“To lose confidence in one’s body is to lose confidence in oneself"
― Simone de Beauvoir
Introduction
Dear Writer,
Our team has compiled a list of resources we believe will be beneficial in your article on the topic of anorexia nervosa. In our research we begin by discussing the definitions of anorexia nervosa as set out by the DSM-5 and the ICD-10, what a psychological disorder is, and what an eating disorder is which we believe will be useful to your article. We continue with providing annotated bibliographies on the related topics such as comorbidity associated with anorexia nervosa, signs of anorexia nervosa, treatment, contributing factors to the development of anorexia nervosa, and the relationship between genetics and anorexia nervosa. We hope our preliminary research will prove useful in your article writing.
All the best,
Courtney, Julie, and Ameera.
Definitions
Anorexia Nervosa:
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.)
The DSM-5 is the fifth edition of the Diagnostic and Statistic Manual of Mental Disorders that is published by the American Psychiatric Association. To be diagnosed with anorexia nervosa as set out by the DSM-5 a person must display:
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
- An intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain.
- Disturbance in the way one views their body weight or body shape or lack of recognition of the seriousness of the current low body weight.
ICD-10 (ICD-10 Version:2010. (n.d.). ICD-10 Version:2010. Retrieved April 6, 2014, from http://apps.who.int/classifications/icd10/browse/2010/en)
The ICD-10 is the tenth edition of the International Statistical Classification of Diseases and Related Health Problems. Features of anorexia nervosa as defined by the ICD-10 include:
- Weight loss (or lack of weight gain in children) leading to a body weight of at least 15% below the normal or expected weight for age and height. The weight loss is self-induced by avoidance of "fattening foods".
- A self-perception of being too fat, with a dread of fatness, which leads to a self-imposed low weight threshold.
- A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis, displays as amenorrhoea in females (an exception is the continuing of menstruation in anorexic women who are on replacement hormonal therapy) and a loss of sexual interest and potency in males.
- Does not meet criteria A and B of Bulimia nervosa.
Criteria A and B of Bulimia nervosa are:
A- Recurrent episodes of overeating (at least two times per week over a period of three months) in which large
amounts of food are eaten in short periods of time.
B- Persistent preoccupation with eating and a strong craving to eat.
Psychological Disorder: A disorder of the mind involving cognitive, behavioural, and emotional changes that causes the self or others distress. Also know as mental disorder or mental illness.
Eating Disorders: A series of psychological disorders commonly categorized by a fixation with food. However, eating disorders often are a way for coping with deeper (sometimes times sub-conscious) issues within the self.
Comorbidity Associated with Anorexia Nervosa
In the article by Lama Mattar, Caroline Huas, Jeanne Duclos, Alexandre Apfel, and Nathalie Godart, the findings of several studies were discussed in context based on the research and discoveries of the relationship between malnutrition and depression or anxiety in Anorexia Nervosa. Looking at 7 studies previously conducted individually between the time period of 1980 to 2010 by S.Channon and W.P. Desilva, N, Coulon, P Jeammet, and N, Godart, E.D Eckert, K. Kawai, K.K Konrad, R.A Carels, D.M Garner, C. Polloce, R.G Laessel and F.S Wamboldt a critical review was created regarding the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment. It is clearly stated in the introduction of this review that depression, anxiety and obsessive-compulsive disorder frequently co-occur with Anorexia Nervosa. The findings of the article provide support from evidence based data that are rare to come across that the malnutrition which comes from the anorexia nervosa closely relates to the correlation between anxiety, depression and obsessions compulsions. Looking at patients when admitted into recovery treatment facilities compared to their discharge it is evident that when levels of malnutrition lower and the patient is returning to a stable balance through weight gain a significant improvement was found in the decreasing of depressive, anxiety and obsessive compulsive symptoms. These seven studies provide a consensus that depressive symptoms and anxiety are the consequences of the malnutrition in Anorexia Nervosa concluding that anorexia may be the precursor for other clinically diagnosed mental illnesses.
Mattar, L., Huas, C., Duclos, J., Apfel, A., & Godart, N. (2011). Relationship between malnutrition and depression or anxiety in anorexia nervosa: A critical review of the literature. Journal of Affective Disorders, 132(3), 311-318. doi:10.1016/j.jad.2010.09.014 http://resolver.scholarsportal.info/resolve/01650327/v132i0003/311_rbmadoacrotl
Signs of Anorexia Nervosa
There are many signs and symptoms when identifying someone who is anorexic, these signs can vary depending on the individual. Sometimes when living with an individual who has anorexia, it means that they are continuously hiding habits. This makes it hard for loved ones to recognize the signs, these signs can be categorized by: food behavior, appearance and purging.
