Exploring anorexia

Abstract

Significant amount of time has been dedicated by researchers in the study of anorexia, an eating disorder. Nonetheless, extensive data that is so far available has not been fully utilized towards combating this disorder. It is against this background that the number of anorexia patients across the world has continued to raise thereby negating available treatment methods.

Initially, the condition was restricted among western population but the very western standards of beauty have spread to other parts of the world leading to rapid spread of the disorder. This review will explore aspects of anorexia nervosa by tracing its historical background, possible causes, prevalence rate as well as treatment.

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Chapter 1

1. Introduction

1.1 Types of eating disorders

As society continues to promote thin body mentality to be the ideal of beauty, Attia and Welsh observe that there is increasing number of people who are developing anorexia as they become more aware of their weight.[1] Most people are concerned about their body weight at some point in life. However, according to the above authors, those who develop eating disorders tend to take their concerns to the extreme.

Abnormal eating habits are a threat to a person’s well being and some extremities can cause death. Research over the past few years, has shown that there has been an increase in the number of people suffering from eating disorders especially anorexia nervosa and bulimia nervosa. The above disorders are more prevalent in young women and adolescents. Among the general population, it is estimated that about five million people will show signs of at least one type of the above disorders.

Three major types of eating disorders have been identified. The first and the most common type is anorexia nervosa. Individuals who suffer from this disorder are have a distorted view of their body image. Despite some of them being extremely underweight, they will always have feelings of being overweight. These individuals will refuse to eat but will continue to exercise compulsively with some starving themselves to death.

The second type is bulimia nervosa which until recently has always been confused with anorexia nervosa. These individuals unlike the one suffering from anorexia nervosa will consume large quantity of food although they feel guilty about it. The affected person will perform the above acts because they feel ashamed and disgusted of the binging act. Once they get rid of their stomachs’ contents, tension and negative emotions dissipate.
Many scholars have dedicated their time to study anorexia. However, due to limitation in scope, the rest of the chapter will explore anorexia nervosa by tracing the historical background of the condition, reviewing prevalence of the disorder in terms of gender, culture and geographical background as well as the causes and the current treatment methods.

1.2 Understanding anorexia nervosa

According to Dare, anorexia has been associated with loss of appetite and does not occur due to physical sickness but mostly triggered by perception of the mind.[2] An individual has a similar appetite with a normal healthy person but they tend to suppress it by either eating very little or avoiding eating for a prolonged period of time. It is against this reason that psychologists view this condition as life threatening if left untreated.[3]

The motivating factor that makes the patient to lose appetite at the sight of food is their obsession to lose weight. Such people are very conscious of their body image, and they always strive to achieve the ideal slim body. The above individuals will deliberately starve themselves to maintain the ideal thin body. In addition, they adopt a strict exercising schedule motivated by their intent fear to become fat.

1.3 Historical perspective of anorexia nervosa

Knowledge about the condition came into the lime light in the late 18th century, when two separate physicians; Charles Lesegue and William Gull researched on anorexia nervosa. The two have been regarded as pioneer researchers in this particular filed. At the initial stages, several names were put forward but, anorexia nervosa came to be widely accepted eventually.

Many other researchers such as Hilde Bruch, Arthur Crisp among other have come forward, and their works have contributed into the research by coming up with treatment plans. Despite the numerous studies into the condition, there is lack of adequate technological innovation as far as treatment is concerned. Hence, it has become a concern among contemporary physician researchers.

The development of anorexia disorder can be traced back to several cultures from ancient times. During this particular time, prolonged fasting was observed but usually it was for religious reasons. The fast was common among the Greek and Egyptian cultures, but, no evidence has been found to show the fasting was as a result of the disorder.

A close resemblance of the disorder in ancient times was that which developed among people who practiced eastern religions. As Steiner documents, some Eastern religious beliefs led to self starvation as people sought spiritual fulfillment.[4]Self starvation is regarded as one of the symptoms of anorexia nervosa today.

Although a slight similarity of ancient times self starvation can be compared with modern day anorexia nervosa, the motivating factors are very different. The ancient people practiced self starvation mainly for religious reasons, but not because they feared getting fat as it evident today.

