Mental Health, Mental Illness and the Principles of Recovery - Essay Example

Eating Disorder Case Study Introduction The focus of this essay is on the case study of a patient with eating disorder. The patient is a 23 year old woman named Tania and presents symptoms of eating disorder such as drastic weight loss, restrictive eating, excessive excising and being too much concerned with dieting. Treatment of an eating disorder is principally a mental health issue and hence nurses and other healthcare providers who care for patients like Tania should provide physical care as well as psychological care. Therefore, this essay will discuss eating disorder as a mental illness, tackle Tania’s assessment and also tackle the patient’s health needs as well as the required treatment. In addition, the essay will provide a reflection on implication for practice as a healthcare provider. Mental Health, Mental Illness and the Principles of Recovery Eating disorders are primarily mental disorders typified by severe disturbances of eating behavior (Chakraborty & Basu 2010, Pg. 1). Anorexia nervosa is a mental illness typified by disturbed body image, restriction of food intake and this leads to significant low weight. People with anorexia nervosa have intense fear to gain weight and become overweight even when it is clear they are underweight (NSW 2010, Pg.2-5). Tania has restrictive eating, excessive excising and distorted body image. The distorted thinking and delusional beliefs in anorexia nervosa are what make this eating disorder a mental illness. According to Steinglass (2007, Pg. 65-67) the diagnostic features of anorexia nervosa in (DSM-IV-TR)2 are refusing to maintain a normal body weight, strong fear of gaining weight, a disturbed body image as well as amenorrhea. Self-starvation in peoples with anorexia nervosa is allied with beliefs regarding eating and body shape that are very extreme and near delusional. Chakraborty & Basu (2010, Pg.2) support this argument and explains that the delusional denial of the extreme low weight is the key symptom of anorexia nervosa. Distorted thinking and delusional beliefs in anorexia nervosa are depicted by lack of concern on emaciation and vigorous defending of the gruesome appearance as the normal and the right body weight (Hay et al 2014, Pg. 2). In this case study, the patient Tania seems to have disturbed eating behaviors as well as concerns about food, eating as well as body image. For instance, Tania has been on restricted diet and excessive exercising for the last six months. Over-valued ideas and delusional beliefs dominate the clinical image of anorexia nervosa and the delusional beliefs preoccupy a person’s mental life. Abbate-Daga et al (2013, Pg. 3) explains that anorexia nervosa develops in an abnormal personality, particularly obsessional, histrionic and schizoid. The need to control one’s weight loss is abnormal and there is a high level of affect when the goal to lose more weight is threatened. Such beliefs result to impaired body function and may even distress other people. The delusional belief is acted on recurrently with more dieting and exercising in order to lose weight (Martín-Murcia 2011, Pg. 1). This is present in Tania since she is delusional about her body weight as she feels she is still fat and needs to continue losing weight despite her current low weight. Studies show that a minority of individuals with anorexia nervosa can progress to other delusions of schizophrenia. Dawson et al (2014, Pg.2) emphasises that individuals who end up having anorexia nervosa in most case have emotional needs that are not being met in their lives. For instance, their family might be lacking a stable background, might be having problems in socialising with friends and colleagues or might not be confortable regarding their sexual relationships (Bergh et al 2013, Pg. 2). In this case study, Tania lives with her parents who have busy lives as doctors and a brother who studies law. Probably the busy schedule of Tania’s family might have contributed to her having inadequate emotional support and feeling neglected which could have led into Tania developing anorexia nervosa. The key principles in recovery from eating disorders include establishing and maintaining therapeutic relationship with patients (Chakraborty & Basu 2010, Pg. 178-180). A number of patients with eating disorders like Tania at first refuse to begin treatment and the symptoms may preoccupy them for a while. Most of them are secretive and might not reveal information regarding their behavior due to shame. Therefore, tackling the individual’s resistance to treatment and improving her motivation for change is a vital aspect for recovery. Abbate-Daga (2013, Pg.6) argues that the key to recovery in eating disorders is psychological treatment. Just like Tania, a high number of individuals with anorexia nervosa refuse to accept they have a problem and are hesitant about change. Evidence shows that for any effective psychological treatment, there should be effective patient engagement (Surgenor & Maguire, 2013, Pg. 3-4). Therefore, the nurse should take time to establish and develop an empathetic, supportive and collaborative relationship with Tania. Even if cases where Tania might appear difficult, for instance avoiding emotions and being uncooperative, the nurse should recognize that the uncooperative behavior is a cry for help and hence the nurse should aim to constantly build and nurture a trusting relationship (Murray et al 2011, Pg. 25). Motivation for Tania to change might go up and down