Nursing Care Plan for Anorexia: Disturbed Body Image

Disturbed Body ImageA client with anorexia can have a nursing diagnosis of Disturbed Body Image.
Disturbed Body Image nursing diagnosis is defined by NANDA as confusion in mental picture of one’s physical self.

Disturbed B0dy Image Related To (Etiology)

  • Cognitive/perceptual factors
  • Pyschosocial factors
  • Morbid fear of obesity
  • Low self-esteem
  • Feelings of helplessness
  • Chemical/biologic imbalances
As Evidenced By (Assessment Findings/Diagnostic Cues)
  • Verbalized negative feelings about body ( e.g., dirty, big, unsightly)
  • Verbalized feelings of helplessness, hopelessness, and/or powerlessness in relation to body and fear of rejection/reaction of others
  • Self-destructive behavior (purging, refusal to eat, abuse of laxatives)
  • Sees self as fat, although body weight is normal, or client is severely emaciated
  • High to panic levels of anxiety over potential for slight weight gain, although grossly underweight to the point of starvation

Disturbed Body Image Outcome Criteria

  • Comfortable with a weight that meet medically safe limits
  • Demonstrates pride in self through dress and grooming
Long-Term Goals
Client will:
  • Describe a more realistic perception of body size and shape in line with height and body type by (date)
  • Refer to body in a more positive way by (date)
  • Improve grooming, dress, and posture and present self in more socially acceptable and appropriate manner by (date)
Short-Term Goals
Client will:
  • Challenge dysfunctional thoughts and beliefs about weight with help of nurse after acute phase of treatment has passed
  • State three positive aspects about self

Disturbed Body Image Interventions and Rationales

  1. Establish a therapeutic alliance with client. R: Anorexic clients are highly resistant to giving up their distorted eating behaviors.
  1. Give the client factual feedback about the client’s low weight and resultant impaired health. However, do not argue or challenge the client’s distorted perceptions (Ibrahim, 2005). R: Focuses on health and benefits of increased energy. Arguments or power struggles will only increase the client’s need to control.
  2. Recognize that the client’s distorted image is real to him/her. Avoid minimizing client’s perceptions (e.g., “I understand you see yourself as fat. I do not see you that way.”) R: Acknowledges client’s perceptions, and the client feels understood, although your perception is different. This kind of feedback is easier to hear than a negation of client’s beliefs.
  3. Encourage expression of feelings regarding how the client thinks and feels about self and body. R: Promotes a clear understanding of client’s perceptions and lays the groundwork for working with client.
  4. Assist the client to distinguish between thoughts and feelings. Statements such as “I feel fat” should be challenged and re framed. R: It is important for the client to distinguish between feelings and facts. The client often speaks of feelings as though they are reality.
  5. Nurses who have training in cognitive-behavioral therapeutic interventions can encourage client to keep a journal of thoughts and feelings and teach client how to identify and challenge irrational beliefs. R: Cognitive and behavioral approaches can be very effective in helping client challenge irrational beliefs about self and body image.
  6. Encourage client to identify positive personal traits. Have client identify positive aspects of personal appearance.  R: Helps client refocus on strengths and actual physical and other attributes. Encourages breaking negative rumination.
  7. Educate family regarding the client’s illness and encourage attendance at family and group therapy sessions. R:Reactions of others often become triggers for dysphoric reactions and distorted perceptions. Relationships with others, although not casual, are the context in which the eating disorder exists and thrives.
  8. Encourage family therapy for family members and significant other. R: Families and significant others need assistance in how to communicate and share a relationship with the anorexic client (Ibrahim,2005).

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