A 24-year old client with anorexia nervosa tells nurse, “When I look in mirror, I hate what I see. I look so fat and ugly.” Which strategy should nurse use to deal with client’s distorted perceptions and feelings?

Correct Answer: D. Provide objective data and feedback regarding the client’s weight and attractiveness

By focusing on reality, this strategy may help the client develop a more realistic body image and gain self-esteem. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. The mental health nurse should educate the patient on changes in behavior, easing stress, and overcoming any emotional issues.

• Option A: This is inappropriate because discussing the client’s perceptions and feelings wouldn’t help her to identify, accept, and work through them. Since recovery involves patients having to face their deepest, most painful, and traumatic thoughts and emotions, supporting them as they go through treatment can be emotionally challenging for nurses. This emotional challenge can be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD), depression, or substance abuse, as these may require more intensive one-to-one support.
• Option B: Focusing discussions on food and weight would give the client attention for not eating. During the early stages of treatment when patients are still new to recovery, they look to nurses to provide them with a highly structured environment, which sometimes involves nurses making food and behavioral decisions on their behalf. While this might not be an ongoing issue for primary care nurses, they may still be required to offer decisive advice on these areas. Here, it is imperative that nurses offer such advice with a clear message that patients have the power to make these decisions themselves.
• Option C: This is inappropriate because recognizing unrealistic cultural standards wouldn’t help the client establish more realistic weight goals. Furthermore, learning motivational interviewing techniques can help facilitate communication with those who might be resistant to discussing topics related to food, weight, and recovery. Such techniques can help develop the skills of empathic understanding, rolling with resistance, and gently assisting patients to make their own, autonomous decision to work towards recovery. Often, the aim is to help patients learn new and healthier ways of coping, and nurses can achieve this through a mix of emotional support, education, and signposting.