Theoretical on Anorexia and Bulimia - Research Paper Example

? Theoretical On Anorexia and Bulimia Theoretical On Anorexia and Bulimia According to DSM-IV-TR, eating disorders are severe disturbances of an individual’s eating behavior. DSM-IV-TR focuses on two categories of eating disorders, which are anorexia and bulimia nervosa. People with eating disorders have disturbances in eating behaviors. These individuals show concern with their weight and body shape. The presentation of eating disorders varies because they appear as severe psychiatric or medical comorbidity. Individuals with these disorders show denial of symptoms and they are reluctant to discuss their state. This challenges the diagnosis and treatment of the disorders. Anorexia and bulimia nervosa are major eating disorders. The criteria used by DSM-IV-TR shows that most patients present both bulimia and anorexia. The criteria shows that close to 50 percent of patients with anorexia develop bulimic symptoms. Additionally, a significant percentage of patients with bulimic symptoms show anorexic symptoms. Anorexia nervosa occurs as a condition where the patient refuses to maintain normal body weight. These individuals have a fear of gaining weight (National Eating Disorder Association, 2013). Anorexia and bulimia are the major eating disorders supported by theories such as the social learning, object relation and cognitive behavior theory. It is worth stating that interpersonal and cognitive behavior therapies are useful during treatment of anorexia and bulimia. Anorexia Nervosa Anorexia Nervosa is one of the primary eating disorders, in which patients show irrational fear of weight gain and immoderate food restrictions. Additionally, patients show a distorted body self-perception. Anorexia typically involves weight loss, and it is usually found in women than in men. People with anorexia restrict the amount of food they consume because they fear gaining weight. Restricting food intake leads to hormonal and metabolic disorders. The characteristics for anorexia include inappropriate eating habits, low body weight and an obsession for a thin body figure (National Eating Disorder Association, 2013). These characteristics are coupled with a distorted self-image, maintained by different cognitive biases. People with anorexia usually view themselves as excessively fat, even though they are already underweight. They practice repetitive weighting, mirror gazing, measuring as well as other obsessive actions. They practice these activities in order to ensure that they are still thin. People with anorexia may feel hungry, but they deny themselves food. They eat small quantities of food despite the hunger. The average Caloric intake of an individual with anorexia is 600-800 calories daily (National Eating Disorder Association, 2013). The disorder is a severe mental condition with high incidences of comorbidity. People with anorexia have high levels of the ghrelin hormone, which is a hormone that indicates a psychological need for food. The high levels of this hormone suggest that these people are hungry, and the body does not receive its desired food portion. The patient suppresses ignores or overrides the hunger call. Anorexia patients exhibit numerous symptoms. The disorder with associated malnutrition may lead to self-imposed starvation and cause complications in major organ systems. Hypokalemia, which is a drop in potassium levels, is a significant sign of anorexia. The drop in blood potassium levels may lead to constipation, muscle damage, fatigue, paralysis and abnormal heart rhythms. Close to 50-75 percent of people with anorexia, suffer from depression and obsessive-compulsive disorder (Kaye, 2007). Patients with this condition refuse to maintain a healthy body mass index. They experience dramatic weight loss and absence of menstrual cycles for three consecutive times. These individuals are usually obsessed with the amount of fat and calories in their food, recipes and cooking methods of food. Recent studies show that prevalent symptoms of the disorder, such as obsessive compulsivity, decreased body temperature and change in psychological state result from starvation. Several studies on the disorder and the continuance of the disordered eating habits may be epiphenomena of malnourishment. The causes of the disorder can be divided into two categories, which are biological or sociological. Biological causes include obstetric complications such as prenatal complications, which may facilitate the development of anorexia (Kaye, 2007). Such prenatal complications include maternal anemia, preeclampsia, diabetes mellitus, neonatal-cardiac abnormalities and placental infarction. Anorexia may also be caused by genetic factors, which are heritable, and nutritional deficiencies. Estimated inheritance rates range from 56-84 percent according to the Cleveland Clinic Center for Continued Studies (2013). Anorexia is consistently associated with polymorphisms associated with brain derived neurotrophic factors and agouti-related peptides (National Eating Disorder Association, 2013). Nutritional deficiencies such as zinc deficiency have a crucial role in the development of anorexia. Zinc deficiency is responsible for the causation of the disorder. It also plays a vital role in the development of the pathway and pathology