The History, Types, Signs and Symptoms, Effects, Diagnosis and Prevention of Anorexia Nervosa - Essay Example

Anorexia al Affiliation Anorexia nervosa is a disorder that results from self-starvation. It is more common among females than males, especially teenage girls. Managing and treating the disorder sometimes takes years since it is quite difficult. In the contemporary world, anorexia is persistent and receives a lot of commentary. Regarding how it is perceived, the disorder is perceived differently by people in different professions. In medicine, it is viewed as an illness, predisposition or physical problem, while in psychology and disciplines related to it, it is viewed as a result of family dysfunction, an obsessive desire to become thin, body image distortion or low self-esteem. Despite the different perspectives, all disciplines perceive it as a problem located within an individual. Although, the desire to be slender existed centuries prior to the identification of the condition, no problem had been identified. The term was coined in the 17th century after research showed that obsessive desire to stay thin could be a disease in itself. In the years that followed, different types, signs and symptoms, causes and risk factors, methods of diagnosis, effects, treatments and therapies and ways of preventing the disorder have been discovered. This paper is a general discussion of the disorder. Keywords: Anorexia Nervosa, History, Restrictive, Binge-eating, Purging, Types, Signs, Symptoms, Risk Factors, Causes, Diagnosis, Effects, Therapy, Treatment, Prevention Introduction Anorexia is a colloquial term for a disorder known as Anorexia Nervosa, which Hall and Ostroff describe as “self-starvation” in simple terms (1999, p. 17). Anorexia is more common among females than males, especially teenage girls. The management and treatment of the disorder can take approximately six years since it is quite difficult. Boughtwood, Halse and Honey point out that “anorexia can last a lifetime and cause extensive, on-going physical, social, and psychological problems for them and their families” (2008, p. 15). In fact, even after regaining weight, some of the problems brought about by the condition still persist. In the contemporary world, anorexia is persistent and receives a lot of commentary. This is because many people, from teenagers to the elderly, aspire to have the kind of bodies which are the envy of others. In an effort to achieve this, most of them end up becoming anorexic. Due to the persistence of the disorder, a lot of analysis has been conducted and different perspectives, models and theories have been formulated in an effort to understand the problem. In fact, what anorexia actually is, is a hugely debated issue, and the reason behind the many opinions and theories. In biosciences and medicine, anorexia nervosa is viewed as an illness, predisposition or physical problem, while in psychology and disciplines related to psychology, it is viewed as a result of family dysfunction, an obsessive desire to become thin, body image distortion or low self-esteem (Boughtwood, Halse & Honey, 2008). It is however important to note that in all instances, anorexia is basically a problem located within a person. According to Boughtwood, Halse and Honey, “anorexia nervosa is a medical term and anorexia is diagnosed using medical criteria” (2008, p. 16). This paper discusses the history, types, signs and symptoms, causes and risk factors, effects, diagnosis, recovery treatment and prevention of anorexia nervosa. History of Anorexia Nervosa Although intense measures aimed at controlling weight existed many centuries ago in history, the probability of the issue being an illness had not been identified. During the Classical period for example, early Greeks and Romans disapproved obesity (Shepphird, 2010). Slim figures were the trend for women in the upper social classes. In ancient Sparta, records have it that monthly examinations were carried out for young people in nudity, and in case any of them had gained weight, exercise was recommended for them. There is also a lot of religious literature on women who fasted for spiritual reasons. According to Shepphird (2010), “fasting was considered a godly pursuit, while being overweight was often considered sinful and equated with gluttony” (p. 12). The earliest medical account of anorexia nervosa was written by an Italian from Genoa known as Simone Porta (Shepphird, 2010). In the years that followed, continuous studies on the disorder were carried out. In 1689, a British physician known as Sir Richard Morton gave an English description of anorexia nervosa. According to Shepphird, Sir Richard Morton “reported of two adolescent cases, one female and one male, which he described as occurrences of nervous consumption, a wasting away due to emotional turmoil” (2010, p. 11). However, it was not until the nineteenth century that the condition was introduced as a diagnosis; this was done by Charles Lasegue from