Is Anorexia Nervosa a psychological issue?

Introduction

Society, media, and culture have created an environment that has distorted our own view of a healthy body. They are constantly bombarding individuals with an ideology, which is the “The Thin Idea” that “thin is in”. (Murray, 2003) With his being said, people are starving and exercising themselves to reach this “ideal” body shape. Eating disorders are becoming more common in society, especially among young women (Lee, 1995) Eating disorder is defined by having abnormal eating habits that may either involve eating excessively or insufficiently which can effect physical and mental health. (Myers, 2012).Anorexia nervosa is an eating disorder, which is characterized by inappropriate eating habits which lead to extreme weight loss and an obsession with a thin figure. (Myers, 2012) Anorexia is a mental illness. There are several causes for anorexia and different treatment types for individuals suffering from this illness which will be discussed in further detail.

Anorexia Nervosa

Forms of eating disorders:

• Anorexia nervosa

• Bulimia nervosa

• Binge-eating

What is Anorexia Nervosa?

An eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15 percent or more) underweight (Myers, 2012).

What is Bulimia Nervosa?

An eating disorder in which a person alternates binge eating (usually of high calorie foods) with purging (by vomiting or laxative use) or fasting. (Myers, 2012)

What is a binge-eating disorder?

Significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa (Myers, 2012).

Before the 1970’s, Anorexia nervosa was often not discussed nor recognized as a disorder within society, which left most individuals unfamiliar with the disorder (Lawson, 1985). With that being said, the recent attention anorexia nervosa has been receiving has left many believing that this disorder is strictly a modern disease (Lawson, 1985). Interestingly, Anorexia nervosa was not recognized nor classified as a condition until the late 19th century (Lawson, 1985). Before the 19th century anorexia was not widely accepted in society and was often viewed as deviant. The very first detailed medical description of anorexia nervosa came from the early 17th century. Richard Morton, who provided the medical description, described the disorder as “nervous atrophy”, and included one of the major symptoms such as weight loss. Richard Morton implied the origin for this disorder was psychological based on symptoms such as nervousness, appetite loss etc. Thus, we can acknowledge that eating disorders have been around for decades. Due to the lack of acknowledgment anorexia have received, many view this disorder as new phenomenon when in fact it is known to have existed for over a century, ''most people think it is a strictly modern disease, but it was named and identified in the 1870's,'' (Lawson, 1985). Anorexia is often viewed as an emotional disorder that allows victims to feel a sense of control of their bodies and image. Today, anorexia nervosa affects young woman in all parts of society, majority being from westernized countries.

Causes of Anorexia (Internal Perspective)

The internal perspective looks within the cognition and biology of an individual to determine the possible causes of anorexia.

To begin with, mental thinking in relation to anorexia derives from self-identity issues. For starters, low self-esteem can really compromise the way an individual defines what is acceptable or not (Bruch, 1982). For instance, the environment one is placed in can really affect the way one feels about themselves; am I too fat? Am I just as skinny as the person beside me? With various questions of self worth coming into play, one may start to dwell in unhealthy ways of reaching their goal of what is perceived to be right. Many individuals turn to anorexic behaviors to redeem self worth and feel accepted.

Cognitive Approach

The cognitive approach deals with the mind and its view of itself. For example, someone suffering from anorexia may believe their body is overweight but it is indeed underweight. Individuals suffering from anorexia may base their feelings of self worth on their physical appearance and eating habits.
A study done by Mackenzie shows that female patients suffering from anorexia nervosa overestimated their own body size. (Mackenzie et al, 1993) Also, after consuming a sugary snack they believed that they body size had increased. The study showed that individuals incorrectly perceive their own body, their own cognition is faulty which leads them to having this distorted image of a healthy body.

Behaviorist Explanation

• Classical Conditioning
• Operant Conditioning
• Social Learning Theory

Classical Conditioning is a type of learning that occurs when a conditioned stimulus is paired with an unconditional stimulus. (Bruch, 1982) In the case of anorexia, there can be an association between eating and anxiety. Eating can be associated with anxiety because it causes individuals to become overweight. Individuals suffering from anorexia believe that loosing weight is the only way to reduce their levels of anxiety.

Operant Conditioning is a type of learning in which an individual’s behavior is modified based on consequences and reinforcements. (Bruch, 1982) Individuals may receive positive reinforcement based on their image of being thin which may cause them to continue restricting food intake. It is believed that anorexia is a learned behavior, people who diet and lose weight are encouraged by peers and society to obtain that thin image. People who are overweight are usually criticized for their body image. This is an important factor in the development of anorexia nervosa.

