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Eating Disorders At least 2 million female Americans have a clinically relevant eating disorder. Diagnosable eating disorders, such as anorexia nervosa and bulimia nervosa, are not uncommon, occurring in approximately three percent of the United States female population. Many people with eating disorders do not recognize that they have a problem and never seek help (Segall, 22). In this paper I am going to evaluate the issue from different perspectives and determine how eating disorders influence the development of an individual. Anorexia nervosa is characterized by refusal to maintain a minimally normal body weight, profound fear of weight gain, body image disturbance, and amenorrhea. Bulimia nervosa involves recurrent episodes of binge eating accompanied by compensatory mechanisms and self-esteem significantly influenced by one's weight and shape.
Compensatory mechanisms include self-induced vomiting, laxative abuse, excessive exercise, and fasting. These disorders usually begin during adolescence with the majority of the cases developing before the age of twenty-five. For an anorexic dieting has become an obsession and the obsession has become a disease. Anorexia Nervosa is a puzzling and cruel disease affecting thousands and thousands of young and healthy women and adolescents (Bruch 3). Anorexia Nervosa is an eating disorder characterized by the pursuit of thinness (Garner & Garfinkel 339).
Anorexics willingly undergo the ordeal of starvation even to the point of death (Bruch 4). Anorexics are people who are obsessed with food and who constantly fight the urge to eat (Marx 22). Anorexia Nervosa strikes mostly adolescent girls. Most estimates place the disease incidence at 1 out of every 250 adolescent girls (Levenkron 1 - 2). It is important to get the anorexic help immediately. If they do not get help, they can die.
There are different ways to help an anorexic. There is therapy for example, family therapy, individual therapy, psychotherapy therapy and what seems to be the most effective; group therapy. If the anorexic is in serious need and therapy is not working, they will be hospitalized. Medicines are often at help to an anorexic. Therapy alone can cure an anorexic patient. Anorexics feel that therapy in general can intervene or cause a deadly threat against robbing them of their specialness (Marx 51).
There are three main stages of therapy. The first stage is the main issue of the anorexic reluctance to be a patient. The illness is addressed during initial consolation. The therapist attempts to establish a verbal contract with patient and to help the patient with problems. The middle stage is where relevant issues are brought up and worked on. The anorexic is engaged in a struggle to gain some self-respect and self-esteem.
Their inner world is chaotic and full of anxiety and horror. Negative therapeutic reaction occurs which is impasse or regression that occurs when least expected. They fall apart psychologically. The final stage the patient begins to experience being valued.
The anorexic begins to feel accepted and can be responsive to themselves and others without guilt (Whitaker 67). The first type of therapy is individual therapy. It is a one-on-one relationship between the patient and the therapist. Individual therapy takes a deeper look at the causes of the behavior. The therapist explores the patients thoughts, feelings, and looking how they express thoughts and feelings in their actions or relationships (Marx 159 - 160). The second type of therapy is psychotherapy.
Psychotherapy is to help the patient in her search for autonomy and self-directed identity by evoking an awareness of impulses, feelings and needs (Bruch 143). The first stage of psychotherapy is establishing an initial way of being together and the therapist is creating an atmosphere that will allow for disclosure without the risk of rejection. The first stage lasts from 1 to 6 months. The middle stage, treatment alliances has been achieved and the patient is able to both regress and take new stances toward oneself. The middle stage lasts 2 to 4 years. The final stage lasts approximately 6 months to a year (Whitaker 92).
Family therapy is treatment of more than one member of a family based on the idea hinting at problems with the way the whole family operates. The anorexic will get better if the family system can change (Marx 198). Family therapy is most useful with the young high-school age anorexic who lives at home (Whitaker 74). Treating the entire family is advisable if the patients appear to be strong enough to adopt a nurturing authoritative posture toward the anorexic in therapy sessions (Levenkron 171).
The goals of family therapy are the first task is to help the patient break her abnormal eating pattern. Family can support the patient better if they know the facts, and educate the family. The exact goal of therapy depends on the patients age. When the patient is under the age of 18, it focuses on the parents. With an older patient, the therapist helps the patient separate from the family and live on their own (Marx 199). Finally, the last type of therapy is group therapy.
There are different types of group therapy. Psychodynamic group therapy, psycho educational and cognitive-behavioral group therapy, family support groups, creative therapy, art therapy, psychodrama groups, and self-help groups. The role of group therapy is made to address some of the problems anorexia nervosa cause loneliness, isolation, and hopelessness. Group therapy helps with self-esteem. Patients gain hope by meeting others who have had the disease (Marx 175 - 178). A type of group therapy is psychodynamic.
Psychodynamic therapy helps the patient gain insight into their situation and bring about changes in their personality. It gives patients a chance to express themselves and interact with others in a supportive environment. The goals of treatment are to help the patients identify and trust themselves and improve relationships with other people. Some other goals are sense of ineffectiveness, low self-esteem, anxiety, misperception of feelings, mistrust of others, disturbances in body image, avoiding maturity, and behavior (Marx 176). Psycho educational and cognitive-behavioral group therapy provides a natural environment for patients to learn the facts about anorexia nervosa. The group gives patients an opportunity to share strategies for improving unhealthy eating.
