Introduction
To begin with we need to define first eating disorders, and briefly mention the different types of eating disorders. Eating disorders are characterised by one or more seriously disturbed eating behaviours such as food restriction or recurrent episodes of uncontrolled food consuming, and weight-control behaviours including self-induced vomiting, excessive exercising or the misuse of laxatives or diuretics. (Murphy et al. 2010). There are few types of eating disorders, and the common two types are anorexia nervosa and bulimia nervosa. A person with anorexia nervosa or bulimia nervosa is preoccupied with their weight, and their self-worth is dependent largely, or even exclusively, on their shape and weight and their ability to control them (Murphy et al. 2010). In this essay we will be discussing bulimia nervosa, its causes, nursing diagnoses, nursing care management, prevalence, population, and issues current and future mental health nursing practice and research implications, treatment, consumer and carer experience and treatment. Bulimia nervosa is characterized by regular, overwhelming urges to overeat (binge), followed by the use of compensatory behaviours to avoid weight gain such as self-induced vomiting, excessive exercise, food avoidance or laxatives misuse. (APA 2013, P 345). According to Michael et al, (2020), environmental and genetic factors usually cause eating disorders. Even though a lot of people consider eating disorders as a modern illness, those illnesses have been around since the 17th century.
Nursing intervention
Bulimia Nervosa is an eating disorder it can also called binge-purge syndrome as it distinguishes bulimia from other eating disorders by extreme overeating followed by voluntarily trying to vomit and get rid of the extra calories in an unhealthy way. Understanding of bulimia nervosa in the teenage population provides nurses an essential knowledge base to plan the treatment interventions for patients. Patients should be supervised during mealtime and after meals as well. Patients should be provided with smaller meals and allow patients to choose their meals, because big meals can make them feel bloated and urges the patient to initiate self-induce vomit. Nurses should monitor patients and identify elimination patterns, in some cases patients may hide the food in pockets and waste bins instead of eating. Patients with bulimia remain in the day room area with no bathroom right for a specific period after eating to prevent self-induced vomiting after eating. The most important one is assessing suicide potential in patients during hospital stay and planning for discharge as well. Patients from non-English speaking backgrounds need more attention and interpreters should be used to get the clear picture of their thoughts, and family members should be involved in the care with patient’s consent.
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Educate patients about the use of laxative emetic, and diuretic abuse in bulimia nervosa. Refer patients to nutritionists and dietitians and establish a realistic weight goal to achieve and maintain a regular weighing schedule. Refer patients to physiotherapy and make an exercise routine for them, moderate exercise will help with muscle tone and weight and also reduce depression, nurses may need to be more careful about patients exercise heavily to burn calories. Behaviour modification programs can be useful for patients and nurses, and it also builds trust between them. Nurses can involve patients while setting up the plan and giving them some controls in choices. Rewards can be provided to patients when they gain weight.
Treatment
Treatment of bulimia nervosa is available in a few steps and it involves several types of specialists, doctors, allied health, and patients may have to attend various appointments in different clinics. The treatment goal of bulimia is to restore normal eating behavior, and also address any psychological problems or trauma, and to treat any medical complications associated with bulimia.
