Current Psychological Treatment of Anorexia Nervosa - Case Study Example

Disabilities impact diverse individuals across generations, gender, and cultures. Not every individual is affect the same way, but there are some generalities. The disability chosen for this paper is the mental aspect of Anorexia Nervosa. The majority of Anorexics are white women, but Anorexia Nervosa crosses gender and race. Since the majority of Anorexics are white women, most counseling techniques are focused on white girls and women. However, with a little bit of sensitivity, men and different races can be treated as well. Anorexia Nervosa is a serious health issue arising from mental trauma. Anorexics can be defined as a disability according to Bryan (2007, p.6). Not all individuals suffering from Anorexia Nervosa has experienced mental trauma, but in a majority of the cases some type of trauma can be determined. The cultural aspects will also be mentioned. The notion of females being the only victims of this illness will be dispelled. The physical aspect of Anorexia Nervosa is dealt with medically, but the psychological is what will be dealt with in this paper as related to minority women and men. Anorexia Nervosa is a serious health issue arising from mental trauma. This statement shows that Anorexia Nervosa has a physical and mental side. Leading doctors and psychologists have not agreed on the cause at this time. For example, Stephens (2008) asserts “Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own.” Not everyone agrees that eating disorders, especially Anorexia Nervosa is only a medical illness. Other doctors and psychologists have seen a trend in Anorexia. The trend leans toward trauma being a predominate cause of Anorexia. Levey states “A variety of psychological, sociological, and family influences have been hypothesized to influence the development of Anorexia Nervosa.” While much research has been done to cure the symptoms of Anorexia Nervosa, the causes still confound many professionals. The American Psychiatric Association (2008) estimates 0.5 percent to 3.7 percent of females and 0.1 percent to 0.2 percent of males suffer from Anorexia Nervosa. The ratio of female to male is higher, but does not make one case of the Anorexia more important than the other. Reasons for women being more prone to Anorexia range from lower self esteem to body image distortion. Since males are less likely to have the illness, it is harder to identify. Many men do not want to come forward with a ‘girl’s disease’. This makes treatment harder because the patient is in denial. Women can be in denial about the disease, but it is easier to break down a woman’s defense than a man’s. One obstacle in diagnosis and treatment of Anorexia is the cost of treatment. Gordon (2000, p. 3) reports “In the United States, the treatment of eating disorders was severely affected by the increasingly stringent economic realities.” The American Psychiatric Association (2008) estimates inpatient care for Anorexia Nervosa around $30,000 to $90,000 monthly. Those without insurance or any type of health care, like minorities, do not receive quality treatment. Gordon (2000, p. 5) concurs “Adequate care for eating disorder patients has been significantly diminished.” This is just thinking of the inpatient costs. Since it takes years, sometimes a lifetime, for an Anorexic to heal, the costs for outpatient care and the complications of Anorexia Nervosa could be astronomical. Morris (2007) explains “Recovery takes years rather than weeks or months.” Without the proper finances, minorities will likely succumb to the illness. Bryan (2007, p. 99) states, “African Americans and Hispanics/Latino Americans with disabilities have lower incomes and lower educational levels than their European American counterparts.” This is true for Anorexic minorities. Money is desperately needed to treat Anorexia Nervosa, but minorities have disadvantages in this area. Recovery then takes money that few Anorexics possess. Morris (2007) outlines the adequate treatment below: Cognitive analytic therapy Cognitive behavior therapy Interpersonal psychotherapy Motivational enhancement therapy Dynamically informed therapies Group therapy Family work Conjoint therapy Separated family therapy Multifamily groups Relatives and carers support groups Not many minorities or men suffering of Anorexia Nervosa have the time or money for treatment. Women suffer from Anorexia Nervosa than males. Saukko (2008, p. 51) concludes “Anorexia, which affected predominately young women.” Which the previous statement is true, more women than men are Anorexic. However, men can suffer as well. Morris (2007) gives these statistics: Anorexia nervosa has the highest mortality of any psychiatric disorder. It has a prevalence of about 0.3% in young women. It is more than twice as common in teenage girls, with an average age of onset of 15 years; 80-90% of patients with anorexia are female. Gordon (2000, p. 5) disputes the “the notion of an ethnic disorder”, wanting the illness to be recognized across gender and race. White female teenagers are what people think of when Anorexia Nervosa is brought up, the disease affects a wider spectrum than that. Anyone can become Anorexic. For example two Anorexic states: I think about food constantly. I am always trying to control the calories and fat I eat, but so often I end up overeating. Then I feel guilty and vomit or take laxatives so I wont gain weight. Each time this happens I promise myself that the next day I will eat normally and stop the vomiting and laxatives. However, the next day the same thing happens. I know this is bad for my body, but I am so afraid of gaining weight….I dont eat all day and then I come home from work and binge. I always tell myself Im going to eat a normal dinner, but it usually turns into a binge. I have to re-buy food so no one notices all the food is gone. (Nova, 2000) The first quote is a 26-year-old African-American female, and the second from a 22-year-old Latina woman. White women are not the only ones to suffer from Anorexia Nervosa. One man that came out as an Anorexic was Michael Krasnow. Krasnow wrote “I felt fat from the sixth grade.” Despite being thin, Krasnow had a distorted body image. He frankly admits “The bottom line is that I am 5’9, and feel fat despite weighing only 75 pounds” (Krasnow, 1996, p.1). Not many men admit to feeling overweight. This could be due to the macho image that they want to perceive, or the higher self esteem. However, Krasnow’s account shows that some men do feel this way. Maybe through his story more men will come forward and share their feelings. Psychological treatment is harder when dealing with minorities or men. Counseling and therapy are harder for a man to be open to. For a male anorexic, it would be helpful to speak with a male therapist. Group therapy can be mixed, but needs to include one or more man to help the Anorexic feel more comfortable. Men can help other men feel more comfortable in opening up. When treating a male anorexic, females can be used in later stages, but male support needs to be available first. The definition of Anorexia Nervosa is an individual who weighs less than their optimal weight due to starvation or over exercising. Morris (2007) defines Anorexia Nervosa ‘hallmarks as: The core psychological feature of anorexia nervosa is the extreme overvaluation of shape and weight. People with anorexia also have the physical capacity to tolerate extreme self imposed weight loss. Food restriction is only one aspect of the practices used to lose weight. Many people with anorexia use overexercise and overactivity to burn calories. They often choose to stand rather than sit; generate opportunities to be physically active; and are drawn to sport, athletics, and dance. Purging practices include self induced vomiting, together with misuse of laxatives, diuretics, and "slimming medicines." Patients may also practise "body checking," which involves repeated weighing, measuring, mirror gazing, and other obsessive behaviour to reassure themselves that they are still thin. No matter what weight goal an Anorexic achieves, they feel fat. In order to fight this feeling, an Anorexic will control food, exercise excessively, and even purge. The need to feel skinny overrides every other aspect in an Anorexics life. The problem becomes what is ‘skinny’. No matter how little an Anorexic weighs, they still feel fat. Different definitions and descriptions can be found of Anorexia Nervosa. Anorexia Nervosa was first diagnosed as: Richard Morton first described anorexia nervosa more than 300 years ago, in 1689, as a condition of "a Nervous Consumption" caused by "sadness, and anxious Cares." In 1873, 2 prominent physicians separately described anorexia nervosa; Charles Laségue described it as "a hysteria linked to hypochondriasis," and Sir William W. Gull described it as "a perversion of the ego. (Levey 2006) Since then Anorexia Nervosa has gotten a medical description. The causes of these symptoms can be from an individual consuming 0-1000 calories a day as an adult. An anorexic might eat these calories then purge everything consumed. Levey (2006) reports, “Purging behaviors associated with binge eating (ie, induced vomiting and/or laxative use), rather than binge