Psychological Side of Anorexia - Coursework Example

Anorexia Customer Inserts His/Her Name Customer Inserts Grade Course Customer Inserts Tutor’s Name Insert Date Here (Day, Month, Year) Anorexia is a psychological illness describing an eating disorder with patient facing below his or her normal body weight and body image distortion. With an excessive obsession of losing weight, patient almost starves to the brink of malnutrition or exercises too much. Individuals having anorexia try to reduce their weight by means of starving, purging and excessive exercises or by the use of artificial weight control methods like diet pills or diuretic drugs. While more of females are affected from this problem, 10 per cent of them are males. Anorexia Nervosa was first described in 1684 but it was only in 1870 that the disease became identifiable and diagnosed as it was Sir William Gull in the 19th century who first coined the term and since then we began to further understand the serious complications anorexia can lead us into. It is understood as the nervous loss of appetite but the various symptoms and mood swings elude us to get a better understanding of the causes of anorexia. Richard Morton was the first one to make the first medical discovery of anorexia in 1968. (Halse, Honey & Boughtwood, 2007) Discovery of this new disease had not only shown us the method of treatment but it also had a profound effect on the changes in society and how we can make our mission idealized. The culture and the several problems in social structure is a reason why anorexia is spreading so fast. Even psychologists had knowledge about the disease much before its official discovery yet it was not until the beginning of the 1970 that media of America began to write about the disease. In 1974, stories were flashed by American media on how young women declined to eat anything but without really coming up with the depth of the seriousness of the problem. During one of the TV shows in America, the host joked about the disease and proposed how anorectic cookbook would look like. But now the people had begun to realize the seriousness of the disease. In 1978, one of the psychologists Hilde Bruch sent his book for publishing, the title of which was The Golden Cage, a complete and thorough book on the disease. This book had mentioned in 70 real cases pertaining to this disorder. (Linda, 2008) Anorexia nervosa is primarily not considered as much serious but if it becomes grave creating neurobiological, psychological and sociological conditions then it may lead to death in several cases. Anorexia is a Greek word, and nervosa a Latin word, together which means “loss of appetite for nervous reasons” (Bjorklund, 2006, p. 14) Person getting affected from anorexia nervosa is termed as anorexic or an anorectic. Clinically, problem can be diagnosed with the help of biological tests, but the problem is diagnosed by observing the changed behavior patterns in the patients, their beliefs and experiences, and certain characteristic traits being shown by the patient. The clinical psychologists, psychiatrists or any other suitable qualified clinicians chiefly conduct diagnosis of the anorexia. Patient having anorexia must display signs of fluctuating body weight for their age or height; failure to increase the weight growth during the period of growth; consequent fear of weight increase of getting fat even though patient is under weight; disturbance in the manner patient experiences in his or her body weight and often denies the seriousness of the low body weight; and three consequent menstrual cycles do not happen in women who though had their first menstrual period but had not gone through the phase of menopause as yet. Other diagnosis could be change in the level of the structure of brain and its functionary often linked with starvation, reduction in the blood flow in the temporal lobes, disorder in the endocrine causing periods to stop in girls, decrease in libido or cause of impotence in males, reduction of metabolism, decrease in heart rate, hypotension, hypothermia, and anemia. People having anorexia may also show abnormalities of mineral and electrolyte levels in the body, thinning of the hair, constantly having a feeling of cold, reduction in count of white blood cells, reduced functioning of immune system, creaking of joints and bones and tooth decay etc. (Stoppler, 2007) Patients can also face psychological dysfunctions like distorted body image, poor insight, having a feeling of low self esteem and self efficacy, phobia, clinical depression, mood swings etc. Patients may also show behavioral disorders like getting secretive about eating habits, causing self-harm and suicide. (Stoppler, 2007) There is no doubt that there is no one cause of Anorexia but originates from the social, biological and psychological factors. There could be number of other causes too that result from several other factors on the development of anorexia. Still there is a continuous debate on the causes of anorexia especially contribution of media pressure on women. There are two kinds of anorexia, which people suffer from, the first one is restrictive anorexia and second is binge eating or purging anorexia. (Seligman & Reichenberg, 2007) Underlying characteristics of both these kinds are same; in both the kinds of anorexia, sufferer will always have a fear of weight gain. Patient will always feel being overweight even though she or he is absolutely skinny and may get into depression. In Binge/Purging Anorexia, patients