France and Sir William Gull from England (Shepphird, 2010). Although their diagnosis gave different views of the disorder, they both described the disorder to be characterized by self-starvation. Sir William Gull was the first to report about his diagnosis to the Clinical Society of London; he termed the illness as anorexia nervosa, which means “nervous loss of appetite” (Shepphird, 2010, p. 11). After the reports about his findings got publishing, the term anorexia nervosa received widespread acceptance. Other great physicians of the nineteenth century described anorexia nervosa as being characterized by mental depression or hysteria. In the early twentieth century, psychotherapy was recognized as a good therapy for treating the disorder. The disorder came to be well understood in the twentieth century, especially from the work of Hilde Brutch, a specialist in eating disorders (Shepphird, 2010). Others who have influenced the understanding of the disorder are Gerald Russell and Arthur Crisp (Shepphird, 2010). Shepphird points out that “in the past few decades, research has dramatically increased our knowledge of the physical effects of starvation, as well as the psychological and social components of anorexia“(2010, p. 13). Consequently, adequate treatments have been discovered as research on the disorder continues. Types of Anorexia Nervosa There are two categories of Anorexia; the restricting type and the purging or binge-eating type. Restricting type of anorexia nervosa: In this type, individuals afraid of getting fat exercise excessively or restrict their food intake. In the diagnosis for this type of anorexia, clinicians look for signs of a person who “has not regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas” (Garner & Garfinkel, 1997, p. 27). Purging or binge-eating type of anorexia nervosa: In this type, individuals consume large portions of food within a short period and after satisfying their hunger, they induce vomiting, use laxatives or exercise excessively; all the tactics used are aimed at getting rid of the food consumed. In the diagnosis for this type of anorexia, clinicians look for signs of a person who “has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas” (1997, p. 27). Signs and Symptoms of Anorexia Nervosa Signs of anorexia 1. Substantial loss of weight. 2. A noticeable obsession with counting calories and fats in food, constantly measuring weight, and dieting (NEDA, n.d.). 3. Complete rejection of certain types of foods, especially carbohydrates. 4. Incessant remarks about feeling overweight or fat in spite of losing weight (NEDA, n.d.). 5. Worry about becoming fat or overweight. 6. Disapproval of any feelings of hunger (NEDA, n.d.). 7. Development of new habits regarding food such as rearrangement of food in a plate, too much chewing or new orders of eating foods (NEDA, n.d.). 8. Constant excuses during mealtimes and matters involving food. 9. Exaggerated exercise plans that are followed in spite of any injuries, unfavorable weather, or illnesses since the person feels the need to burn any calories consumed (NEDA, n.d.). 10. Withdrawal or social isolation from usual activities and friends (NEDA, n.d.). Symptoms of anorexia Amenorrhea: Amenorrhea is a term used to mean absence of monthly periods or menstruation (ANAD, 2014). In young females, whose periods have started amenorrhea is a symptom of anorexia (ANAD, 2014). Some miss their periods for as long as 3 months consecutively. This however does not apply to females, whose periods have not started, males, and females using birth control pills. According to Reel, “using amenorrhea restricts the anorexia nervosa diagnosis from being appropriately used for children or early adolescents who have not yet reached menarche as well as for postmenopausal women who no longer have a period” (2013, p. 29). Issues with body image: Individuals suffering from anorexia do not see the accurate images of themselves when they look at the mirror. Though some may be extremely thin, they see an image of a person who is fat or overweight (ANAD, 2014). Since they are scared of gaining weight, most of them continue to diet. For individuals who get to accept that they are extremely thin, they do not see the danger in the situation. In fact, for most of them, it is very hard convincing them that the situation could be fatal. Acute fear of growing fat: Anorexics diet to the point of starving themselves. Although they get hungry, they deny this and refuse to eat for fear of gaining weight however little. Although a good amount of fats and calories is essential, these individuals ignore foods with them completely. In fact, most anorexics are vegetarians (ANAD, 2014). By constantly thinking about food and attempting to count each calorie, individuals begin to focus on only one issue in life. This denies such people the joys that come with life such as eating favorite foods and having fun with family and friends. Unwillingness to preserve normal weight: Anorexics refuse to