of anorexia. Sociological causes of the condition are related to the role of cultural factors such as the promotion of weight loss and thin body structures as the ideal female structure or figure. Western and industrialized countries promote thin female bodies as the ideal female figure. This shows the connection between anorexia and culture, where culture is a trigger and cause of the disorder (American Psychiatric Association, 2010). Distinct cultural factors, determined by factors such as family interactions, biological predisposition and individual psychology trigger the condition. Bulimia Nervosa This eating disorder is characterized by purging and binge eating. Patients with this condition consume large amounts of food followed by attempts to remove the consumed food. Patients purge by taking laxatives, stimulants or diuretics. Additionally, they may vomit or participate in excessive exercising. These activities result from the patient’s concern for their body weight. People with bulimia may also fast over long durations. The dangerous habit forming practices occur as the patient try to keep weight under self-imposed thresholds. The habits may lead to the loss of potassium, health deterioration or depressive symptoms that are usually severe. Though bulimia is not life threatening, the condition has high occurrence rates than anorexia. Additionally, the disorder is nine times more likely to occur in women than in men. Studies indicate that bulimia is a familial disorder with estimated heritability of 54-83 percent (American Psychiatric Association, 2010). The DSM-IV-TR criteria for bulimia require recurrent episodes of binge eating. The recurrent episodes should occur during discrete period based on amounts of food that are larger than the intake of a healthy person. Additionally, the patient should not have control over their eating during the episodes. This leads to the feeling that an individual cannot control or stop the urge to eat. Additionally, the criteria for bulimia require recurrent and inappropriate behaviors that aim to prevent weight gain. These include the performance of activities such as fasting, self-induced vomiting, and misuse of laxatives and other medications, in addition to excessive exercise. The patient’s self-evaluation is influenced by body weight and shape. DSM-IV-TR classifies bulimia into two groups, which are the purging and non-purging type. The purging type bulimia involves self-induced vomiting or misuse of substances that might lead to vomiting. The non-purging type involves the use of inappropriate compensatory behaviors (American Psychiatric Association, 2010). However, the patient does not engage in self-induced vomiting or misuse of diuretics or laxatives. People with bulimia have additional psychiatric disorders. Common disorders include anxiety, mood disorders, impulse control and substance abuse disorders. Bulimia patients have impulsive behaviors characterized by overspending (American Psychiatric Association, 2010). They usually have family backgrounds characterized by alcohol and substance abuse, and eating and mood disorders. Bulimia Nervosa features cycles of rapid and uncontrollable eating habits, which stop in case another person interrupts the bulimia. Purging follows the excessive eating. The cycles of eating and purging may cause chronic gastric reflux, hypokalemia and dehydration, esophagitis, electrolyte imbalance, oral trauma, constipation, infertility, Gastro paresis, peptic ulcers and constant weight fluctuations (National Eating Disorder Association, 2013). The disorder has two categories of causes, which are sociological and biological. Biological causes include genetic factors. Genetic predisposition contributes to the development of the disorder. Additionally, abnormal levels of hormones such as serotonin are responsible for the disordered eating disorder. Sex hormones have an influential role in the development of bulimia. They influence the appetite of an individual, which leads to the onset of bulimia, especially in women. According to different studies by the Columbia University, elevated levels of polycystic ovary syndrome and hyperandrogenism have dysregulation effects on appetite (National Eating Disorder Association, 2013). Sociological causes of bulimia have a relationship with the sociological causes of anorexia. Both rely on the portrayal of an ideal body figure by the media. Social-cultural perspectives and context have a crucial role in developing cognitive perspectives about an ideal body figure. An exploration of bulimia shows that patients have an uncomfortable feeling with their body shape and size. These people show dissatisfaction with their bodies, which leads to the development of a drive towards thinness. Eating binges lead to the development of self-disgust that facilitates the development of purging activities in order to prevent weight gain. Social Learning Theory Albert Bandura According to Albert Bandura, the social learning theory focuses on internal and external stimuli. These stimuli influence the ways people learn social behaviors and responses. Bandura highlighted the importance of modeling with a focus on learning. According to the social learning theory, individuals should learn to respond to a stimulus in a similar manner to the model. This means that