Even though the treatment strategy depends on the patient's needs. The combination of nutritional counselling and psychotherapy can be initiated, and cognitive behavioural therapy (CBT) is preferred as well. The American Psychiatric Association (APA) guidelines for treating bulimia nervosa recommend the above-mentioned treatments. (Publishing, 2020). Nutritional counselling is preferably used to break the cycle of binge eating and purging. In this session patients are given the structure and pace of the meals and daily calorie intake also considered to maintain the weight of the patient. Cognitive behavioural therapy is the most effective therapy in adults with bulimia nervosa. This therapy is liked by patients as well, they identify manipulated thoughts about themselves and food, which underline their uncontrollable behaviour and then identify ways to cope with day to day life. The CBT provides 20 sessions over a five-month period and there is a guideline provided by APA to start medication after the 10th session if sessions only do not reduce symptoms. In practise, CBT combined with medication or with another psychotherapy works well and there is research to support this. (Publishing, 2020). Interpersonal therapy frames problems as a function of difficulties in relationships and tries to improve the relationship to address the eating disorder. (Publishing, 2020). Self-help strategies are available as well, there are some support groups available, online modes are to help. However, the research evidence is not as strong as compared to other therapies. It can be regarded as second help but not as primary treatment.(Publishing, 2020). SSRIs are used with eating disorder patients such as fluoxetine. The research has found out that this medication is helpful in adults and adolescents as well. Sertraline is also available but there is a little research about the drug, and it is mainly effective in adults. The dosage of the drug is usually higher to treat bulimia nervosa and can be prescribed from nine months to a year. SSRIs work well and must be combined with therapy for effective results. (Publishing, 2020)
There are some other medications are available as well, but the evidence is weak for alternatives. Monoamine oxidase inhibitors or tricyclic antidepressants are not well studied in bulimia nervosa. There is a warning issued by FDA against bupropion because it increases the risk of seizure. Topiramate trails show useful effects but often cause adverse effects and weight loss is one of the adverse effects.(Publishing, 2020)
Prevalence, population, and issues
Eating disorders in general affect people from different ages and different backgrounds. Most people affected by bulimia nervosa are between 16-18 years old, however, recently there is a growing number between people younger than 16 years old. According to (Butterfly foundation,2012), approximately 913,986 people in Australia have some sort of eating disorder which is almost 4% of the population, nearly 12% of those have bulimia nervosa. Females are more affected with bulimia nervosa than males. Bulimia nervosa is a hidden condition and hard to detect, and this is because normally people with bulimia nervosa have a normal weight unlike anorexia nervosa where people tend to be extremely underweight. 3% to 5% of the population in Australia have bulimia nervosa. (Gaskill, & Saunders, 2000). According to, (NEDC,210), Lifetime prevalence of bulimia nervosa in females is 0.9% to 2.1% and in males is only 0.1%. A study has been conducted in South Australia where almost 2977 participants were interviewed in the Health Omnibus Surveys, the study results were the following, the lifetime prevalence of bulimia nervosa was 1.21% for males while 2.59% for females. Another study was conducted 3 months ago and found that the bulimia nervosa prevalence was 0.40% for males and 0.81 for females. (Bagaric et al, 2020). In conclusion, based on the last study we can say that bulimia nervosa prevalence is not increasing in Australia. Asian women are getting affected by eating disorders due to westernization, and from the research we can see there is an increase in numbers since 2003. From the studies we can see three are two main reasons for the development of bulimia nervosa in Asian women, they are acculturation and culture clash. This survey was completed by eighty-one Chinese women and they were affected by perceived sociocultural influences to lose weight, overprotective parents, and self-perception of physical appearance. Those women were under high pressure to lose weight, and that pressure was coming from family and friends, especially parents. To lose weight the well-educated women were pressurized mainly from their fathers and best male friends, while on the other hand traditional women experienced the pressure from their mothers. Overall, as a result, those women found binge eating, self-inducing as the only solution to overcome their stress and pressure. (Humphry,T. et al, 2003).