preserve the ideal body weight for their age and height (ANAD, 2014). It is however important to note that not all individuals who fall below the ideal body weights for their heights and ages are anorexic since there are a variety of reasons behind this. Anorexia is very difficult to identify in children. For those with eating disorders, stunted growth is usually the result. This is the main reason why there is need for growth charts of children to be studied carefully (ANAD, 2014). Causes of Anorexia Nervosa What causes anorexia is one of the most frequently asked questions regarding anorexia. From the research conducted over the years, there is no distinct cause of anorexia (Shepphird, 2010). A blend of factors can cause anorexia and the existence of risk factors can increase a person’s susceptibility to the disorder. Risk factors include biological or genetic factors, developmental factors, cultural or social factors, psychological factors, and a range of other factors such as occupational factors (Shepphird, 2010). Biological or genetic factors: According to studies, individuals with a family history of anorexia are more likely to suffer from the disorder (Shepphird, 2010). Shepphird (2010) points out that “some individuals may have a genetic predisposition toward developing an eating disorder, with some research indicating a hereditability factor greater than 50%” (p. 58). A range of genetic factors combined with environmental factors increase the risk of individuals acquiring the disorder. It is however important to note that not all anorexic patients have a history of eating disorders in their families. Brain chemistry has also helped in understanding anorexia. According to Shepphird, “scientific investigations have shown that the regulation of certain brain chemicals, called neurotransmitter, play an important role in certain psychiatric illnesses, such as depression and anxiety disorders” (2010, p. 59). Neurotransmitters contribute a lot in the occurrence of anorexia. This is because there are neurotransmitters such as dopamine, norepinephrine, and serotonin that affect elements of mood and behavior in people (Shepphird, 2010). It has also been found out that when individuals are stressed, some hormones released into their bodies play a role in causing anorexia. Developmental factors: Anorexia is common during adolescence. This is because “developmental changes that occur with puberty can increase a youth’s attention to, and dissatisfaction with, his or her body image” (Shepphird, 2010, p. 61). During this stage, most boys and girls experiment dieting and this increases susceptibility to anorexic tendencies. In girls, increase in body fat is a requirement for menstruation to occur and this is why most anorexics experience amenorrhea. Factors from peers such as teasing about weight and appearance lead to greater risks of eating disorders. It is common to find close friends performing dietary restrictions as a weight loss strategy and this influences their attitudes about food and weight. Shepphird (2010) asserts that the life transitions that occur during puberty for example “starting high school, the onset of dating, or leaving home to go to college , may interact with other risk factors to trigger eating disorder behaviors in vulnerable individuals” (p. 61-62). Cultural or social factors: Cultural factors such as western cultural influences, which uphold slimness as the right way to look, contribute to people’s vulnerability in generating eating disorders such as anorexia. Many westerners pursue thinness, beauty and appearance. According to Shepphird (2010), “one can scarcely pass a magazine rack, turn on the television, or watch popular films without being bombarded with images and ideas that equate success, happiness, and social acceptance with the thin ideal” (p. 66).The prevalence of anorexia in these western societies is caused by these cultural expectations. The pursuit of happiness and dieting are common norms in industrialized nations and this is the main reason why anorexia is more prevalent in these nations. Non industrialized and non-western nations have very low rates of people suffering from anorexia. Shepphird asserts that “cultural influences of a social nature may also contribute to the increased risk of anorexia among females” (p. 67). In fact, one of the reasons why more females are anorexic can be attributed to pressures from their respective societies and cultures to stay thin. Psychological factors: There are many psychological factors that lead to the occurrence of anorexia. Examples are factors such as loneliness, guilt, anger, feeling inadequate and low self-esteem. There are particular personality traits that have been observed in anorexics, although there is no personality formula established for recognizing anorexia. The common characteristics observed in anorexics include social isolation, concerns about identity, rigidity in thinking, extreme shyness, fears about maturing, issues with body