A 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
- 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)
- 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
- Establish a therapeutic alliance with client. R: Anorexic clients are highly resistant to giving up their distorted eating behaviors.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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).