entire world is exposed to the
Western ideal, which equates thinness with beauty
and desirability. As this ideal becomes widespread
to non-Western cultures, anorexia and bulimia will
likely increase there as well.
TREATMENT
Anorexia Nervosa
Clients with anorexia nervosa can be very difficult
to treat because they are often resistant, appear
uninterested, and deny their problems. Treatment
settings include inpatient specialty eating disorder
units, partial hospitalization or day treatment pro-
grams, and outpatient therapy. The choice of setting
depends on the severity of the illness, such as weight
loss, physical symptoms, duration of binging and purg-
ing, drive for thinness, body dissatisfaction, and co-
morbid psychiatric conditions. Major life-threatening
complicationsthat indicate the need for hospital ad-
mission include severe fluid, electrolyte, and meta-
bolic imbalances; cardiovascular complications; se-
vere weight loss and its consequences (Muscari,
2002); and risk for suicide. Outpatient therapy has
the best success with clients who have been ill for less
than 6 months, are not binging and purging, and have
parents likely to participate effectively in family ther-
apy (Halmi, 2000).MEDICAL MANAGEMENT
Medical management focuses on weight restoration,
nutritional rehabilitation, rehydration, and correc-
tion of electrolyte imbalances. Clients receive nutri-
tionally balanced meals and snacks that gradually
increase caloric intake to a normal level for size,
age, and activity. Severely malnourished clients may
require total parenteral nutrition, tube feedings, or
hyperalimentation to receive adequate nutritional
intake. Generally, access to a bathroom is supervised
to prevent purging as clients begin to eat more food.
Weight gain and adequate food intake are most
often the criteria for determining the effectiveness
of treatment.PSYCHOPHARMACOLOGY
Several classes of drugs have been studied, but few
have shown clinical success. Amitriptyline (Elavil)
and the antihistamine cyproheptadine (Periactin)
in high doses (up to 28 mg/day) can promote weight
gain in inpatients with anorexia nervosa. Olanza-
pine (Zyprexa) has been used with success because
of both its antipsychotic effect (on bizarre body
image distortions) and associated weight gain. Flu-
oxetine (Prozac) has shown some effectiveness in
preventing relapse in clients whose weight has been
partially or completely restored. Close monitoring is
needed, because weight loss can be a side effect (Zhu
& Walsh, 2002).PSYCHOTHERAPY
Family therapy may be beneficial for families of clients
younger than 18 years. Families who demonstrate
enmeshment, unclear boundaries among members,
and difficulty handling emotions and conflict can442 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS