Disturbed Body Image/chronic low Self-Esteem | NCP Anorexia/Bulimia

Nursing diagnosis: Disturbed Body Image/chronic low Self-Esteem related to Morbid fear of obesity, perceived loss of control in some aspect of life, Personal vulnerability; unmet dependency needs, Dysfunctional family system, Continual negative evaluation of self

Possibly evidenced by
Distorted body image—views self as fat even in the presence of normal body weight or severe emaciation
Expresses little concern, uses denial as a defense mechanism, and feels powerless to prevent or make changes
Expressions of shame, guilt
Overly conforming, dependent on others’ opinions

Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Establish a more realistic body image.
Self-Esteem
Acknowledge self as an individual.
Accept responsibility for own actions.

Nursing intervention with rationale:
1. Have client draw picture of self.
Rationale: Provides opportunity to discuss client’s perception of self and body image, and realities of individual situation.

2. Involve in personal development program, preferably in a group setting. Provide information about proper application of makeup and grooming.
Rationale: Learning about methods to enhance personal appearance may be helpful to long-range sense of self-esteem and image. Feedback from others can promote feelings of self-worth.

3. Recommend consultation with an image consultant.
Rationale: Positive image enhances sense of self-esteem.

4. Suggest disposing of “thin” clothes as weight gain occurs.
Rationale: Provides incentive to at least maintain and not lose weight. Not seeing “thin” clothes removes visual reminder of thinner self.

5. Assist client to confront changes associated with puberty and sexual fears. Provide sex education as necessary.
Rationale: Major physical and psychological changes in adolescence can contribute to development of eating disorders. Feelings of powerlessness and loss of control of feelings, in particular sexual sensations, can lead to an unconscious desire to desexualize self. Client often believes that these fears can be overcome by taking control of bodily appearance, development, and function.

6. Establish a therapeutic nurse-client relationship.
Rationale: Within a helping relationship, client can begin to trust and try out new thinking and behaviors.

7. Promote self-concept without moral judgment.
Rationale: Client sees self as weak willed even though part of person may feel sense of power and control, for example, through dieting and weight loss.

8. State rules clearly regarding weighing schedule, remaining in sight during medication and eating times, and consequences of not following the rules. Without undue comment, be consistent in carrying out rules.
Rationale: Consistency is important in establishing trust. As part of the behavior modification program, client knows risks involved in not following established rules (e.g., decrease in privileges). Failure to follow rules is viewed as client’s choice and accepted by staff in matter-of-fact manner so as not to provide reinforcement for the undesirable behavior.

9. Confront denial and respond with reality when client makes unrealistic statements such as “I’m gaining weight, so there’s nothing really wrong with me.”
Rationale: Client may be denying the psychological aspects of own situation and is often expressing a sense of inadequacy and depression.

10. Be aware of own reaction to client’s behavior. Avoid arguing.
Rationale: Feelings of disgust, hostility, and infuriation are not uncommon when caring for these clients. Prognosis often remains poor even with a gain in weight because other problems may remain. Many clients continue to see themselves as fat, and there is also a high incidence of affective disorders, social phobias, obsessive-compulsive symptoms, drug abuse, and psychosexual dysfunction. Nurse needs to deal with own feelings so they do not interfere with care of client.