Lack of a direct link between ancient and modern day disorder has made development of deep research in this disorder to be limited in scope.[5] The disorder has always been viewed from a social perspective, and earlier researchers have ignored the medial aspect of it.

Initially, anorexia was viewed as a social condition, that affected young women and girls from the high-class circles, and it was viewed as their fashion trend. For this reason, scholars saw the disorder as a pass time activity, which did not have any medical effects. It was not until later when the disorder was given attention by the medial experts when serious medial implications started to be discovered.

2. Prevalence of anorexia nervosa disorder

The prevalence of the disorder affects people of both gender types. It can affect individuals of any age. However, women are more predisposed to the disorder as compared to men. Statistics have identified the ratio to be one out of ten men. Scholars say the incidences of the disorder are increasing day by day, and we might have new statistical out look in the future.

The numerous studies conducted show the disorder is more prevalent among the population from the industrialized nations. Despite the industrialized nations having abundant-food supply, the population especially the females shy away from eating to maintain the slim image, which is considered to be attractive.

The disorder has been found to be common in the western countries such as United Kingdom, USA, Canada and other highly industrialized nations. Studies in the US show that 0.5 to 1 % of females in the US are likely to develop the disorder. In United Kingdom, an estimated 0.7 % to 1.2% females are at high risk of developing anorexia.

However, research of the spread of the disorders in African countries is very limited; hence it may not be easy to hypothesize prevalence rate in those areas due to limited research conducted in the past.

The results of such studies are hard to generalize across African and other minority cultures. The results of the above studies showed very minimal cases of the anorexia nervosa. Indeed, Rumney expounds that the low level of prevalence rate is a clear indication that cultural factors contribute in the development of anorexia nervosa.

Previous studies have also indicated that the disorder is common among post -puberty adults. However, in recent years, isolated cases have been identified among children as young as 7 years.[6] In addition, more recent studies have noted that the disorder is gaining momentum among pre-puberty individuals.

This information has led scholars today to agree that the disorder begins in mid and late adolescence. When the disorder develops at this age, prognosis is always better as compared to those who develop it past the age of 40 years. The disorder at rare times can affect order adults as life stresses catches up with them.

Individuals who develop the disorder do so when they start perceiving in their mind that they are overweight. When such a person begins to diet, he/she does not notice when the weight falls. They will thus continue to diet and exercise intensively, and the habit turns into an obsession.

Such people will do anything to lose weight, and the reason they undertake self starvation measures is because they see weight gain as a sign that they have failed. Eventually, if left untreated the disorder can lead to fatality as the individuals continue to lose weight beyond the required healthy weight for their age and height. Anorexia disorder prognosis is good when diagnosed at early stages.

3. Possible Causes of anorexia nervosa

Researchers have been interested to know what causes the anorexia nervosa disorder. Further, they have been interested to know the contributing factors that lead to the development of the disorder. However, it is difficult to determine the specific causes of the disorder, and most of the causes put forward are hypothetical. Scholars believe that anorexia nervosa can be attributed to a combination of factors, ranging from environmental, cultural, biological and psychological.

3.1 Biological causes

Researchers of anorexia disorder through numerous experiments have come across evidence, that some people could be genetically predisposed than others to develop the disorder. The probability of a person whose close family member suffered from an eating disorder, to get anorexia nervosa is higher than for a person whose family has not history of eating disorder.

Statistics has shown that the probability is 10 times higher, and more than 50 % of anorexia nervosa cases can be linked to the hereditary factor.[7] Although numerous experiments have been conducted, the researchers have failed to provide a clear explanation of how biological factors are directly related to the eating disorder.

However, research has been success as researchers have discovered specific chromosomes, which are directly linked to the disorder. The specific chromosomes identified are known to increase susceptibility to the eating disorders; anorexia nervosa and others.

Another biological factor that can be linked with the increased risk to the disorder has to do with the brain abnormal biochemical make up. The abnormal biochemical make up is related with the hypothalamic-pituitary-adrenal axis (HPA) which regulates a person mood, stress and appetite.