individuals should learn to imitate the model. Additionally, motivation is a crucial aspect during the process of learning. Individuals must value expected outcomes and consequences of their behaviors in order to develop appropriate strategies for imitating a model. The application of the social learning theory in studying the prevalence of eating disorders should consider the aspect of media through outlets such as magazines, movies, televisions and radio. Additionally, the theory should consider the internet as a mass media tool that has the abilities to change social trends. The media portray a thin body image as an ideal image for a woman’s body. For instance, 90 percent of models on mass media such as the internet, television and posters are thin. This gives an impression that a thin body is ideal for any woman. In addition to portraying thin women, these media show these women as successful, happy and revered (Ambwani, Warren, Gleaves, Cepeda- Benito & Fernandez, 2008). The perceived successes of these models serve as a motivation to individuals who use them as their models during learning processes. Using these models, people learn that being thin increases happiness and social acceptance. Family members and caregivers can also serve as models for people to imitate. This means that social members can use caregivers and family members as models to learn and imitate their behaviors. Family dynamics have the potentials to influence an individual’s eating habits. Family dynamics provide risk factors for the development of eating disorders. This led the social learning theory to suggest that people have a tendency to imitate the behaviors of their family members. According to different studies conducted on a national scale, children born of mothers with eating disorders develop the eating disorder at an early age. Additionally, these children have a high likelihood of developing eating disorders compared to their peers born of mothers who do not show disordered eating habits (Ambwani, Warren, Gleaves, Cepeda- Benito & Fernandez, 2008). These studies confirm that children and people can imitate the disordered eating behaviors and trends modeled by their close family members. The social learning theory also emphasizes on self-reinforcement, in addition to imitation. This means that people have the capabilities to develop standards for themselves. As a result, these individuals will reward themselves in case they attain these standards. Additionally, they will feel guilt and shame in case the standards are not met. These ideas are applicable with eating disorders. It is essential to note that individuals with eating disorders place value on their body weight. In case, these individuals do not maintain their targeted body weight they usually feel guilt and shame. The maintenance of the targeted body weight leads to a feeling of accomplishment. The social learning theory states that people have the capabilities to control their behaviors through self-reinforcement. With eating disorders, high levels of self-control are vital in order to abstain from eating (Ambwani, Warren, Gleaves, Cepeda- Benito & Fernandez, 2008). Additionally, these levels of self-control are required in order to, consistently purge. The social learning theory implies that self-control comes from self-reinforcement generated by the maintenance of a targeted body weight. Object Relations Theory The object relation theory focuses on people’s interactions and strategies for internalizing their experiences. This contrasts the social learning theory, which focuses on external and internal factors that influence behavior and learning. Object relations theory applies to actual interactions and strategies used in the formation of unique mental representations of interactions (Applegate & Shapiro, 2005). Additionally, the theory focuses on self-image. The object relations theory suggests that the primary drive as humans interact with each other is the need to achieve an object. W.R.D Fairbairn According to this theory, people believe that they do not have control over their surrounding or environment. This causes them to have notions that they must change themselves in order to change their environments or situation. As a result, events, environments and behaviors are split into two categories, which are bad and good. The development of eating disorders can be understood using the concepts of this theory. For instance, individuals may feel that a caregiver did not meet their needs. These individuals create notions that the negative aspects of the environment are unchangeable (Applegate & Shapiro, 2005). As a response to the bad environment, the individuals may take to controlling Caloric intake in order to achieve a low body weight. The theory suggests that people develop eating disorders because they struggle to control aspects of their chaotic life. D. W. Winnicott The object theory relates the development of eating disorders to the environment. In this case, a child’s mother plays a crucial role in the development of an infant. According to the object relation theory, a mother should adapt an infant to the ever-changing environment. This will enable the child to grow independently. As a result, the child will have strategies for forming healthy relationships with the environment. Failure to adapt