image, obsessive behaviors, difficulty describing personal feelings, extreme control of emotions, a passion for thinness, an anxious attitude and extreme care especially for things consumed (Shepphird, 2010). This however does not mean that people with the listed characteristics are anorexic, but rather the characteristics together with other risk factors increase individual’s susceptibility to becoming anorexic. Vulnerability to anorexia is also increased by factors such as effects of chronic illnesses, feeding problems during childhood, a history of obesity or weight anxiety, sexual or physical abuse, emotional conflict, a traumatic experience in the past or a history of a psychological disorder (Shepphird, 2010). Other factors: A range of other factors increase individual’s vulnerability to becoming anorexic. Examples are activities that emphasize weight control and slenderness. Compared to the general population, ballet dancers have a higher prevalence rate of anorexia. According to Shepphird, “other sports such as gymnastics, figure skating, wrestling, rowing, swimming, jockeying, track and field, and body building can involve certain weight restrictions that may lead to unhealthy attempts at weight control” (2010, p. 63). Other occupations that experience pressures for slenderness are entertainment personalities and models. Effects of Anorexia Nervosa Anorexia nervosa has dangerous effects on an individual’s social, psychological, and physical well-being. Social effects The main social effect of anorexia is withdrawal or social isolation. This usually results from the fact that most anorexics don’t believe they look good enough. It is common to hear most of them say they look fat when they look at themselves on the mirror, while this may not be the case. Social isolation is also a result of low self-esteem. Psychological effects Depression, distraction and mental slowdown are common in anorexics. Depression results from a lot of emotional anxiety and the fear of getting fat or overweight. Thinking about matters related to food all the time also leads to distraction. In fact, it can be said that “anorexics are obsessed with food” (2011, p. 89). Physical effects Anorexia leads to malnutrition. According to Sonenklar, “a lack of proper nutrition affects every organ and system of the body, especially the brain, heart, kidneys, bones, skin, hair and intestines” (2011, p. 83). There are many physical changes that result from sudden weight loss. Body fat: A healthy body weight must consist of fat, muscles and bones. Additional weight comes from the skin. Fat is necessary for a normal, healthy functioning body. It forms part of the cell structure, provides the body with energy, and insulates organs from cold. The total percentage of body fat in women is higher than that of men (Sonenklar, 2011). Subcutaneous fat located under the skin is necessary for providing the body with energy, protecting the skin from trauma and supplying oxygen to the skin through the blood vessels (Sonenklar, 2011). Loss of subcutaneous fat leads to protrusion of bones and veins on the skin and a sunken look on the face, especially for anorexics. Decreased glucose levels and metabolism: Through food consumed, the body obtains glucose. Through the process of metabolism, the glucose is converted to energy, which fuels the body for good health to prevail (Sonenklar, 2011). When anorexics starve themselves, their body glucose levels dramatically reduce and this causes decreased metabolism. The decrease in metabolism shuts down or slows down many body processes such as monthly periods in mature females. The body attempts to conserve heat in people with low rates of metabolism and this often results in a decrease of body temperature. Sonenklar points out that “anorexics often have temperatures lower than normal and are often cold, even in the summer” (2011, p. 85). Electrolyte imbalance: Electrolytes fall under the vital minerals in the body. This is because they preserve an electrical charge across cell membranes and this helps in the normal functioning of the body. Examples of electrolytes are potassium and calcium. Hence, “the dehydration….and starvation that occur with anorexia reduce fluid and mineral levels and cause an electrolyte imbalance” (2011, p. 85). Decreased heart rate: Electrolyte imbalance and decreased metabolism affect blood pressure and heartbeat. Anorexics have decreased heart rates compared to healthy individuals. Headaches are a common symptom of decreased blood pressure, due to consequent decrease of oxygen to the brain. It is common for anorexics to feel lightheaded or faint, especially when they stand up after a rest (Sonenklar, 2011). Their hands and feet often a bluish tinge, due to the decrease in oxygen in the blood. Anorexics also experience chest pains, irregular heartbeats and heart palpitations. According to Sonenklar, “in severe cases of anorexia, the heart muscle actually shrinks” (2011, p. 85-86). In fact, the deaths of most