during the treatment and hence a nurse should remain sensitive to this. Generally, the psychological treatment aims at promoting weight gain as well as healthy eating in order to promote psychological recovery as well as reduce other symptoms resulting from the eating disorder (Wildes & Marcus 2011, Pg.422-425). Eating disorders adversely affects physical and mental health as well as development. Additionally, eating disorders are allied to other psychological and physical illnesses like depression, personality disorders in addition to substance abuse (Bergh, 2013 et al, Pg. 884). Evidence also shows that an individual having eating disorder might have a long-term impairment to one’s social and functional roles and lack of effective treatment can adversely affect both the physical and mental health and even cause death. Martín-Murcia (2011, Pg. 2-5) further explains that eating disorders maybe as a result of response to various risk factors and in most cases are a way of tackling underlying personal, emotional and psychological complications. Eating disorders impair an individual’s social and functional roles and the effect may consist of psychiatric and behavioural effects, medical complications, social isolation and disability (NEDC, 2010, Pg. 4). Accordingly, Tania’s eating disorder has impaired her social and functional roles. This is indicated where Tania’s social life has been affected by the eating disorder as well as her physical health. The Nexus between Mental Health and Physical Health The pathogenesis of anorexia nervosa is as a result of both psychological and social factors. In addition, lifestyle issues for instance nutrition and physical activities form the basis of pathogenesis and treatment of anorexia nervosa (Sidiropoulos 2007, Pg. 22). Tania suffers from anorexia nervosa as characterized by the symptoms. As a result of Tania’s mental illness, she is suffering from excessive-exercising and malnutrition and this has caused symptoms like faint feeling, gastrointestinal disturbances and heart problems, and these symptoms have direct relationship to her excessive exercising and dieting. Tania is 21 years old and nutrition plays an important role in young adults who have busy lifestyles. Nutritional intake is necessary to support the bodily requirements such as energy and suitable balance of vitamins, proteins, fats, carbohydrates and minerals. Lack of adequate nutrition as well as excessive exercising can result to various physical complications as presented in Tania (Mehler P & Brown C, 2015, Pg. 2-6). Evidence shows that medical complications that result from over-dieting and excessive exercises as in case of anorexia nervosa basically affect all organ systems. Common symptoms consist of fatigue, bradycardia, hypotension, loss of fat tissue, hypothermia, amenorrhea, gastrointestinal disturbances etc (Mehler P & Brown C, 2015, Pg. 2-6). Tania has gastrointestinal disturbances, fatigue, and loss of fat tissues as well as heart problems. In addition, over-exercising and excessive dieting seen in anorexia nervosa results to wasting of skeletal, smooth and cardiac muscle mass. Wasting of these muscles causes weakness and this is what causes cardiac manifestations in anorexia nervosa as presented in Tania, for instance faint feeling and the heart problems Tania is being suspected to have (Sidiropoulos 2007, Pg. 23). Cardiac failure can cause conditions of severe starvation which can result to death. This is because of loss of acute cardiac muscle mass along with ensuing abnormalities in heart conduction via electrolyte imbalances due to poor nutrition (Mehler P & Brown C, 2015, Pg. 2-6). Cognitive changes also occur in patients with anorexia nervosa. For instance, Tania had some difficulties in relating with her parents and also her reasoning had been affected. Being deficient of nutrients and calories as well as strenuous and excessive exercising can result to lack cognitive and social stimuli and neglecting of social events, family members and friends (NEDC 2010, Pg. 5). Additionally, literature shows that during severe weight loss, individuals lose the white and gray matter as well which affects cognitive functioning (Sidiropoulos 2007, Pg. 25). Recognizing and Responding to the Mental Health Needs of the Identified Person Assessment of symptoms of eating disorder that Tania has will help in identification of target symptoms and behaviors that will be tackled within the treatment plan. Therefore, assessment of Tania will include assessment of mood disorders, weight and eating behaviour assessment, as well as assessment for substance abuse. On the other hand, Tania’s mental treatment goals will include; promoting weight gain and healthy eating, reducing other symptoms related to the eating disorder and promoting psychological recovery (Madden et al 2014, Pg. 148-150). Substance abuse in people with eating disorders encompasses use of diet pills, laxatives and diuretics to suppress appetite and increase metabolic effect. From the information, Tania is not abusing substances. The nurse will assess the patient regarding her fears of gaining weight. From the case study, it is obvious that Tania has fears to gain weight. Madden et al (2014, Pg. 148) argues that weight restoration process can be a big challenge to nurses since patients with anorexia nervosa normally resist treatment due to their fears to gain weight. In the case study, Tania refuses to acknowledge that she has a problem and hence she would be ambivalent about change and this is seen where she is insisting on losing