Eating Disorders Among Teenagers - Term Paper Example

? A Teenager with Eating Disorder The essay aims to address a two-fold objective to wit to analyze the case study presented; and (2) to answer six relevant questions pertaining to the case study and eating disorders among teenagers. A Teenager with Eating Disorder 1. What is the leading cause of death in patients diagnosed with anorexia nervosa? According to the American Psychiatric Association (APA) (2006), suicide is the leading cause of death in patients diagnosed with anorexia nervosa (p. 1165). Aside from suicide, starvation-related effects such as heart failure, organ failure, and malnutrition also contribute to the high mortality rate of anorexia nervosa. Patients with anorexia are excessively preoccupied with weight, food, and body shape. As much as they would like to eat, patients feel guilty because of a distorted body image or perception that one is distressingly large despite obvious thinness. When the goal of losing of weight is not met, patients with anorexia nervosa lose their desire to live and thrive, fall into depression, and eventually commit suicide or die from starvation-related complications. In the case study, the teenager posed the highest risk for depression as she became "almost obsessive" in her physical activity, taking part in paddling, track, tennis and aerobic exercises at home. There are also signs of cardiac alteration, as manifested in abnormally low heart rate of 44 beats per minute, and malnutrition since the teenager has lost 9 kg (20 lbs.) for approximately a year, height at 50th percentile weight is now at the 10th percentile for her age, obvious thinness, and lack of menstrual periods. 2. What is the most likely electrolyte abnormally in patients with bulimia nervosa who engage in self-induced vomiting? Patients with bulimia nervosa who engage in purging behavior (self-induced vomiting) are likely to have abnormally low level of potassium electrolyte in the blood, a condition called hypokalemia. Potassium is lost during episodes of purging as vomiting of gastric fluid occurs. In addition, the metabolic imbalance termed “hypochloremic alkalosis” greatly contributes in occurrence of hypokalemia in patients with bulimia nervosa as potassium ions shift into the cells to help neutralize metabolic alkalosis and high pH (Day, Paul & Williams, 2009, p. 313). In short, alkalosis can cause hypokalemia and vice versa. In the case study, there has been no evidence of any binging or purging behaviors and any laboratory result that would confirm hypokalemia. However, health care provider must address hypokalemia promptly as the electrolyte potassium is essential for skeletal and cardiac function. 3. Name three indications for medical hospitalization of a patient with an eating disorder. As stated earlier, patients with eating disorder are likely to die from suicide and starvation-related effects. Thus, early medical hospitalization and treatment is necessary. Goroll and Mulley (2009) enumerate the medical criteria for hospitalization of a patient with an eating disorder, among of which include: more than 40% weight loss of premorbid or ideal body weight in three months, rapid progression of weight loss, presence of cardiac arrhythmias, and persistent hypokalemia (p. 1512). In the case study, weight loss of 9 kg (20 lbs.) since last year and cardiac abnormalities manifested by a heart rate of 44 beats per minute warrant medical attention to prevent further complications and correct physical and psychological abnormalities. 4. A teenaged female reports feeling healthy, denies feeling fat, and has normal menstrual periods. However, she has evidenced a 20 lb. weight loss. What is the most likely diagnosis? Anorexia nervosa is the most likely diagnosis of a teenaged female, who reports feeling healthy, denies feeling fat, and has normal menstrual periods but has evidenced a 20 lb. weight loss. In making differential diagnosis for mental and eating disorders, the International Classification of Diseases (ICD) version 10 and the Diagnostic and Statistical Manual for Mental Disorders-IV are the major diagnostic tools used worldwide. Both of the diagnostic criteria consider the following as definitive diagnosis for anorexia nervosa: body mass index (BMI) of less than 17.5 or body weight less than 85% of expected, fear of gaining weight or becoming fat, denial of the illness despite obvious thinness, and hormonal changes resulting to amenorrhea (Gentile, 2010, p. 186). All of the criteria presented suggest that anorexia nervosa is the most likely diagnosis except for normal menstrual periods. In the new update of the DSM-IV criteria in 2010, amenorrhea for three consecutive menstrual cycles has been omitted in the criteria due to consideration of developmental factors that may narrow or limit the diagnosis of anorexia (Knoll, Bulik & Hebebrand, 2011, p. 96). Thus, a teenager could possibly have anorexia nervosa despite having normal menstruation cycles. 