anorexics are usually as a result of heart diseases. Interrupted hormone functions: properly functioning hormones are vital for good health. A common problem with the normal functioning of hormones is amenorrhea. Sonenklar points out that “hormones are responsible for amenorrhea, one of the most common effects of dramatic weight loss and self-starvation” (2011, p. 86-87). In anorexics, severely low body weight interrupts the functioning of hormones and this can cause a halt in ovulation. Females in certain occupations such as ballet dancing, gymnastics, long distance running and athletes lose their periods as a result of using a lot of energy in these activities, stress and low body fat. A combination of these factors also causes amenorrhea. Osteoporosis: This is the reduction of bone density that results from starvation. Most anorexics have abnormal bone density, since they fail to consume a healthy diet for fear of growing fat. Diagnosis of Anorexia Nervosa Diagnosing anorexia is difficult. In fact, there is no physical test for anorexia, but rather medical tests that measure the degree of physical complications of anorexia. An anorexia nervosa diagnosis is made when “a person’s symptoms meet the diagnostic criteria given in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision), or DSM-IV-TR for short” (Shepphird, 2010, p. 3). In the manual there are descriptions of guidelines, research findings, symptoms and signs that healthcare professionals can use in classifying mental disorders. In order to rule out any other symptoms, both physical and mental that may be exhibiting symptoms similar to anorexia symptoms, individuals go through a complete professional assessment and medical exam. Since there are two types of anorexia, the type of anorexia nervosa a person is suffering from is specified by the healthcare professional, who performs the diagnosis. The other resource used in diagnosing anorexia is “the International Classification of Diseases, 10th Revision (ICD-10)” (Shepphird, 2010, p. 5). The coding contains clinical findings, symptoms and signs that can be used by healthcare professionals in classifying illnesses and other health problems. Due to the fact that it is broader that the DSM-IV-TR, ICD-10 is used internationally in classifying all types of diseases and health problems, as well as mental illnesses (Shepphird, 2010). ICD-10 can be used together with or in absence of DSM-IV-TR (Shepphird, 2010). It is however important to note that in both resources, the descriptions of anorexia are the same. Treatment and Therapy for Anorexia Nervosa The treatment of anorexia involves doctors, dieticians, counselors and psychologists. Family members also participate in treatment and hugely contribute to its success. For anorexia to be completely treated, individuals are expected to regain a healthy weight, begin eating more and change their attitudes towards food and themselves. Adequate treatment for anorexia nervosa “combines medical management, nutritional counseling, individual, group, or family psychotherapy” (Beau, 2011, p. 12). Medical treatment: In medical treatment, healthcare professionals focus on and stabilize sever health issues (“Anorexia,” n.d.). Individuals who are seriously malnourished or very distressed are hospitalized. Those with weight below normal levels are also hospitalized, given a good diet, and only get to be discharged when their weight reaches a less critical level. According to Yager and Powers, “medical management involves weight restoration, nutritional rehabilitation, rehydration, and correction of serum electrolytes” (2007, p. 116-117). Patients who are not in critical condition are optionally treated as outpatients. Nutritional treatment: This treatment is performed by a dietician or nutritionist. Individuals suffering from anorexia are taught about proper nutrition and healthy eating (“Anorexia,” n.d.). Patients are also taught how to develop and follow established meal programs; these meal programs usually consist of balanced diets that help in regaining and maintaining healthy body weights (“Anorexia,” n.d.). The first step in nutritional treatment is restoration of nutrient and fluid intake and discontinuation of behaviors that cause weight loss. The second step involves recovery of normal body weight, and the third step involves “establishment of regular, balanced ‘good enough’ eating and health exercise patterns” (Hoek, Treasure & Katzman, 1998, p. 431). Counseling and therapy: Counseling helps in getting rid of negative thoughts and feelings in anorexics. These are in turn replaced with beliefs that are less distorted and healthier. Individuals are also taught constructive ways of dealing with stress, relationship problems and challenging emotions (“Anorexia,” n.d.). Shepphird points out that nutritional counseling is “highly recommended in conjunction with medical and psychological treatment, both for short-term weight recovery as well as to prevent long-term relapse” (2010, p. 