Anorexic Food Behavior consist of:
• Eating certain low calorie foods and prohibiting fatty foods
• Obsession with calorie counting, evaluating helpings and recording a food diary
• Constant lying about food intake
• Sudden interest in food (cooking, collecting recipes and memorization caloric content)
• Practicing odd food customs (eating at a certain pace)
Anorexic Appearance consists of:
• Dramatic weight loss, hair loss and feeling cold
• Obsession with body image
• Denial of body size
• Criticizing ones appearance
Anorexic Mental Process:
• Social withdrawal
• Isolation and irritability
• Depression
Purging consists of:
• Drug intake
• Vomiting after eating
• Increased physical activity
As the signs and symptoms develop, it becomes harder to confront and help those who are experiencing Anorexia Nervosa. Making the decision to provide help for those in need is difficult. As any condition is hard to treat, it does not mean that it isn’t possible.
Image Source: National Women's Health Information Center
Lucas, A. R. (2004). Demystifying Anorexia Nervosa: An Optimistic Guide To Understanding and Healing. N.p.: Oxford University Press. N.p.: Oxford University Press. Retrieved April 8, 2014, from sit.elbrary.com.
Treatment
There are two parts when conducting a treatment on an individual with Anorexia. There is the physical treatment, which deals with peoples eating patterns. Then there is the mental, which deals with the patient’s feelings and emotional process. There are multiple steps that can be taken during the recovery process to help those with Anorexia. They include receiving a medical evaluation from an eating disorder program or hospital. Making sure the patient understands his/her condition, clarifying any question they might have. Enrolling or hiring a Dietitian to keep track of nutrition and Psychotherapist to constantly assess the patients thought process. Normalizing the patients eating habits, as they have to adapt to a different nutritional daily routine. By regulating the patient’s food diet they will be able to regain strength and self-esteem. Reassuring an individual’s recovery, as this increases their confidence and encourages them to keep going through this difficult time. Lastly, gaining support from family and friends can help immensely. This makes the patient feel important and loved.
There are also downsides to the treatment process, which include individuals denying treatment, relapse and severe depression. Individuals with anorexia have the right to deny treatment. Often when one does condone to treatment sometimes are unwilling to take the necessary precautions to recover. This usually creates conflict between family, medical staff and the patient. Relapse occurs when someone who has previously recovered from their condition has the urge of practicing their ways again. Depression can occur after or during the recovery process when patients are asked to take medication, as experiencing depression can be a side effect. Or when individuals feel as if they are missing apart of themselves because they have stopped their routine.
Giordano, S. (2005). Understanding Eating Disorders Understanding Eating Disorders: Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa. N.p.: Oxford Scholarship Online. Retrieved April 8, 2014, from from http://www.oxfordscholarship.com.ezproxy.library.yorku.ca/view/10.1093/0199269742.001.0001/acprof-9780199269747-chapter-12
Contributing factors
With societies view on the image of what beauty is, and the expectations people are influenced to meet, it is no wonder that anorexia nervosa has become such a growing trend especially in the lives of young women who look up to fabricated images of thin models and celebrities in the media and fashion world. It has reached the levels of extremity where people aspire to have this condition, and are encouraged the take on what is referred to as a “lifestyle change” by websites and blogs that are known as pro-ana. Pro-ana websites and blogs consist of people who have been diagnosed with anorexia nervosa, or those who aspire to reach that level, and encourage others to lose weight and be skinny through tips and tricks, a “thinsperation” page providing images of dangerously skinny models and celebrities meant to inspire the pro-ana followers to become that, quotes about strength to persevere through the journey of weight loss, and contact page to reach out to the creators of the website for support. Although these people have been diagnosed with Anorexia they do not see it as a mental disorder affecting their cognitive system and behavioral actions. Followers of the Pro-Ana websites and blogs view anorexia as a lifestyle choice that is liberating and empowering for people to take charge of their own life and peruse their goals of appearance. These websites provide a sense of community where people with the same aspirations come together and help each other on their journey, providing a sense of inclusiveness and belonging. “Ana” is referred to like a god-like figure to its followers, and this lifestyle is viewed as the Ana religion with commandments, creed’s, psalms, and laws that must be followed to be apart of this regime.