Social Learning Theory is described by learning that occurs in the social context and can occur purely through observation or direct instruction.(Bruch, 1982) People admire what they see in the media, and society. They attribute being slim to being successful and this is what causes them to adopt a certain lifestyle. A study done by Goresz supported the view of mass media portraying a slender body as ideal. A review of 25 studies was conducted and it showed that the ideal body image contributes to the development of eating disorders. (Goresz et al, 2002)

On the other hand, anorexia nervosa can be a result of genetic predisposition. An individual can have a series of genes that have been passed down from family members and have susceptibility to taking part in eating disorders (Canetti, Kanyas, Lerer, Latzer, & Backar, 2008). Self-image is not only of ones cognitive thoughts but also ones biological make-up. Many individuals can not help but take part in anorexic behaviors no matter how much they have tried to feel of self worth; their biology can release certain hormones and make it that much harder for one to fight off anorexic behaviors.

Heres a further look into the importance of the susceptibility to anorexia due to genetic predisposition:

Causes of Anorexia (External Perspective)

The external factors look at the outside influences that can impact an individual when they are struggling with anorexia. There are two main sociological factors that receive considerable attention in the literature regarding the development of anorexia; family and culture. There is a strong relationship between the role of family and the development of an eating disorder. Research suggests that there is a strong relationship between the role of family and the development of eating disorders among adolescent females (Murray, 2003). An individual that is struggling with anorexia can develop a sense of separation towards the family. The separation individuation process between mothers and daughters, and a distant father daughter relationship are all moderators that increase the likelihood of an individual developing a disorder.

We live in a culture obsessed with thinness. The society has created a unrealistic image of the perfect “body” which leads to more pressure to be thin. Media has a profound impact in today’s society when we are dealing with anorexia. The internet, television shows, magazine articles and advertisements have created a social context that contributes towards body dissatisfaction and leads to eating disorders like anorexia. An everyday example could be when you walk into any supermarket and stand in any check out line, and you will find many different magazines with ultra thin models that represent the thin ideal. The media constantly reinforces restrictive eating which influences today’s generation to look thin. It glorifies a slender ideal and consistently shows how important it is to be thin.

An article written by Lee Sing explains that culture and psychopathology are mutually dependent aspects of a socially constructed world (Sing, 1995). This article explains how psychiatric theories cannot deny its contribution towards anorexia, which can lead to personal misery. The author explains that although often individuals seem to look at anorexia grounded in western societies, it is actually rooted in the culture of modernity. A quote by Lee Sing "Now a days abnormal eating attitudes associated with anorexic behaviormay be a universal phenomenon that transcends cultural boundaries, contrary to the earlier notion that they were restricted to western countries" (Sing, 1995). They concluded that abnormal eating attitudes associated with anorexia is a universal phenomena that go beyond cultural boundaries.

Simpson, K explains that globalization has allowed societies throughout the world be exposed to the western culture (Simpson, 2002). Through the internet, magazine and this has contributed to the evidence that anorexia nervosa does effect western cultures however it is a universal phenomena that is reaching other cultures throughout the world.

Treatments

Treatments for anorexia nervosa are usually linked to past childhood experiences and looked at the individuals self-perception and self-image. A therapist’s main goal is to tackle self-image and self-perception. Anorexia nervosa is mental illness and the best way to tackle a mental illness is examining it from a psychological point of view. Individuals who suffer from anorexia have a distorted image of a healthy body. Self-image is defined as the way you see yourself and or your abilities. Self-image plays a huge part of individuals who consider themselves as overweight. Most patients dealing with anorexia are usually in denial. They refuse to admit that they have a problem and do not view themselves as being underweight. Seeking counseling from a psychologist who is experience in the field of anorexia is highly necessary.

Psychotherapy is the most common treatments; it is not just used for anorexia but also for sexual abuse, depression, substance abuse and problems with relationships. (Grohol, 2006) This type of therapy is used to enhance an individual’s general health and life contentment. Psychotherapy mostly focuses on emotional and cognitive aspect to use to help treat anorexia.

Cognitive-Behavioral Therapy is another way to treat anorexia. This is a mixture between both cognitive therapy and behavior therapy. The cognitive aspect looks at out mental state of being, which includes ideas, mental images, beliefs and attitudes. (Grohol, 2006) The behavioral part comes in on how they carry out the cognitive aspects. How does their beliefs make them act a certain way? This treatment is analyzing how someone talks negatively talks about themselves. This therapy will try to change an individuals attitudes and beliefs and slowly remove their focus on irrational thoughts.