The gland releases certain neurotransmitters such as serotonin, norepinephrine and dopamine, which are responsible for mood regulation. When the release of the above neurotransmitters is reduced, such a person is likely to develop the disorder. The above evidence shows that abnormal biochemical make up which is biological factor can be attributed to the eating disorder.

3.2 Cultural factors

Cultural beliefs and attitude factors can also be linked to the development of anorexia nervosa disorder, and other eating disorders. The rates of the disorders vary from one race or ethnic group to the other, and the dimension or extent changes with time as cultures evolve. So many studies have concentrated their researches among people within the western culture.[8] However, extensive research needs to be done all over the world to demonstrate the spread of the disorder across all cultures.

A cultural factor that has contributed to the development of the disorder originates from the western culture, where a thin body is viewed as the ideal. This idealization, which receives much attention through the numerous mass media, has been listed as a significant cultural factor that leads to the development of the disorder.

The media are powerful tool when it comes to influencing peoples’ attitudes towards a particular topic. The media are to blame for the widespread anorexia disorder as they portray slim body as the measure of attractiveness.

Although eating disorders can be traced back in history, the massive shift to the view that slim is ideal has emerged recently as promotions of slim body increases. The evidence that today men and women are not satisfied with a big body is evident from the numerous diet articles, diet medication and the like.

A further elaboration on the aspect of culture is that which explains the role of changing cultures to the change of development of anorexia nervosa, as well as the changing prevalence.

Several proposals have been put forward to classify anorexia as cultural-change syndrome rather than a cultural specific syndrome as many tend to believe.[9] This proposal cites studies done among the immigrants which show that though the disorder is rare, it is gaining momentum, as the immigrants culture change because of interaction with the host culture.

In addition, rare cases of the disorder are being reported in less developed world since the process of industrialization brings with it changes in culture. As the world become a global village, the interaction and transfer of cultural values is inevitable; hence anorexia will be a cultural-changing syndrome in the future.

The reason why anorexia disorder is being transferred from the western to other world cultures is because the western culture has always been viewed as ideal. The media have played a great role in communication the values of the western culture to other parts of the world and hence eroding traditional values especially among the young people.

Apart from the idealization of slim body among the western culture, another cultural force which has caused the widespread occurrence of the disorder is identified.[10] In the recent decades, the role of women in society has taken a great shift.

Several feminist theorists have associated the rapid development of eating disorder with the changing roles of women in society especially in western cultures.[11] Feminists theorists have hypothesized that the pressures placed on today’s woman will increase their vulnerability to eating disorders. A historical perceptive of eating disorders to support the hypothesis, is that which shows that eating disorders among women develop, when they are presented with many opportunities.

However, the available opportunity has to be combined with absolute freedom for such a woman to develop anorexia nervosa. Lack of freedom is what makes wealthy women in Muslim cultures to shy away from self starvation since they live restricted lifestyles.

Today woman is pushed to be a high achiever; at the same time, society expects her to maintain her femininity and attractiveness. The anorexia disorders among females come about as they try to balance the demand by society to be both successful and attractive.

3.3 Psychological causes

Studies to link the development of anorexia disorder and psychological factors received much attention in the 20th century. The early theorists focused their attention on studying how person unconscious sexuality conflicts contributed to the development of the disorder.

They also wanted to find out the link between adolescent rebellion and regression to the oral stage of development to the anorexia nervosa. Similarly, earlier psychologists also associated the disorder with the advent of object relations theory.[12] The above theory focuses on how a parent relation with an infant affects the personality development of an individual.

The modern-day psychologists have developed a theory which shows anorexia disorder to be caused by emotional disturbances. The variables of emotional, logical and stimuli come into play in an attempt to classify anorexia as an emotional disorder. According to the anorexia nervosa theory, anorexia, which resides on the emotional side of the human brain, can occur whenever the emotional elements are disturbed.

The disorder is said to develop during mental growth where one of the key points is affected. The theory postulates that the adolescence stage of growth is the most likely point, when the disorder will develop. This is because during adolescence an individual is developing a sense of self, and most of the times adolescents are not able to handle any form of criticism positively.[13]

During this search of identity stage, criticism carries a lot of weight and the person will try to distance themselves from it by manipulating the external environment to avoid further criticism. This escapism behavior suppresses the internal being and the person expresses though unconsciously the preferred emotional image.