to an environment leads to the creation of notions of loss of control over life (Applegate & Shapiro, 2005). This leads a child to seek control by restricting Caloric intake in order to control body shape and weight. Cognitive Behavior Theory Though the DSM-IV-TR categorization of eating disorders encourages the view of the disorders as distinct conditions, it is essential to note that each disorder requires its own form of treatment. Additionally, it is essential to note that the eating disorders share common clinical features including core psychopathological and the overvaluation of the importance of weight and shape. The cognitive behavioral theory account of eating disorders extends to both bulimia and anorexia. According to the cognitive behavioral theory, the overvaluation of weight and shape is vital in the maintenance of eating disorders (Robins, Chatterjee & Canda, 2006). This leads to dietary restrictions and restraint. Additionally, the patient is preoccupied with thoughts of eating and food, shape and weight. The patient repeatedly checks body weight and shape and avoids gaining weight (Berzoff, Flanagan, Melano & Hertz, 2008). The cognitive-behavioral theory postulates that eating disorder episodes result, from attempts, to adhere to multiple, extreme and specific dietary rules. Failure to follow these rules is viewed negatively. The individual views such incidences as proof that they have poor self-control. As a result, the individual temporarily responds by abandoning efforts to restrain or restrict their eating habits (Robins, Chatterjee & Canda, 2006). This leads to binge eating. Binge eating in turn maintains the individual’s core psychopathology through the intensification of concerns about the individual’s ability to control their body shape, eating and weight (Berzoff, Flanagan, Melano & Hertz, 2008). This encourages additional dietary restraint, which increases binge eating. Three additional processes may lead to binge eating. The first process is difficulties in a patient’s life and linked mood changes. The patient face challenges in maintaining dietary restraint. As binge eating temporarily lessen, negative moods start and they become a strategy for coping with difficult life experiences (Robins, Chatterjee & Canda, 2006). Patients who engage in compensatory purging have mistaken beliefs on the effectiveness and appropriateness of vomiting. Additionally, these individuals believe in the use of laxatives as a strategy for controlling weight (Berzoff, Flanagan, Melano & Hertz, 2008). The use of compensatory purging has the potential of maintaining binge eating. Psychological and physiological consequences in underweight patients may contribute to eating disorders. For instance, the delayed emptying of gastric leads to the feeling of fullness even after the consumption of modest amounts of food. Social withdrawal and the loss of previous interests may prevent patients from exposure to experiences that diminish the importance placed on weight and shape (Berzoff, Flanagan, Melano & Hertz, 2008). The cognitive-behavioral theory emphasizes on psychopathological aspects, which vary with different patients. Treatment The treatment of the two eating disorders relies on early intervention. This will facilitate effective treatment. The treatment of anorexia and bulimia targets three crucial areas, which are the restoration of healthy weight, treatment of psychological conditions related to the condition and the reduction of thoughts or behaviors that led to disordered eating habits. Though the restoration of an individual’s weight is the primary aim of treatment, the treatment of the eating condition should monitor behavioral changes (Crow, Mitchell, Roerig & Steffen, 2009). It is essential to note that some of the patients do not recover completely. Additionally, close to 20 percent of anorexia patients develop the condition as a chronic illness. Cognitive Behavioral Therapy The cognitive-behavioral therapy uses strategies and flexible series of therapeutic procedures aimed at achieving behavioral and cognitive changes. Cognitive behavioral therapy uses generic behavioral and cognitive strategies that focus on eliminating the main behaviors and thoughts that lead to eating disorders. The first process in cognitive behavioral therapy is the preparation of treatment and change. The therapist conducts an evaluation interview that aims to assess the extent and nature of the psychiatric condition (Cozolino, 2010). The therapist must engage the patient in treatment and jointly create the formulations. The therapy relies on the establishment of real-time self-monitoring strategies. This requires the recording of eating behaviors and practices, feelings, events and thoughts. The therapy introduces self-monitoring during the initial session. Cognitive behavioral therapy establishes weekly weighing where the therapist weights the patient once weekly. The weekly weighing activities are vital for the establishment of regular eating habits. The second stage of therapy is a short transitional stage that comprises of two weekly appointments. This stage focuses on evaluating the progress of the first stage. Additionally, the therapist and patient collaboratively establish goals for the next stage. The third stage of the treatment addresses crucial processes