Family therapy examines how the family can impact individuals eating patterns. (Murray, 2003) For example; is more than one person in the family affected by anorexia? Why? Specific questions like these are used to help the family or family member suffering overcome this tragic illness. The whole family is used to play a role in moral support and help the victim seek out treatment. 
There is no Medication specifically for anorexia but a medication also used to treat depression is used called selective serotonin reuptake inhibitor (SSRI) antidepressants. (Murray, 2003) This will help with the mental distress the patient is facing. There is also a drug called fluoxetine that discourages binging and purging. (Grohol, 2006)

Relapse

It has been a challenge since Anorexia Nervosa was first described to find a treatment for this specific medical illness. One study found that “effective weight-restoration treatments have been established, but the effects are often not maintained and relapse is common.” (Carter, Blackmore, Sutandar & Woodside, 2004, pg. 671-9) To go through the whole process of treatment, it takes a lot of courage and strength to stay motivated. Evidently, majority of the time the people suffering with Anorexia, cannot successfully finish the whole process of treatment without having a few setbacks. This is when Relapse in Anorexia patients occurs. Generally, relapse will occur when the patient who is in recovery stage, quits and goes back to their disordered eating behaviour and starts having the same negative thought about their body prior to recovery. (Kelty Eating Disorders, 1 April 2014)

The risk of relapse in Anorexia patients is very high, so it is vital to be familiar with some characteristics that are displayed in anorexic patients when they are in the midst of their treatment. These characteristics can range from anywhere along the lines where, patients who were unsuccessful in their first few attempts in recovery are likely to relapse, patients who are still anxious about their shape and weight and how their body looks like, patients who exercise at very high intensive levels after recovery are also likely to relapse. These characteristics help the doctors determine that the patients are not able to keep a very positive attitude about the changes that have occurred with their body past treatment. Some of the main factors for Anorexic patients to relapse are “past suicide attempts, a dysfunctional or negative family environment, and trouble hanging out with or meeting people.” (Kelty Eating Disorders, 1 April 2014)

One study found some warning signs of relapse (post-recovery):
• Obsessively thinking about food, weight or shape of their body.
• Urge to diet on a large scale by skipping meals, counting calories or fat, cutting on portions
• Increased social isolation
• Fantasizing about perfection, such as imagining the perfect body, perfect mark at school and more
• Masking their emotions such as their anxiety, depression, guilt from others
• Wearing loose-fitting clothes or very baggy clothes to hide their negative body image

These are just a handful of signs that can aid in judging if the anorexic patient has relapsed and the treatment has proved to be ineffective. (Hurley & McSherry, 2002)

References

British Medical American Journal of 19 Bruch, H. Anorexia Nervosa: Therapy and Theory. Psychiatry, v. 139, no. 12, 1982. p. 1531.

Canetti, L. A., Kanyas, K. K., Lerer, B. L., Latzer, Y. L., & Backar, E. B. (2008). Anorexia nervosa and parental bonding. The Contribution of Parent–Grandparent Relationships to Eating Disorder Psychopathology, 64(6), 703-716. Retrieved from http://psychology.huji.ac.il/.upload/articles/Canetti.pdf

Carter, J. C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D. B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34(4), 671-9. Retrieved April 1, 2014, from http://search.proquest.com.ezproxy.library.yorku.ca/docview/204489073?accountid=15182

Groesz LM, Levine MP, Murnen SK. (2002). The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders. 31, 1-16

Groesz LM, Levine MP, Murnen SK. The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders. 2002;31:1–16

Grohol, J. (2006). Treatment for Anorexia. Psych Central. Retrieved on April 6, 2014, from http://psychcentral.com/lib/treatment-for-anorexia/000101

Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348-358.

Hurley, D. J., & McSherry, J. A. (2002). Management and finding common ground. Eating Disorders: A Patient-Centered Approach (p. 140). London, Ontario: Radcliffe Publishing.

Kelty Eating Disorders. (n.d.). Recognizing the Risks & Signs of Relapse. Retrieved April 1, 2014, from http://www.keltyeatingdisorders.ca/recovery/risks-signs-relapse

Lawson, Carol. (1985). Anorexia: It’s Not A New Disease. New York Times.

Lee, S. (1995). Reconsidering the status of anorexia nervosa as a western culture-bound syndrome. Social Science & Medicine, 42(1), 21-34. Retrieved from http://search.proquest.com.ezproxy.library.yorku.ca/docview/618810166?accountid=15182

Murray, T. (2003). Wait not, want not: Factors contributing to the development of anorexia nervosa and bulimia nervosa.The Family Journal, 11(3), 276-280. doi:http://dx.doi.org/10.1177/1066480703011003007

Myers, G. David. (2012). Psychology Tenth Edition In Modules. Worth publishers.

Patient.co.uk - Trusted medical information and support. (n.d.). Patient.co.uk. Retrieved April 4, 2014, from http://www.patient.co.uk/health/bulimia-nervosa-leaflet

Simpson, K. J. (2002). Anorexia nervosa and culture. Journal of Psychiatric and Mental Health Nursing, 9(1), 65-71. doi:http://dx.doi.org/10.1046/j.1351-0126.2001.00443.x

Thornton, K. (2012). Excerpt from my secret past [Web]. Retrieved from https://www.youtube.com/watch?v=bxj3No3AJoI

Williams, M. S., Thomsen, S. R., & McCoy, J. K. (2003). Looking for an accurate mirror: A model for the relationship between media use and anorexia. Eating Behaviors, 4(2), 127-134. doi:http://dx.doi.org/10.1016/S1471-0153(03)00015-1

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