When prolonged, exposure of the internal self to suppression will eventually lead to mental segregation presented as anorexia nervosa. Dare expounds that it is a form of mental illness that originates from emotional. Hence, an individual is always concerned with peoples perception of his/her image.[14]

Family therapists have also contributed to debate on how psychological factors associated with family relations, lead to the development of anorexia nervosa disorder.[15] The said therapists have tried to demonstrate the relationship between dysfunctional family relationships and broken down family interaction bonds, with the development of anorexia nervosa.

Individuals whose mothers are intrusive, overprotective and exhibit perfectionists’ characteristics are likely to develop anorexia disorder. In addition, if ones’ father is passive, withdraw, moody or ineffective the probability for such an individual to develop anorexia nervosa is increased.

Personality traits have also been linked with the development of the anorexia nervosa disorder. The individuals have been cited to have low self esteem, extreme fear of becoming fat and feeling of helplessness in life.[16] The individuals are usually people who are high performers in whatever sector they are in life, but their tendency of perfectionism is what compels them to develop the disorder.

Such people are always concerned with peoples’ opinion about them, and always strive to portray a perfect picture.[17] The see the tendency to control their weight as advantageous in gaining peoples approval. It is very hard to know that individuals have a problem as they tend to keep their feelings to themselves, and rarely show rebellious behavior.

4. Danger signs

Individuals who are developing anorexia nervosa disorder are likely to use weight reduction drugs during the initial stages of the obsession. Other behavioral signs have been identified by researchers. The individuals will start by cutting back on the portion of food they are used to take previously. The individuals will also exhibit an obsessive interest in exercises, and will spend every opportunity exercising.

Those with the bulimia nervosa disorder will be seen going to the bathroom right after they take any meals.[18] Those who suffer from anorexia nervosa will also avoid gathering where food is likely to be served as they do not want to be forced to eat under the circumstances. The above behaviors affect the body negatively and the patients start showing signs of poor health. The most initial symptom associated with anorexia nervosa is gradual but constant weight loss.

Initially, the weight loss is not harmful to the body especially if the patient was overweight.[19] At the later stage as the patient increases weigh losing exercises, the individual will start complaining about stomach problems accompanied by constipation diarrhea. As days goes by, the patient becomes weaker and weaker as the energy reserves are dangerously utilized by the body.

Dizziness may also be a common complaint, and at times, the patient may experience fainting episodes. If left untreated, the symptoms continue to appear which might lead to death.[20]

5. Conclusion

Eating disorders are very common problem among the population. Anorexia nervosa, which is one type of eating disorders, has become so common and if not watched more health problems are likely to arrive in the future. Researchers should put more effort to innovate on preventive and treatment measures of the condition.

References

Attia Evelyn, Walsh B. Timothy, 2007. “Anorexia Nervosa”. American Journal Psychiatry 164(2007): 1805-1810.

Bell, Rudolph M. Holy anorexia. Chicago, Illinois: University of Chicago Press, 1987. Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz .“Psychological

Therapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry, 178 (2001): 216-221.

DeAngelis Tori, 2002. “A Genetic Link to Anorexia”. Monitor on Psychology 33(2002), 34-37.

Halmi, Katherine A. “The Multimodal Treatment of Eating Disorders”. World Psychiatry 4(2005): 69-73.

Kaye Walter H., Bulik Cynthia M., Thornton Laura, Barbarich Nicole, Masters Kim and the Price Foundation Collaborative Group. “Co-morbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa”. American Journal of Psychiatry 161 (2004): 2215-2221.

Mehler, Philip S. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings.” Annals of Internal Medicine 134(2001):1048-1059.

Naqvi, Syed. “Review of Child and Adolescent Psychiatry.” Focus 2 (2004):529-540. Palmer, B. “Come the Revolution. Revisiting the Management of Anorexia Nervosa.” Advances in Psychiatric Treatment 12 (2006):5-12.

Papadopoulos Fotios C, Ekbom Aders, Eselius Lisa & Brandt Lena. “Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa.” British Journal of Psychiatry 194 (2009): 10-17.