more weight and this can make her reluctant to treatment. Assessment of mood disorders and other emotional problems will be necessary because studies show that depression and mood disorders feature prominently in eating disorders. This is because people with anorexia nervosa do not perceive themselves entitled to express emotions and they use eating disorders as coping mechanisms to block emotions: this means they use food restrictions to control and deal with painful emotions (The Royal Australian and New Zealand College of Psychiatrists 2009, Pg. 12-13. Therefore, it will be necessary for the nurse to find out the emotional problems that might have led Tania into having a food disorder. It may be hard for the nurse to engage Tania due to her lack of emotional expression. Accordingly, it would be important for a nurse to build a therapeutic relationship with Tania because a trusting relationship between the nurse and Tania will encourage Tania to talk about any emotional concerns she might be having (Martin-Murcia, Cangas & Gonzalez, 2011, Pg. 200-202). Additionally, the nurse has the responsibility of the nurse to educate Tania’s family regarding her eating disorder. The nurse will encourage the family to participate in Tania’s care and offer support. Of equal importance the nurse should assess and observe Tania for potential suicide risk. Lastly, management of Tania’s eating disorder will include a multidisciplinary approach that will involve psychiatrists, nurses, psychologists, endocrinologists, dentists, gastro-enterologists and such (Chakraborty K & Basu D, 2010, Pg. 178-180). All these healthcare professionals should work closely together and maintain open communication. Implications for Practice as a health Professional I have learnt that many people with eating disorders use the disorders as a mechanism to block out emotions. Consequently, this is one aspect that makes it difficult to engage people with eating disorders and establish a therapeutic relationship with such patients. Some patients with eating disorders can be dishonesty with their eating habits and resist treatments and since the foundation of therapeutic relationships is trust, empathy and reliability: developing a therapeutic relationship with patients with eating disorders can be challenging. Therefore, as a healthcare professional I should be able to remain non-judgmental and try to nurture the relationship because resistance to treatment and other negative behaviors maybe a cry for help for the patients. I have also learnt that an eating disorder is more of a mental health problem than a physical health problem. Therefore, as a healthcare provider, the main goal should be on providing the emotional and psychological care to the patient. This is because treatment of mental health for the patient is the key to preventing the physical health problems because the root cause of the eating disorder as well as the resulting physical health problems is the mental health problem. More importantly, in regard to weight restoration, healthcare professionals should work on self-esteem together with weight restoration so as to reduce the fear of patients to gain weight. This is because patients can have strong fears regarding weight gain which is emotional because they base their self-worth on the weight. As a result, patients tend to resist weight gain process and hence it is important to focus on the self-esteem of the patient and emotional needs to ensure that their self-esteem is raised and emotional needs addressed for them to gain weight without any fears. Additionally, it is very important to monitor the activity and exercise levels of patients because patients with eating disorders such as anorexia nervosa can do exercises excessively and this can be harmful to their physiological state and can also slow their recovery especially if there have a physical illness. Conclusion Tania is suffering from an eating disorder namely, anorexia nervosa as depicted by her symptoms such as obsession with losing weight and excessive exercising. Since the eating disorder is a mental illness, Tania has lost touch with her body needs. The self-esteem of such patients is primarily based on eating and weight. As the essay indicates, the food disorder is a coping mechanism to other mental and emotional needs and that is why some patients become depressed and also suffer from other mental health problems. Therefore, nurses caring for Tania should understand that she is suffering from a mental illness and not a physical health problem. The nurses should aim at promoting Tania’s psychological recovery, reducing other emotional problems that Tania has and also promoting weight gain and healthy eating. In conclusion, I have learnt that eating disorders are more of mental health problems and hence as a healthy care provider one should focus on mental recovery of such patients. References Abbate-Daga G, Amianto F, Delsedime N, De-Bacco  C & Fassino S, 2013, Resistance to treatment and change in anorexia nervosa: a clinical overview, BMC Psychiatry, 13:294 Bergh C, Callmar M, Danemar S, Hölcke M, Isberg S et al, 2013, Effective Treatment of Eating Disorders: Results at Multiple Sites, Behavioral Neuroscience, 127( 6): 878–888. Chakraborty K & Basu D, 2010, Management of anorexia and bulimia nervosa: An evidence-based review, Indian J Psychiatry, 52(2): 174–186. Dawson L, Rhodes P & Touyz S, 2014, The recovery model and anorexia nervosa, Australian & New Zealand Journal of Psychiatry, 1(7). . 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