Consumer and carer’s experience
This study aimed to identify the experiences of teenagers and their parents during care for eating disorders, these experiences can be positive or negative depending on the healthcare treatment settings or depends on the methods or ways of care that could be improved by the full analysis. Qualitative studies in the teenage case can help to facilitate a good comprehension of what consumers perceive as best care (Schmidt et al., 2017). Having a teenager with an eating disorder impacts the whole family and as well as the child. The family members emotional involvement, as well as such changes in routine including meetings with therapists and care groups, these all cause disturbances to family relationships and daily life patterns. The purpose of this study is to identify the difficulties that parents face and how they adapt these changes. There is one example to explain parents' experience and impacts of this on children. A questionnaire that includes subjective and qualitative enquiries finished by 52 moms in Ontario. These findings show there is a noteworthy impact on relationships associated with the age of a kid. Personal leisure and the confusion level in the family. These findings differentiate the way how families cope up the situation when their child is in crisis, either empathetically. The guardians give accommodating suggestions to scientists, professionals, and service providers (McArdle, 2017). By analysing some more experiences, teenagers and their parents want better care that can fastly lead them towards recovery. Eating disorders lead to anxiety, depression, substance abuse or alcohol, self-injury, borderline personality disorder or obsessive-compulsive disorder. These things can affect people’s occupation, their relationships, and their personal life. Depression leads to sadness, changes in sleeping habits, suicidal ideations, or self-injury (Jones et al., 2012).
Current and future mental health practice and research implementation
The prevalence and incidence of Eating Disorders in Australia is increasing and constitutes the third most common chronic disorder in adolescence. Effective, targeted prevention and intervention strategies will reduce the incidence and duration of the illnesses (Eating disorders Victoria, n.d.). In current mental health practice, comprehensive cognitive behavioural approach, self-monitoring, body image therapy, energy balance training, psychoeducation and relapse prevention has been effective evidence based practice for the treatment of bulimia nervosa (oxford academy, 2017). Research supports the recovery from eating disorders such as bulimia nervosa is possible, though it might take longer. A recent, large 22‐year follow‐up study of 228 women with anorexia nervosa or bulimia nervosa treated in a specialist centre found the majority around two third of them recovered, and patient with bulimia nervosa were among the most successful recovered within 9 years (Wiley online library, 2020). Care for people with eating disorders should be provided within a framework that supports the values of recovery-oriented care (Australian Health Ministers Advisory Council, 2013). Effective psychological therapies are the first line in care and most people recover in the medium to longer term. The National Institute of Clinical Excellence (NICE) guidelines suggest that people should have equal access to treatment regardless of their cultural background, gender, and age. It has given Cognitive behaviour therapy the grade of ‘A’ reflecting the evidence of strong empirical data and recommended a psychological therapy as the initial intervention for a psychiatric disorder. evidence also supports guided self-help (GSH) can be used effectively as the first line of treatment (NICE, 2018). A major issue associated with bulimia nervosa in the culturally and linguistically different background is that they delay seeking help and care for a decade or longer. Research shows there has been an increased number of eating disorders in Chinese Australian population since 2003 due to the acculturation and cultural clash (Humphry, T. et al, 2003). National eating disorders collaboration (2010) suggest the consistent, coordinated national continuum of care approach to the promotion, prevention, early intervention, treatment, and management of eating disorders. By Involving multidisciplinary team of registered dietitian, specialist physician/paediatrician, psychiatrist, nurses, an exercise therapist, activity/occupational therapist and social worker or family therapist will enhance care and outcomes of people with eating disorders in both inpatient and community treatment settings (Wiley online library. 2020).For the future practices, Eating Disorders need to be recognised as a significant priority and focus on providing care that meet the individualise need and providing a recovery-oriented care approach involving families and communities. Research found that one of the significant challenges is to be able to provide accessible and seamless delivery of treatment services across the full continuum of care, which can be achieved by accessing different collaborative services, cross-sector professional networks and eating disorder centres. However, more research is needed to fully understand the effectiveness of this program (National eating disorders collaboration, 2010).
Conclusion
Eating disorders are common in Australia and increasing in population with culturally and linguistically different backgrounds. Young people with eating disorders encounter enormous stress and pressure due to acculturation and culture clash. In addition, sociocultural influences of weight loss, family pressure and physical appearance play a big role in binge eating and developing eating disorders. However, recovery is possible but the way to recovery can be sustained. Through effective treatment and intervention, people with eating disorders and bulimia nervosa need consistent support from the medical services in addition to psychological therapy, evidence-based practice, family therapy, involving communities and recovery-oriented care.
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