will have the tendency for induced vomiting once they have eaten it. Though sufferer will eat but he or she will feel guilty immediately of the action and would force to get rid of the same. This could lead to serious disorder in the digestive system especially in the area of oesophagus, which on account of the acid could burst or rupture. Another kind of purging is due to the use of laxatives with many anorexics thinking its use can help in reducing the weight but this is wrong notion as the use of laxatives only takes place at the lower side of the bowel. In the restrictive anorexia, the patient will reduce the food content, or will not eat anything at all. They will keep on thinking about their looks only, will always have same fear of getting being overweight, same kind of worthlessness and isolated feeling which gets exaggerated by depression. The sufferer will exercise to the extreme limit only but with one aim, to get rid of the fat from the body. (Seligman & Reichenberg, 2007) As discussed above, anorexia can have several causes and many can also be underground causes. These are psychological, neurobiological, nutrition, social and environment factors. There has been lot of research on the psychological factors of anorexia suggesting how several biases in thinking process and perception help in maintaining or contributing towards the risk of developing anorexia. The most important is no doubt being always possessed with the feeling of fatness and unattractiveness and always having cognitive biases of the same. Recent research done by Jansen, Smeets, Martijn & Nederkoorn in 2006 focused on the fact that people having anorexia nervosa lack in confidence or you can say self-esteem promoting bias because many unaffected people face more attractive people than themselves but still consider themselves more attractive. This is not in the case of people suffering from anorexia as they lack a kind of overconfidence bias. The psychodynamic model of abnormal behavior also explains anorexia nervosa by the family systems theory and the struggle young person faces in the familial environment. Anorexia is also result of the adolescents causing rebellion against the constraints of the family and their struggle for attaining autonomous power. Hilda Bruch had also showed the expression of the same when she suggested that food is mother’s way of showing love and affection and refusing of the same is the children’s way to show their regression and autonomy. Often sexually abused child also wants to degrade or destroy her body by refusing food. (Eysenck, 2005) Professor Chris Fairburn of University of Oxford and his colleagues developed a transdiagnostic model in 2003 whereby they aimed to establish how anorexia and also related disorders like bulimia nervosa as well as ED-NOS occur in the patients. They have developed model with the help of psychological therapies especially keeping cognitive behavioral therapy in mind and provided areas where clinicians could deliver the psychological treatment. Their model depends on the basic assumption that major eating disorders share some kind of psychopathology, which makes patients retain their eating disorder behavior. These psychopathological causes are clinical perfectionism, a very low self esteem, showing intolerance for others and interpersonal difficulties. (Fairburn, Cooper & Shafran, 2003) Some of the factors causing anorexia are genetic. There is enough evidence to come out with the fact that genes regulate our eating behavior, personality and emotions. Klump, Kaye and Strober conducted twin and family studies in 2001 and found the fact that genetic factors contribute to around 50 per cent of the variant behavior during the eating disorder whereas Wade, Bulik, Neale and Kendler found in 2000 that anorexia shares a genetic risk along with the clinical depression. In 2002 report by Tori DeAngelis, Kaye commented, “Recently, there’s been accumulating evidence for contributory biological, family and genetic components. I suspect we’re going down the path we did with schizophrenia and autism 20 years ago--that is, that anorexia, like these other psychiatric disorders, appears to have genetic susceptibilities”. (DeAngelis, 2002, Online) In one of the studies, variations in the norepinephrine transporter gene promoter have been found to be the cause of the restrictive anorexia nervosa but not the binge-purge anorexia. (Urwin, Bennetts, Wilcken et al., 2002). Several other models have also been developed by conducting tests on animals, which were made to expose to various environmental stresses. These models came with one result that the hypothalamic pituitary adrenal axis may be the main cause of anorexia nervosa. But these models were also not without criticism, as these models did not take into account several sociological and cultural factors that go with causing anorexia nervosa. Generally families having its one or the other member affected with anorexia show the traits of enmeshment, over-protectiveness, rigidity, lack of conflict resolution and involvement of a vulnerable symptomatic child. Generally families have a feeling of emotional and physical bond with each other making them to feel other’s movements. In families, it is also seen that generally parents are over protective and this nature creates a hindrance in the path of their growth. Sequences and the behaviors in the family are fixed and reflect in the same way even though whatever circumstances outside forces exert. Basic problem with the