Ana’s Creed
I believe in control, the only force mighty enough to bring onrder in the chaos that is my world.
I believe that I am the most vile, worthless an useless person ever have to existed on this planet, and that I am totally onworthy of anyone’s time and attention.
I believe in oughts, musts and shoulds, as unbreakable laws to determine my daily behaviour.
I believe in perfection and strive to attain it.
I believe in salvation trough starvation.
I believe in calorie counters as the inspired word of god, and memorise then accordingly.
I believe in bathroom scales as an indicator of my daily succeses and failures.
I believe in hell, cause sometimes I think I live in it.
I believe in a wholly black and white world, the losing of weight, recrimination for sins, the abnegation of the body and a life ever fasting.
The above segment is an example of an "Ana Creed" provided by The Pro-Ana Lifestyle Forever encouraging its followers that they are in control of their own life the decisions they choose are self chosen in order to follow this lifestyle that will benefit them by becoming their ideal image of themselves.
These pictures retrieved from The Pro Ana Lifestyle are examples of the "thinsperation" posts to inspire its followers to achieve their goals
Images source: The Pro Ana Lyfestyle Forever
"My Pro Ana Blogs" (2014) retrieved April 6th 2014 from http://www.myproana.com/index.php/blogs/
"The Pro-Ana Lifestyle Forever" (2014) retrieved April 6th 2014 from http://theproanalifestyleforever.wordpress.com
Anorexia Nervosa and Genetics
According to Dr. Wade Berrrettini eating disorders can be heritable. He states that family studies have found increased rates of eating disorders in relatives of women. (Barrettini, 2004)
The Twin study proves his theory, fraternal (dizygotic DZ) twins share only half of their genes compared to identical (monozygoic MZ) twins because the relationship between MZ is two times greater then DZ this suggests a genetic effect. In DZ Anorexia and Bulima has been found 58 to 76 percent of the variance in the liability to Anorexia (Barrettini, 2004) and 54 to 83 percent of the variance in the liability to Bulimia (Barrettini, 2004). Consistent data shows and supports the correlation between the heritable traits. There are also uncontrolled traits that suggest a relation between genetics and eating disorders such as: weight concerns, attitudes, and eating behavior, but this theory hasn’t been scientifically proven.
Berrettini, W. (2004, November). The Genetics of Eating Disorders. Psychiatry, 18-25. Retrieved April 8, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010958/
Conclusion
To conclude, through our research on the comorbitity associated with anorexia nervosa, signs of anorexia nervosa, treatment, contributing factors, and the relationship the disorder has with genetics we have provided information to assert that anorexia nervosa can be a psychological problem and also rather a lifestyle choice to some that do not consider it a psychological disorder. The definitions provided by the DSM-5 and ICD-10 assist in classifying anorexia nervosa as a psychological problem while pro-ana websites portray anorexia nervosa as a "lifestyle change" that is necessary for the pursuit of perfection. We hope that the research we have conducted will prove useful to your article.
References
Berrettini, W. (2004, November). The Genetics of Eating Disorders. Psychiatry, 18-25. Retrieved April 8, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010958/
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Giordano, S. (2005). Understanding Eating Disorders Understanding Eating Disorders: Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa. N.p.: Oxford Scholarship Online. Retrieved April 8, 2014, from http://www.oxfordscholarship.com.ezproxy.library.yorku.ca/view/10.1093/0199269742.001.0001/acprof-9780199269747-chapter-12
Lucas, A. R. (2004). Demystifying Anorexia Nervosa: An Optimistic Guide To Understanding and Healing. N.p.: Oxford University Press. Retrieved April 8, 2014, from sit.elbrary.com.
ICD-10 Version:2010. (n.d.). ICD-10 Version:2010. Retrieved April 6, 2014, from http://apps.who.int/classifications/icd10/browse/2010/en
Mattar, L., Huas, C., Duclos, J., Apfel, A., & Godart, N. (2011). Relationship between malnutrition and depression or anxiety in anorexia nervosa: A critical review of the literature. Journal of Affective Disorders, 132(3), 311-318. doi:10.1016/j.jad.2010.09.014 http://resolver.scholarsportal.info/resolve/01650327/v132i0003/311_rbmadoacrotl
"My Pro Ana Blogs" (2014) retrieved April 6th 2014 from http://www.myproana.com/index.php/blogs/
"The Pro-Ana Lifestyle Forever" (2014) retrieved April 6th 2014 from http://theproanalifestyleforever.wordpress.com