that maintain eating disorders. The processes and mechanisms addressed are tackled according to their role and importance in maintaining the eating disorder. The final stage of the treatment process focuses on ending the treatment. This stage aims to maintain the progress made in early stages. The patient discontinues self-evaluation and begins weighing at home on a weekly basis. Interpersonal Therapy Interpersonal therapy of eating disorders is a time-limited and focused treatment that aims at interpersonal problems associated with the development and maintenance of the eating disorders. The therapy relies on substantial empirical evidence that documents the role of interpersonal aspects in the development and maintenance of the disorders. The interpersonal therapy postulates that eating disorders develop because of interpersonal problems. The therapy focuses on identifying these problems instead of the symptoms of the disorder. Interpersonal therapy has three different phases. The first phase involves gathering a history of the patient. The phase also focuses on the development of a relationship between the client and therapist. During the first phase, the therapist determines the diagnosis and expected treatment and outcomes. The second phase involves the exploration of the disorder, problematic relationships and current problems that affect the patient. During this phase, the therapist develops strategies focused towards change. The third phase is a review phase, which focuses on reinforcing change (Wilson, Grilo & Vitousek, 2007). Conclusion DSM-IV-TR describes eating disorders as severe disturbances that affect an individual’s eating behavior. Anorexia and bulimia Nervosa are the two major eating disorders. It is essential to note that eating disorders are usually accompanied with psychiatric and medical comorbidity. People with these conditions usually deny that they are suffering from an eating disorder. Patients of this condition do not wish to discuss their state or body condition because they hold their body size and weight highly. Theories such as the social learning, object relation and cognitive behavior theory are applicable in the definition and description of eating disorders. The interpersonal and cognitive behavior therapies are useful in the treatment of anorexia and bulimia. Patients with anorexia show irrational fear of gaining weight and immoderate food restrictions. The patient also shows a distorted body self-perception. The condition is more common in women than in men. Anorexia patients restrict food intake because they fear gaining weight. Bulimia is different to anorexia because the patient engages in excessive eating, which followed by purging. These individuals purge by taking laxatives, diuretics and stimulants. Albert Bandura’s social learning theory focuses on internal and external stimuli. These stimuli influence people’s strategies as they learn social behaviors and responses. The object relation theory focuses on people’s interactions and strategies for internalizing their experiences. This contrasts the social learning theory, which focuses on external and internal factors that influence behavior and learning. Object relations theory applies to actual interactions and strategies used in the formation of unique mental representations of interactions. The cognitive behavioral theory focuses on weight and shape. This means that people’s tendency to value their weight is a crucial factor towards the maintenance of eating disorders. The cognitive-behavioral therapy uses strategies and flexible series of therapeutic procedures aimed at achieving behavioral and cognitive changes. Interpersonal therapy is a time-limited and focused treatment that aims at interpersonal problems associated with the development and maintenance of disorders. References Ambwani, S., Warren, C., Gleaves, D., Cepeda- Benito, A., & Fernandez, M. (2008). Culture, gender & assessment of fear of fatness. European Journal of Psychological Assessment. 24: 81-87. American Psychiatric Association (2010). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author. Applegate, J., & Shapiro, J. (2005). Attachment: The relational base of affect regulation. Neurobiology for Clinical Social Work: Theory and Practice. New York: Norton. Berzoff, J., Flanagan, L., Melano & Hertz, P. (2008). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. (2nd ed). Lanham, MD: The Rowman & Littlefield Publishers, Inc. Cozolino, L. (2010). The neurobiology of attachment. In The neuroscience of psychotherapy (pp. 213-238). New York: Norton. Crow, S. J., Mitchell, J. E., Roerig, J. D. & Steffen, K. (2009). What potential role is there for medication treatment in anorexia nervosa. International Journal of Eating Disorders. 42: 1-8. Kaye, W. (2007). Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior. 94: 121-135. National Eating Disorder Association (2013). Statistics: Eating Disorders and Their Precursors. Retrieved from: www.nationaleatingdisorders.org. Wilson, G.T., Grilo, C.M. & Vitousek, K.M. (2007). Psychological treatment of eating disorders. American Psychological Association. 62: 199-216. Robins, S. P., Chatterjee, P. & Canda, E. R. (2006). Contemporary human behavior theory: A critical perspective for social work (Ed. 2). Boston, MA: Pearson Education, Inc. Read More