Ramsay Rosalind, Ward Anne, Treasure Janet & Russel Gerald F. M. “Compulsary Treatment in Anorexia Nervosa. Short Term Benefits and Long Term Mortality.” British Journal of Psychiatry 175 (1999): 147-153.

Rumney, Avis. Dying to please: anorexia, treatment and recovery. Jefferson, N.C. : McFarland, 2009.

Steiner Hans, Mazer Cliff & Litt Iris F. “Compliance and Outcome in Anorexia Nervosa”. West J Med 153 (1990): 133-139.

Swain, Pamela I., Scaglius, Fernanda Baeza., Balfour, Louise., and Hany Bissada. Anorexia Nervosa And Bulimia Nervosa: New Research. New York: Nova Biomedical Books, 2006.

Wade Tracey D., Bulik Cynthia M., Neale Michael, and Kendler Keneth S. “Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors”. Am J Psychiatry 157 (2000):469-471.

Attia Evelyn, Walsh B. Timothy. “Anorexia Nervosa”. American Journal of Psychiatry 164 (2007), 1805-1810.
Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz. “PsychologicalTherapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry 178 (2001): 216-221.
DeAngelis, Tori. “A Genetic Link to Anorexia.” Monitor on Psychology 33 (2002), 34-37.
Steiner Hans, Mazer Cliff & Litt Iris F. “Compliance and Outcome in Anorexia Nervosa”. West J Med 153 (1990): 133-139.
Wade Tracey D., Bulik Cynthia M., Neale Michael, and Kendler Keneth S. “Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors”. Am J Psychiatry 157 (2000), 469-471.
Mehler, Philip S. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings’. Annals of Internal Medicine 134(2001):1048-1059.
Swain, Pamela I., Scaglius, Fernanda Baeza., Balfour, Louise., and Hany Bissada. Anorexia Nervosa And Bulimia Nervosa: New Research. New York: Nova Biomedical Books, 2006.
Papadopoulos Fotios C, Ekbom Aders, Eselius Lisa & Brandt Lena. “Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa.” British Journal of Psychiatry 194 (2009): 10-17.
Ramsay Rosalind, Ward Anne, Treasure Janet & Russel Gerald F. M. “Compulsary Treatment in Anorexia Nervosa. Short Term Benefits and Long Term Mortality.” British Journal of Psychiatry 175 (1999): 147-153.
Steiner Hans, Mazer Cliff & Litt Iris F. “Compliance and Outcome in Anorexia Nervosa”. West J Med 153 (1990): 133-139.
Papadopoulos Fotios C, Ekbom Aders, Eselius Lisa & Brandt Lena. “Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa.” British Journal of Psychiatry 194 (2009): 10-17.
Mehler, Philip S., 2001. “Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings.” Annals of Internal Medicine 134(2001):1048-1059.
Rumney, Avis. Dying to please: anorexia, treatment and recovery. Jefferson, N.C.: McFarland, 2009.
Palmer, B. “Come the Revolution. Revisiting the Management of Anorexia Nervosa.” Advances in Psychiatric Treatment 12 (2006):5-12.
Bell, Rudolph M. Holy anorexia. Chicago, Illinois: University of Chicago Press, 1987.
Naqvi, Syed. “Review of Child and Adolescent Psychiatry.” Focus 2 (2004):529-540.
Halmi Katherine A. 2005. “The Multimodal Treatment of Eating Disorders”. World Psychiatry 4, no. 2 (2005): 69-73.
Dare Chris, Isler Ivan, Russel Gerald, Treasure Janet & Dodge Liz . “Psychological Therapies for Adults with Anorexia Nervosa.” British Journal of Psychiatry 178 (2001): 216-221.
Attia Evelyn, Walsh B. Timothy, 2007. “Anorexia Nervosa”. American Journal Psychiatry 164 (2007): 1805-1810.
Kaye Walter H., Bulik Cynthia M., Thornton Laura, Barbarich Nicole, Masters Kim and the Price Foundation Collaborative Group. “Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa”. American Journal of Psychiatry 161 (2004): 2215-2221.