eating, have been viewed to be better indicators for subclassifying Anorexia nervosa”. Exercising constantly throughout the day would be another manner in which to achieve the above symptoms. Family members of an ailing Anorexic or individuals with no experience with Anorexia Nervosa might wonder what the goal is for Anorexic behavior. The payoff is the control over one’s body. Anorexics want to control every aspect of their life, even their bodies. Macsween (1995, p. 105) explains “Anorexia, then, is an attempt to remake the body.” Anorexics feel if they can remake their bodies, then anything is possible. All of their problems will cease to exist, if they can make their bodies skinnier. African American women, culturally, have a higher body image opinion. Africans and African American women perceive their bodies differently. They dress up, put make up on, wear flattering clothes despite being thin, medium, or large. This makes family support even harder to receive. If a culture of high self esteem regarding one’s body is common, a low self body image will be misunderstood. More and more minorities suffering from Anorexia need to come forward to help their communities and families to understand the illness. Sexual and child abuse are common in Anorexics. It is because all Anorexics have low self esteem. Sexual and child abuse lower an individual’s self esteem. Herman (1996, 121) explains “Anorexia…self destructive behavior and a history of abuse in childhood.” Trauma like being robbed a gun point, being in a natural disaster, living through an event where someone dies, and so forth causes some individuals to feel out of control. The low self esteem and out of control feelings may lead to Anorexia Nervosa. Anorexics want to be in control, but cannot control external aspects of their life. This leads to controlling the one thing they can; their eating behavior. Levey (2006) explains one expert’s findings as the following: Bruch viewed self-starvation as a representation of struggle for autonomy, competence, control, and self-respect. Failure of the mother to recognize and confirm the childs independent needs was purported to produce inner confusion in 3 overlapping areas. These areas include a tendency to overestimate body size; an inability to correctly identify internal sensations such as hunger, satiety, affective states, and sexual feelings; and a sense of ineffectiveness characterized by feelings of loss of control. The feelings of loss of control make Anorexics want to be in control even more. This need for control becomes compulsive. The above shows that Anorexia is defined by culture. The concept of whites women being more affected of trauma, than men or minorities is portrayed. This actually dismisses the cause of Anorexia Nervosa in men and minorities. When a white woman is raped, she is perceived to be more likely to have an eating disorder. Does this mean a raped African American woman is less likely to have Anorexia Nervosa, or is the disease being ignored in minorities? African Americans might have their own culture, but are human (Bryan, 2007, p. 88). This means they can become Anorexic through trauma. The Psychological aspects of Anorexia Nervosa can be cause and effect. Some causes of Anorexia Nervosa are trauma, media, and culture. Some effects of Anorexia Nervosa are depression, anxiety, suicide, and compulsive behaviors. Anorexia Nervosa can be thought of as a purely psychological disease, whether cause or effect. Levey (2006) reveals: In the first half of the 20th century, a variety of views of the disorder emerged. Pierre Janet considered anorexia to be a purely psychological disorder. Morris Simmonds proposed that pituitary insufficiency led to weight loss in some patients. Berkman viewed physiological disturbances as secondary to the psychological etiology of the disturbance. These psychological causes and effects of Anorexia Nervosa need to be examined individually in each minority group and with men in order to understand this devastating illness. Another psychological cause of Anorexia Nervosa is the media. Thin models are seen everywhere. When Tyra Banks was photographed weighing 160 pounds at 5’10, the media proclaimed her to have ballooned. Stephens states: Dieting to a body weight leaner than required for health is highly promoted by current fashion trends, by sales campaigns for special foods, and in some activities and professions. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, move beyond control for some people and develop into eating disorders. Girls and women are seeing these Caucasian images and trying to live up to them, when minorities are built differently like Tyra Banks. Stephen (2008) states, “Dieting to a body weight leaner than required for health is highly promoted by current fashion trends, by sales campaigns for special foods, and in some activities and professions.” Trendy clothes are made for the thin. While healthy women, who are well within their weight range are labeled fat. This can lead girls to diet, and then take it to the extreme if not seeing immediate results. Wolf states “At a certain point in the cult of ‘beauty,’ dieting becomes anorexia.” Normal girls might start out to lose a couple of pounds, and then find they cannot stop. This leads to them becoming Anorexics. Thin white models are defined as pretty, while Trya Banks is labeled fat. Until more minority and male research into the psychological aspect of Anorexia Nervosa brings prevention or cure, signs of Anorexia Nervosa need to be explained to the public. By understanding the signs of Anorexia Nervosa earlier, intervention can be possible earlier and more successfully. Not only a physical intervention, but a psychological intervention can be attempted successfully in many cases. Theses signs need to be looked for in every race and gender. A few signs would be: 1. Change in eating habits. 2. Any type of psychological or physical trauma. 3. Tooth decay. 4. Baggy clothes. 5. Distorted body images such as statements of ‘I’m fat” or ‘I need to go on a diet’ when below optimal weight. 6. Fatigue. 7. Excessive laxative use. 8. Appearing too thin, tired, or sick. 9. Instinct something’s wrong. The above symptoms could be signs of Anorexia Nervosa. Since signs of Methamphetamine addiction can be similar, the last tip would be the best. Family members should follow their instincts. The most important thing is action. By acting upon suspicions, all family members can do is either help or be wrong. When a life is on the line, it is better to be safe than sorry. Professional or family to help an Anorexic should use community help and understanding. An example would be bilingual counselors or doctors for Hispanic/Latino Americans (Bryan, 2007, p. 206). It is hard to explain Anorexia Nervosa symptoms and feelings to people speaking the same language, thus the need for psychotherapy. It would be easier for someone bilingual to reach a bilingual Anorexic. African Americans have a strong basis in church; this should be involved in treatment for them. Each individual minority or man should be treated like an individual Anorexic, not mass treated like a white female. Minorities and male Anorexia Nervosa needs to be studied more in the U.S. and around the world. Although current psychological treatment can help minorities and males, a more specifically targeted treatment needs to be developed. Minorities and males suffering from Anorexia Nervosa feel the same feelings of pain, shame, and isolation, but need to be encouraged to seek treatment. Only when minority communities and males are educated about Anorexia Nervosa will people suffering from this illness be recognized. This will enable them to get help. Americans should not die from starvation. America is supposed to be an advanced country, not a third world country where people die of starvation daily. Books Bryan, W.V. (2007). Multicultural aspects of disabilities: A guide to understanding and assisting miniorities in the rehabilitation process (2nd ed.). Springfield IL: Charles C. Thomas. Gordon, R.A. (2000). Eating disorders: Anatomy of a social epidemic. New York: Blackwell Publishing. Herman, J. (1996). Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. New York: Basic Book. Krasnow, M. (1996). My life as a male anorexic. New York: Routledge. Macsween, M. (1995). Anorexic bodies: A feminist and sociological perspective on anorexia. New York: Routledge. Wolf, N. (2002). The beauty myth: How images of beauty are used against women. New York: Harper Perennial. Electronic Sources Levey, R., PhD and MPH. “Anorexic nervosa.” eMedicine. 17 April 2006. Accessed 7 July 2008 from http://www.emedicine.com/med/topic144.htm Morris, Jane. “Anorexia nervosa.” BMJ. 334 (2007): 894-898. 28 April 2007. Accessed 7 July 2008 from http://bmj.bmjjournals.com/cgi/content/full/334/7599/894?ck=nck Nova. “Dying to be thin, minority women: The untold story.” Nova. 2000. Accessed 7 July 2008 from http://www.pbs.org/wgbh/nova/thin/minorities.html. Stephens, Laura. “Anorexia nervosa.” Psychology Today. 05 December 2007. Accessed 7 July 2008 from http://psychologytoday.com/conditions/anorexia.html. Publications American Psychiatric Association. In: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association Press; 2008. Read More