family is unending arguments and conflicts that bring out number of tensions and disagreements. These conflicts and tensions give birth to symptomatic child. (Perlmutter, 2004) It is also suggested that some families carry a specific tendency to pathology in the area of eating and weight per se. For e.g. If we see a family history of the patient, we will find problem is carried from ancestors. Studies conducted have found that one quarter of the anorexia patient had at least one relative who had at least one time suffered from anorexia nervosa. Others could be families showing their unusual interest in weight, food or shape. It had also been found by many researchers that patients with eating disorder generally don’t eat in front of their children or don’t behave in the positive way towards their children. (Gilbert, 2005) It also happens that if one child is affected then it is most likely other child would also get affected and a child would have a feeling of gloominess and insecurity. Parents may be affected in one-way or the other and on the whole, would feel confused, helpless, anxious, and even angry. Their anxiousness is clearly seen when their child starts getting secretive about eating habits and often seen complaining on the deceptions they thought their child had given them. (Perlmutter, 2004) Along with the gender, it has also been found that ethnicity and socio economic status created in the environment all around atmosphere of deepest appeal for pride and prejudice and looking beautiful and the most attractive face in the crowd. This fascination of looking beautiful and adding to it a culture of western media creates a deep psychological impact on the teenagers to the extent that in a bid to be a face in the crowd, they adopt unhealthy attitude making way for large chances of adopting anorexia nervosa. A study by Garner and Garfinkel suggested that profession demanding people to be thin like models or dancers often are affected by anorexia. Sexually abused child is also often found affected with anorexia. (Eysenck, 2005) There are also strong indications of the relationship between the neurotransmitter serotonin and several other psychological symptoms like emesis, mood, vomiting, sleep, appetite and sexuality. A recent survey indicated the link between the anorexia and disturbed serotonin system, especially with the highest level of areas in the brain with 5HT1A receptor. This system is connected to the mood, anxiety, and impulse control. These cause patients to starve but again starvation is found to reduce the steroid hormone and tryptophan metabolism. (Kaye et al., 2005) Several evidences reveal the fact that both the personality characteristics like anxiety and perfectionism and several other disturbances to the serotonin system are still abundantly found even after patients have been recovered. If we talk about nutritional causes, deficiency in zinc results in the decrease of appetite that could get deteriorated if one gets affected from anorexia nervosa. Deficiency of other nutrients like tyrosine and trytophan as well as vitamin B1 could also lead to malnutrition. If serotonin (5-HT) is found to be in low level it can cause several problems in the hypothalamus, which in turn can develop eating disorder. Studies were conducted to get exact measurement of the levels of serotonin among individuals having eating disorder and among normal individuals. Studies came up with the conclusion that more deeply patients are suffering from eating disorder, lower they have levels of serotonin. (Watson, 2001) Many owed the issue of anorexia with the physiological explanations, which bore the idea that there is a malfunction of hypothalamus. This concept was advocated by Gelfand, Jenson and Drew. Physiological researchers have pinpointed the fact that among all the self-regulating measures of the hypothalamus is one which regulates body weight. Experiments conducted on laboratory rats have found out the fact that damages in some areas of hypothalamus can cause changes in the body weight. One kind of damage can cause overeating on the part of rats as well as other kind of damage can cause animals leading to the starvation and then their deaths. According to Gelfand, “Anorexia comes from a similar source-that it happens because of the damage to the hypothalamus.” (Hayes, 2006, p. 252) In other words patient cannot feel proper hunger signals and may not eat appropriate food to remain healthy. Anorexia is thought to possess with the highest level of mortality rate with around 6 per cent of the patients finally diagnosed with anorexia succumb to death. The suicide rate among people is also more as compared to the other people but we cannot say that anorexia is limited to the any age or area. (Herzog et al., 2000) Several cases have to come to light where elder people too have died on account of anorexia. Psychological treatment is generally preferred for anorexia but when problem gets serious, patient should be hospitalized. Immediate treatment for anorexia is a weight gain especially for patients with serious conditions but physicians, or psychiatrists or clinical psychologists treat other cases as outpatients. Another review suggested psychotherapy as the most effective form of treatment enabling patients to increase their weight, improve in the sociological and psychological functioning and return of menses. (Hay, Bacaltchuk, Claudino, Ben-Tovim, & Yong, 2003) Family therapy is considered as best treatment beside others because main treatment