Also, model patterns of thinking and feelings (Marx 177). Family support groups are led by a social worker. These groups involve members of anywhere from 5 to 10 families of eating disorders patients. Families learn how to be supportive of their child, how to set limits, and how to handle problems. People share experiences and trade advice, giving each other emotional support (Marx 177).
In self-help groups people bond together to solve their common problems. It offers patients a chance to share experience, fellowship, and advice. The group reinforces change by offering role models for behavior and sharing successful strategies and attitudes and also emphasizing personal responsibility and valuable lessons. Self-help groups reflect traditions of self-reliance and voluntarism (Marx 185). Other types of group therapies are creative therapy, which is movement or dance therapy to help patients get in touch with their bodies. Art therapy lets patients draw or sculpt to express feelings about their bodies and relationships with others.
In psychodrama, groups patients can act out of scenes, playing different roles to carry on conversations or demonstrate feelings. Finally, there are womens issues groups which are concerns relating to sexuality and the role of women in society (Marx 178). Why anorexia nervosa arises, is put into four perspectives; biological, family, sociocultural, and psychological. In the biological perspective, biologists see eating disorders as a foul-up in the body systems that regulate hunger and eating, particularly the hypothalamus. The hypothalamus is a cluster of nerves in the brain that controls body functions. By releasing hormones, the hypothalamus also regulates puberty an important connection to anorexia nervosa.
Although biologists do not know exactly what pulls the trigger, puberty may begin when the body reaches a certain percentage of body fat. Starving makes both weight-to-fat ratios fall too low, metabolic changes occur, including the loss of menstruation. Biologists also look for problems in the way the body converts food into neurotransmitters (chemicals that carry signals between cells). The brain knows when the body needs certain foods to make the neurotransmitters tell people when to eat next. Anorexia Nervosa may arise from a malfunction in this feedback system (Marx 28 - 29). Some patterns that have been identified in certain eating disordered families include an overemphasis on appearance, social isolation, emotional rigidity, and the inability to resolve conflicts.
There is no such thing as a typical eating disordered family. The same dynamic that triggers an eating disorder in one person may allow another to thrive (Marx 30). To sociologists, eating disorders result from the value our culture places on thinness. Through advertisements, magazines, and TV programs they all give the hidden message: Thin wins.
The cultural pressure to be thin can make feelings of insecurity, self-doubt, or unworthiness (Marx 30). Women are given the message from the media, that beauty (success, personal happiness, and self-worthiness) is based on thin shape. The fashion industry is responsible for promoting the view that one can be loved and respected only when slender (Whitaker 149). Peer group pressures combine with media pressures; fashion magazines and newspaper fashion ads all feature unrealistically, unhealthily thin actresses and models for high achieving perfectionists to compete with (Levenkron 149). The psychological perspective, most experts feel that biology cannot explain eating disorders. Experts believe that the answer lies in a persons life experiences.
A loss or rejection, death in the family, or leaving home, can start the disease (Marx 29). Another point of view, of why anorexia arises, is the females refusal to be an adult. It is a disorder of puberty, an attempt to stay a girl, a denial of femininity (Orbach 24). Anorexia represents a way to avoid maturity, not just physical or sexual development, but also psychological and social.
Achieving thinness lets the anorexic turn back the clock and have a childlike physical appearance (Marx 31). There is a criterion for diagnosing patients with anorexia nervosa. Patients must have at least two out of the four criterions to be diagnosed with the disease. The first criterion is the refusal to maintain body weight or the failure to make expected weight gain during period of growth, leading to body weight 15 % below that expected. The second criterion is the intense fear of gaining weight or becoming fat. The third criterion is the disturbance in the way in which ones body, weight, size, or shape is experienced.
Finally, the last criterion is the absence of at least three consecutive menstrual cycles (Marx 46). The symptoms for an anorexic is as follows: 1. Phobias concerning changes in bodily appearance is the most outstanding feature. 2. Obsessional thinking about food and liquid intake. 3. Obsessive-compulsive rituals dominate much of the day for an anorexic. 4. Feelings of inferiority about intelligence, personality, and appearance are common. 5.
The anorexic never sees choices as moderate, and fears making mistakes. 6. Passive-aggressive behavior often develops as parents and health professionals try to coerce the anorexic in what becomes a power struggle over eating and nutrition. 7. Disinterest in sexuality is often a personality characteristic of the anorexia nervosa syndrome and results from: (a) General immaturity and need to see oneself as a child, toward off feelings of parental abandonment (b) Fear of intimacy, physical and emotional. (c) Failure of father to romance daughter healthily, to offer affection and compliments (d) In the case of maturity onset, sexual energies are distracted by obsessional fears of weight gain and ritualistic behaviors over planning of meals, special ways of cutting foods. 8. Delusion thinking develops, especially concerning body size and quantities of food ingested. 9. Paranoid fears of criticism from others are often experienced, especially with respect to being seen as too fat. 10. Depression can be observed particularly in the chronic anorexic. 11.
