Type: Process Essays
Sample donated: Vernon Parsons
Last updated: September 21, 2019
Anorexia nervosa is more common inwomen than men, but that does not mean the latter does not fall victim to thisdisorder. For an individual to be diagnosed as “anorexic,” they must experiencethe following requirements: (1) drastically limit their food intake in order tomaintain a low body weight, (2) have an overwhelming preoccupation withbecoming fat or overweight, along with avoiding any behaviors that would resultin the increase of body weight, and (3) suffer from an altered perception oftheir body image, as well as their ideal body weight. In addition, othercharacteristics, while not explicitly stated, are prominent in this disorder.Those with anorexia nervosa are generally classified as underweight (whencompared with their height), as well as believe there is no such thing as “toothin,” due to their distorted self-image and thought process.
Anothercharacteristic is how the individual is often preoccupied with certain sectionsof their body, deeming them as overweight. These individuals’ self-esteem isassociated with their thinness, oftentimes feeling the best about themselveswhen they are the smallest. Thereare two classifications of anorexia nervosa.
The first is restricting type, andrefers to an individual who severely limits their food consumption in order tomaintain a low body weight. The second classification is binge-eating/purging,and describes an individual who feels a compelling urge to consume a largequantity of food (the binge), followed by a feeling of guilt, and in order toregain control over the situation, forces themselves to relieve their body ofthe excess food by either vomiting or consuming laxatives (the purge). Thisdisorder generally follows a stressful life event (which leads to dieting), andtypically begins in early adolescence. Diagnoses of depression, panic disorder,personality disorders, obsessive-compulsive disorder, and specific phobias arecommon with those who have also been diagnosed with anorexia nervosa. Thisdisorder is highly comorbid with others.
Dueto these negative perceptions of food, and the behaviors accompanied with thismindset, those with this disorder suffer from harmful physical consequences.The side effects an individual could experience with this disorder include thefollowing: decreased blood pressure, slowed heart rate, kidney and GI problems,bone loss, dry skin, brittle nails and hair loss. In addition, the individualmay experience altered hormone levels and mild anemia. As well as thesephysical changes, the levels of potassium and sodium can be affected, and thedecreased levels can result in tiredness, weakness, cardiac arrhythmias andeven sudden death.
Thereare many factors as to why one would develop anorexia nervosa. These includegenetic, environmental and social factors. Starting with genetic factors, thosewho have a relative who has been diagnosed with the disorder have been shown tohave a higher chance of also being diagnosed with either anorexia nervosa orbulimia nervosa. In addition, in twin studies, genes have been shown to accountfor some of the prevalence of the disorder (Bulik, Wade, & Kendler, 2000;Kring et al., 337). Specific characteristics of the disorder, such as a desireto be thin, a negative view of one’s body, and preoccupations with weight, havebeen found to be heritable. Researchers have also identified a group of singlenucleotide polymorphisms that are associated with anorexia nervosa (Boraska,Franklin, Floyd et al., 2014; Kring et al.
, 338). This furthers the idea thatthere is a genetic component to the development of an eating disorder. Sincethose with anorexia nervosa primarily starve themselves, it has beenhypothesized that the number of endogenous opioids increases, which results ina positive mood (and therefore continues the reinforcing cycle). As well as therelease of opioids during starvation, excessive exercise increases the releaseof opioids and endorphins, which is also reinforcing. Researchers are confidentthe opioids play a role, but are unsure if the levels of opioids cause thedisorder or if the disorder causes the level of opioids. Serotonin and dopaminehave also correlated to this disorder.
Serotonin relates to eating and thefeeling of being satiated, and dopamine is related to the rewarding/pleasingaspects of food. Food restriction interferes with the serotonin synthesis inthe brain, meaning that those who have anorexia nervosa are thought to have anunderactive serotonin system, and those who limit their food intake may be moresusceptible to food cues, since one of the functions of dopamine is tostimulate. InfMRI studies, those with anorexia nervosa showed an increase in activation inthe ventral striatum, an area of the brain associated with dopamine, as well asreward. Other studies have also indicated that women with an eating disorder havea greater expression of the dopamine-transported gene DAT, which influences therelease of a protein that regulates the reuptake of dopamine. Another dopaminegene believed to be related to this disorder is DRD2, which has been shown tohave a decreased expression. (Fladung et al., 2010; Kring et al.
, 339) Thereare numerous sociocultural factors that could play into the development of aneating disorder. Those diagnosed may have a negative schema that forces theirattention to focus on fears of fatness and issues with body weight, shape andfood. This emphasis is one of thedriving forces behind this disorder. The reduction of anxiety from achieving alevel of thinness, as well as positive comments from others regarding theircurrent weight, reinforces their belief that the thinner they are, the happierthey are. Interestingly, there are specific personality characteristics thatare associated with anorexia nervosa, such as perfectionism or a general senseof inadequacy. Inaddition, the emphasis our society places on the “female body” factors in tothe development of this disorder.
Comparing themselves to thin models, especiallyat a young age when they are extremely susceptible to these messages, resultsin them looking at their own bodies and questioning why they do not look thesame. This greatly unachievable ideal is a likely explanation for the “fear offatness”. Another factor is the criticism from others. If parents or peers tellan individual that they are overweight, that may be the single turning point ofthe development of the disorder. Along those lines, if after losing weight, theindividual receives positive comments from the same people, they will associatethat sense of pride with the weight loss, which reinforces the behaviors usedto lose the weight in the first place. Thetreatment for anorexia nervosa is called a “two-tier” process, meaning thatthere are two important steps to combat the disorder.
The first step involveshelping the person to gain enough weight; the second step is long-termmaintenance of weight gain. Oftentimes, treatment involves hospitalization. Inmany cases, where the individual’s BMI is so low that they are experiencingmany of the physical consequences mentioned above, the first step is toregulate their food intake and monitor their health. In addition, whilemedication (antidepressants) have been shown to somewhat help bulimia nervosa,no medications have been effective in anorexia nervosa.
The most effectivelong-term solution for anorexia nervosa is therapy. Typesof therapy involve cognitive behavioral therapy, psychotherapy, psychodynamictherapy, and family-based therapy, among others. It has been shown that CBTcombined with hospital treatment (monitoring and regulating) is the mosteffective treatment, with the symptoms of the disorder being absent for up to ayear after treatment. Along these lines, psychotherapy treatment is mostbeneficial for older women and those who have experienced more severe symptoms.Family-based therapy is treatment that is centered on the idea thatinteractions among family members can play a large role in treating thedisorder.
This type of therapy is especially helpful for young adolescents whoare in the beginning stages of the disorder. Anotherapproach involves prevention, typically done through education. This type oftreatment could involve a psychoeducational approach, which focuses oneducating youth about eating disorders. There is also a form of therapy thathelps children resist cultural pressures to be thin, as well as therapy thathelps children identify risk factors for developing an eating disorder. Sincethere is very limited research on treatment for this disorder within thetextbook, I decided to focus the next section on studies that explore thedifferent ways to overcome the symptoms of anorexia nervosa.