5. Name six possible conditions or disorders on the differential diagnosis of excessive weight loss in an adolescent. Other than having eating disorders, excessive weight loss in an adolescent can be caused by a number of diseases or conditions affecting the body. Among of the possible causes of weight loss in an adolescent includes gastrointestinal disorders (e.g., cancer, celiac disease, chronic diarrhea, infection, peptic ulcer, inflammatory bowel disease, and malabsorption syndrome), endocrine and hormonal disorders (e.g., diabetes, hyperthyroidism, and Addison’s disease), substance abuse, use of medications such as laxatives, malnutrition, HIV/STDs, and diseases of the kidney (Better Medicine, 2012, n.p.). Because of the denial of the teenager of weight loss and the probable causes, the obvious thinness, bradycardia, and obsessiveness in physical activity pointed an eating disorder and malnutrition as the causes of weight loss. 6. Which disorder is most likely to present with a normal physical exam, anorexia nervosa or bulimia nervosa? Bulimia nervosa is most likely to present with a normal physical exam than anorexia nervosa. Patients with anorexia nervosa have obvious thinness and significant weight loss which is less than expected of their age and height while patients with bulimia often present body weight within the normal range (Dahlmann, Hebebrand & Trivedi, 2009, p. 32-33). The growth status of patients with bulimia nervosa is usually not affected and nutritional deficiencies vary. Unless a laboratory exam and dental examination are taken, a health care provider could not notice biochemical abnormalities, dental enamel erosion, and calluses on the back of the hand among patients with bulimia nervosa; unlike in patients with anorexia nervosa where is arrested growth and maturation, protein-calorie malnutrition and various micronutrient deficiencies, bradycardia, and obvious sign of dehydration. Detecting anorexia nervosa or bulimia nervosa during a physical exam is not easy due to denial of the symptoms and shame in admitting purging behavior. A multisystem and comprehensive assessment, along with parent’s interview, will aid in the diagnosis of an eating disorder. In the case study, the obvious thinness, denial, significant weight loss, and bradycardia signify that the teenager might probably be suffering from anorexia nervosa. References American Psychiatric Association (APA). (2006). Practice Guideline for the Treatment of Patients with Eating Disorders, Third edition. American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders (p. 1097-1222). Virginia: American Psychiatric Association. Better Medicine. (2012).Weight Loss: Causes. Retrieved on June 15, 2012 from http://www.localhealth.com/article/weight-loss/causes Dahlmann, B. H., Hebebrand, J. & Trivedi, H. K. (2009). Adolescent eating disorders: definitions, symptomatology, epidemiology, and comorbidity. Child and Adolescent Psychiatric Clinics of North America, 18(1): pp. 31–47. doi:10.1016/j.chc.2008.07.005. Day, R. A., Paul, P. & Williams, B. (2009). Fluid and Electrolytes: Balance and Distribution. Brunner and Suddarth's Textbook of Canadian Medical-Surgical Nursing (2nd ed.) (p. 293-343). Philadelphia: Lippincott Williams & Wilkins. Gentile, M. G. (2010). Anorexia nervosa: identification, main characteristics and treatment. Nutritional Therapy and Metabolism, 28(4): pp. 185-192. Goroll, A. H. & Mulley, A. G. (2009). Approach to Eating Disorders. Primary Care Medicine: Office Evaluation and Management of the Adult Patient (6th ed.) (p. 1507-1513). Philadelphia: Lippincott Williams & Wilkins. Knoll, S., Bulik, C. M. and Hebebrand, J. Do the currently proposed DSM-5 criteria for anorexia nervosa adequately consider developmental aspects in children and adolescents? European Child and Adolescent Psychiatry, 20: pp. 95-101. doi. 10.1007/s00787-010-0141-5. Read More