for the anorexia lies in the hands of family members and support groups. Medications can reduce gravity of the problem but family members can build the support base and family structure in the way their whole disease could subside. Proper diet and nutritious food may also go along with the other treatments to give final look. It is found that SSRI or any other antidepressants medications have not been proved to be effective in case of anorexia. (Claudino, et al., 2006) Anorexia nervosa is a psychological turmoil attacking person of any age and is found to have serious repercussions if not timely diagnosed and treated. All the medical, nutritional, and psychiatric care is required for the patients to recover. But more than the treatment, patients require tender love, emotional support and friendly atmosphere at their own home. Here nurses can be of great help as they can help family members to create an environment most conducive for patients. Foremost thing they have to look at the food habits of the patients and secondly they can also help in keeping the family dysfunction to the minimum, in other words, they can act like a counselor to the family members keeping their problems to the minimum and also create most conducive and friendly environment to make the patient at ease. Once cured, nurses should teach patient and their family for the use of Mcknight Risk Factor Survey to further prevent the disease. The most important part in the whole treatment is the regular monitoring of weight and it is recommended that nurses should weigh patients and keep the record of their weight for diet specialist to prepare proper diet for them. (Byod, 2007) Psychotherapy should be focused on many issues including carefully monitoring of the patient’s weight including proper nutrition. If client is seen in an outpatient center in an emancipated state, then he or she should be immediately provided with proper food, which can be taken care of with the help of IV. If individual is not in a state of immediate crisis or suffering from any medical complications then good psychotherapy is the best remedy including cognitive-oriented therapies and even group therapies. Overall, people who have constant feeling of low self esteem and lack of confidence get caught in the situation of anorexia nervosa and what better medicine for them could be than love and emotional care. Reference List Bjorklund, R. (2006). Eating disorders. Tarrytown, New York: Marshall Cavendish. Boyd, M. A. (2007). Psychiatric nursing: Contemporary practice. Philadelphia: Lippincott Williams & Wilkins. Claudino, et al. (2006). Antidepressants for anorexia nervosa. Cochrane Database Syst Rev, 1. DeAngelis, T. 2002. A genetic link to anorexia. Retrieved on August 15, 2008 from W.W.W: http://www.apa.org/monitor/mar02/genetic.html Eysenck, M.W. (2005). Psychology for AS Level. Madison Avenue, New York: Psychology Press Ltd. Fairburn C.G., Cooper Z. & Shafran R. (2003) Cognitive behavior therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research Therapy, 41 (5), 509-28. Gilbert, S. (2005) Counselling for Eating Disorders. London & California: SAGE. Halse, C., Honey, A. & Boughtwood, D. (2007). Inside anorexia: The experiences of girls and their Families. New York: Jessica Kingsley Publishing. Hay, P., Bacaltchuk, J., Claudino, A., Ben-Tovim, D. & Yong PY. (2003). Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev, 4. Hayes, N. (2006). Foundations of psychology. Bedford Row, London: Thomas Learning. Herzog, D.B., Greenwood, D.N., Dorer, D. J., Flores, A. T., Ekeblad, E. R., Richards, A. Blais, M. A., Keller, M. B. (2000), Mortality in eating disorders: A descriptive study. International Journal of Eating Disorders 28 (1), 20–26. Jansen A., Smeets T., Martijn C. & Nederkoorn C. (2006) I see what you see: the lack of a self-serving body-image bias in eating disorders. Br J Clin Psychol, 45 (1), 123-35. Kaye W.H., Frank G.K., Bailer U.F., Henry S.E., Meltzer C.C., Price J.C., Mathis C.A., Wagner A. (2005) Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies. Physiol Behav, 85 (1), 73-81. Klump K.L., Kaye W.H., Strober M. (2001) The evolving genetic foundations of eating disorders. Psychiatr Clin North Am, 24 (2), 215-25 Linda Gehlin, L. (2008). The history of anorexia nervosa and other eating disorders. Retrieved on August 15, 2008 from W.W.W: http://www.web4health.info/en/answers/ed-anorexia-history.htm Perlmutter, R. (2004). A Family Approach to Psychiatric Disorders. Arlington, VA: American Psychiatric Pub, Inc. Seligman, L. & Reichenberg, L. W. 2007. Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders. San Francisco: John Wiley and Sons. Stoppler, M.C. (2007). What are anorexia symptoms and signs (psychological and behavioral)? Retrieved on April 6, 2008 from W.W.W: http://www.medicinenet.com/anorexia_nervosa/page3.htm#tocf Stoppler, M.C. (2007). What are anorexia symptoms and signs (physical)? Retrieved on April 6, 2008 from W.W.W: http://www.medicinenet.com/anorexia_nervosa/page4.htm#tocg Urwin, R.E., Bennetts, B., Wilcken, B. et al. (2002). Anorexia nervosa (restrictive subtype) is associated with a polymorphism in the novel norepinephrine transporter gene promoter polymorphic region. Molecular Psychiatry, 7(6), 652–657. Wade T.D., Bulik C.M., Neale M. & Kendler KS. (2000) Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry, 157 (3), 469-71.   Watson, D. (2001) Anorexia: Explanations. Retrieved on April 6, 2008 from W.W.W: http://udel.edu/~djwatson/explanations.html Read More