154). Prevention of Anorexia Nervosa The question of whether anorexia can be prevented is hugely debated. The main means of prevention of the disorder has been secondary prevention, where anorexia is identified and treated early enough. Other means of prevention are primary and tertiary prevention. Primary prevention is aimed at interrupting the factors that lead to anorexia, while tertiary prevention involves taking steps for anorexics to regain their normal body weight and completely get rehabilitated. In Britain and the United States, early diagnosis of anorexia and intervention through therapy for those found to be suffering from the disorder are encouraged (Garner & Garfinkel, 1997). Scandinavian nations on the other hand emphasize on primary prevention (Garner & Garfinkel, 1997). According to Garner and Garfinkel, strategies to prevent anorexia and other eating disorders can be more effective if more focus could be placed on “higher-risk children with several known predisposing factors, rather than on unrealistic efforts to change the broader sociocultural norms promoting slimness” (1997, p. 346). For adolescents, parents have a major role to play in helping them prevent becoming anorexic. By being good role models for their children, children learn the importance of eating healthy and balanced diets (Engel, Reiss & Dombeck, 2007). Parents can encourage children to take part in family activities for fun, moderate exercises, and healthy eating. For a parent, criticizing his or her body in the presence of children is wrong. Other ways are through sports organizations, the clergy, teachers and physicians (Engel, Reiss & Dombeck, 2007). Even before they reach the adolescent stage, male and female children can be educated about the importance of maintaining a positive body image and eating healthy foods, which include fats and carbohydrates (Engel, Reiss & Dombeck, 2007). In schools for example, children can be educated about the dangers that come with too much dieting, the significance of exercises, nutrition and the fact that body types are different and everyone ought to appreciate his or her own body type. Critical thinking should also be taught and encouraged. This way, children learn not to compare themselves to unrealistically perfect body images displayed on the media. Children also learn how to reject negative pressure from peers. All the identified factors promote healthy lifestyles and self-esteem in children, as well as construction of healthy body images. Conclusion In conclusion, anorexia is a disorder that occurs when individuals starve themselves as they aim at becoming slender. Although the disorder also affects males, females are mostly affected, with majority being adolescents. In medicine, the condition is perceived as an illness, predisposition or physical problem, while in psychology and disciplines related to it, it is viewed as a result of family dysfunction, an obsessive desire to become thin, body image distortion or low self-esteem. The effort for people to maintain slim figures has been in existence from the Classical period and obesity was viewed as a big problem. No health condition had been identified at the time however. In the seventeenth century, the term anorexia nervosa was coined. Numerous researches have been carried out after this, and different signs, symptoms, causes and risk factors, effects, methods of diagnosis, treatments and therapies and ways to prevent the condition have been identified. Reference List ANAD. (2014). Anorexia Nervosa. Retrieved from http://www.anad.org/get-information/get-informationanorexia-nervosa/. Anorexia Nervosa. (n.d.). Retrieved from http://www.helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm. Beau, M. (2011). Medical Marijuana. Bloomington: Xlibris Corporation. Boughtwood, D., Halse, C. & Honey, A. (2008). Inside Anorexia: The Experiences of Girls and their Families. London: Jessica Kingsley Publishers. Engel, B., Reiss N. S. & Dombeck, M. (2007). Prevention of Eating Disorders. Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=11768&cn=46. Garner, David M. & Garfinkel, Paul E. (Eds.). (1997). Handbook of Treatment for Eating Disorders. New York: The Guilford Press. Hall, L. & Ostroff, M. (1999). Anorexia Nervosa: A Guide to Recovery. Carlsbad: Gurze Books. Hoek, H. W., Treasure, J. & Katzman, M. A. (Eds.). (1998). Neurobiology in the Treatment of Eating Disorders. Chichester: John Wiley & Sons Ltd. NEDA. (n.d.). Anorexia Nervosa. Retrieved from http://www.nationaleatingdisorders.org/anorexia-nervosa. Reel, Justine J. (2013). Eating Disorders: An Encyclopedia of Causes, Treatment, and Prevention. California: ABC-CLIO, LLC. Shepphird, S. F. (2010). 100 Questions & Answers about Anorexia Nervosa. Sudbury: Jones & Bartlett Publishers. Sonenklar, C. (2011). Anorexia and Bulimia. Minneapolis: Twenty-First Century Books.  Yager, J. & Powers, P. S. (Eds.). (2007). Clinical Manual of Eating Disorders. Arlington: American Psychiatric Publishing, Inc.   Read More