Anxiety is alleviated only by weight loss and fasting. 12. Denial is used, along with delusional thinking, to keep the anorexic starving, exercising, and away from people and the food, they need (Levenkron 2 - 3). The most outstanding behavior seen in an anorexic includes a conservative rigidity, outward compliance toward others alternating with temper-tantrum behavior, and repetitious patterns normal in the infant and toddler but not in the adolescent (Levenkron 3 - 4). Anorexics also have peculiar behavior with food.
Some prepare elaborate meals for families, but eat nothing themselves, or they toy with food on their plate and eventually throw the whole meal away (Marx 51). Depending on which perspective the anorexic patient struggles with the most may determine which type of therapy they will need. Different types of therapy prove to work better for some people then do others. With the variety of different group therapy's available it may be in the best interest of the patient to seek help from one.
Group therapy not only provides the patient with help, but the friends, family, and others associated with the patient. Hospitalization is indicated when therapy has not stopped or reversed the physical or psychological course. The indications for admissions are weight loss, low serum potassium and other serious medical problems, severe psychological distress, and lack of response to outpatient treatment. During the first week of hospitalization the patient manages their own dietary intake with the knowledge that if they do not gain weight, the treatment team will take over. An extensive laboratory workup is done. A pediatrician or internist monitors physical conditions.
Weekly examinations and tests keep the internist aware of the patients health. After the first week if the patient is continuing the anorexic course, the treatment team takes over. The patient is informed that they need to learn how to eat normal foods again. Eating is supervised by nursing personnel during each meal to prevent purging. If the patient cannot eat as instructed, they are informed that tube feeding might be necessary.
Hospital treatment goals are to have the patient return to a normal medical condition. The patient must gain weight to a normal level and maintain it and resume normal eating patterns. Finally the last goal is to counsel the anorexics family (Whitaker 71 - 73, 152). Although hospitalization is expensive, it is certainly more effective in terms of both symptom improvement and cost than a prolonged, unsuccessful outpatient treatment (Marx 118). Some medicines are used to try to treat some symptoms of anorexia nervosa. Antidepressant medications are used along with antianxiety medications, Antipsychotic medications.
Antidepressant medications include clomipramine and amitriptyline. Clomipramine and amitriptyline are used to treat obsessive compulsive disorder. These medications can improve depressive moods. When this happens patients attitudes may improve not just about eating but also about life. Antidepressants do cause risks such as lowered blood pressure or with the heart. Antianxiety medicine is given to an anorexic that is highly anxious.
This medicine is used for small minority of anorexic patients who have such extreme anxiety about eating. Some side effects of taking antianxiety medications are sedation, dizziness, highly sensitive feelings, and serious risk of addiction. Doctors and therapists have not had much luck with antipsychotic medicines. Antipsychotics can cause weight gain. However, this medicine has many drawbacks: lowered blood pressure, risk of seizures, and delayed return of menstruation. In addition, these drugs are known for causing long-term or even permanent neurologic damage.
Some doctors continue to prescribe this, but its popularity has dropped. Other medications that doctors have prescribed are cyproheptadine. Cyproheptadine is an antihistamine, which is used to treat allergies and often causes weight gain. Others are bethanechol, metoclopramide, and simethicone (Marx 129 - 130). People must learn to recognize some signs of an anorexic person such as; thinning of hair and fine downing hair on arms and legs, reductions in interest, withdrawl from family and friends, and sensitivity to cold (Garner and Garfinkel 339). Being able to recognize the systems is the only way to help an anorexic person.
Anorexics dont think they have a sickness or an illness. They think their illness is their identity (Levenkron 51). In conclusion it is best to seek group therapy for help. By doing this not only does the anorexic get educated, but the others around as well. This is important, because this way everyone learns how to deal with this problem.
Bibliography: Bruch, M. D. Hilde. The Golden Cage. New York: Vintage Books, 1978.
Garner, David M. & Garfinkel, Paul E. Handbook of Psychotherapy for Anorexia Nervosa and Bulimia. New York: The Haworth Press, 1989. Levenkron, Steven. Treating and Overcoming Anorexia Nervosa.
New York: Charles Scribner's Sons, 1982. Marx, M. D. Russell. Its Not Your Fault.
New York: Villard, 1991. Orbach, Susie. Hunger Strike. New York: W. W.
Norton & Company, 1986. Whitaker, Leighton C. The Bulimic College Student. New York: The Haworth Press, 1989. Cost, C, Eating Disorder Sourcebook, Lincolnwood, IL: Lowell House, 1999. Eagles, D, Nutritional Diseases, New York: Franklin Watts, 1997.
Hall, L, Bulimia: A Guide to Recovery, Carlsbad, CA: Gorse Books, 1998. Segall, Rebecca. "Never Too Skinny." Psychology Today. Mar/Apr 2001. Vol. 34.
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