Other diagnosis could be change in the level of the structure of brain and its functionary often linked with starvation, reduction in the blood flow in the temporal lobes, disorder in the endocrine causing periods to stop in girls, decrease in libido or cause of impotence in males, reduction of metabolism, decrease in heart rate, hypotension, hypothermia, and anemia. People having anorexia may also show abnormalities of mineral and electrolyte levels in the body, thinning of the hair, constantly having a feeling of cold, reduction in count of white blood cells, reduced functioning of immune system, creaking of joints and bones and tooth decay etc.

(Stoppler, 2007) Patients can also face psychological dysfunctions like distorted body image, poor insight, having a feeling of low self esteem and self efficacy, phobia, clinical depression, mood swings etc. Patients may also show behavioral disorders like getting secretive about eating habits, causing self-harm and suicide. (Stoppler, 2007) There is no doubt that there is no one cause of Anorexia but originates from the social, biological and psychological factors. There could be number of other causes too that result from several other factors on the development of anorexia.

Still there is a continuous debate on the causes of anorexia especially contribution of media pressure on women. There are two kinds of anorexia, which people suffer from, the first one is restrictive anorexia and second is binge eating or purging anorexia. (Seligman & Reichenberg, 2007) Underlying characteristics of both these kinds are same; in both the kinds of anorexia, sufferer will always have a fear of weight gain. Patient will always feel being overweight even though she or he is absolutely skinny and may get into depression.

In Binge/Purging Anorexia, patients will have the tendency for induced vomiting once they have eaten it. Though sufferer will eat but he or she will feel guilty immediately of the action and would force to get rid of the same. This could lead to serious disorder in the digestive system especially in the area of oesophagus, which on account of the acid could burst or rupture. Another kind of purging is due to the use of laxatives with many anorexics thinking its use can help in reducing the weight but this is wrong notion as the use of laxatives only takes place at the lower side of the bowel.

In the restrictive anorexia, the patient will reduce the food content, or will not eat anything at all. They will keep on thinking about their looks only, will always have same fear of getting being overweight, same kind of worthlessness and isolated feeling which gets exaggerated by depression. The sufferer will exercise to the extreme limit only but with one aim, to get rid of the fat from the body. (Seligman & Reichenberg, 2007) As discussed above, anorexia can have several causes and many can also be underground causes.

These are psychological, neurobiological, nutrition, social and environment factors. There has been lot of research on the psychological factors of anorexia suggesting how several biases in thinking process and perception help in maintaining or contributing towards the risk of developing anorexia. The most important is no doubt being always possessed with the feeling of fatness and unattractiveness and always having cognitive biases of the same. Recent research done by Jansen, Smeets, Martijn & Nederkoorn in 2006 focused on the fact that people having anorexia nervosa lack in confidence or you can say self-esteem promoting bias because many unaffected people face more attractive people than themselves but still consider themselves more attractive.

This is not in the case of people suffering from anorexia as they lack a kind of overconfidence bias. The psychodynamic model of abnormal behavior also explains anorexia nervosa by the family systems theory and the struggle young person faces in the familial environment. Anorexia is also result of the adolescents causing rebellion against the constraints of the family and their struggle for attaining autonomous power.

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