Treatments of Anorexia Nervosa

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Table of Contents

Introduction
Diagnosis
Treatment
Individual therapy
Group Therapy
Comparison of Individual and Group Therapy
Conclusion
References

Introduction

Aneroxia nervosa (AN) refers to a condition whereby a person is fearful of food intake occasioned by the need to achieve a slender body size because they are fearful of increased body fat which they attribute to these two factors (Hoermann, 2009). Anorexia nervosa is described as a psychological disorder because it is largely a factor of self image which makes a person to have biased perception regarding food intake and own body image.

Psychological disorder is a common term mostly used by psychologists that refers to all types of disease conditions among persons that are known to emanate from the mental dysfunctions of an individual. Anorexia nervosa, like any type of psychological disorders is regarded as a mental illnesses which predisposes a person to act in an irrational manner which is not characteristics of normal development process, or in that case according to the society expectations.

Aneroxia nervosa is a serious eating disorder and is one of the psychological disorders with the highest mortality rate as well as co-morbidity incidence (Hoek and Van Hoeken, 2003). The National Institute of Mental Health (NINH) which is an organization based in US estimates that more than 4% of the population is predisposed to suffer from anorexia nervosa at one point in their life, majority of them being females at 95% (Chamberin, 2010).

More specifically, aneroxia nervosa is defined as a type of eating disorders; this refers to abnormal eating characteristics caused by mental attitudes regarding food intake (Chamberin, 2010). As such, an individual is predisposed to excessive intake of food, in which case the condition is described as bulimia or binge eating, or likely to engage in hunger strikes episodes with intentions to minimize food intake as is the case with aneroxia nervosa (Gershon, 2007).

Many studies have been able to determine the existence of causal relationship between eating disorders and other types of psychological disorders. The major causes of eating disorders, like all other disorders cannot be accurately determined, however what is clear is that lifestyle and social factors contributes significantly to this type of disorders.

Because eating disorders, notably aneroxia nervosa has very high co-modity with DSM-IV cluster B disorders, they are most often also categorized as personality disorders. This is because personality disorders is used to describe conditions where individuals pattern of actions is influenced in unnatural way by their nature of thoughts, habits and behaviors which together combine to form the personality (Eysenck and Keane, 2005). This also appears to be the case among persons suffering from aneroxia nervosa.

The type of personality among people is influenced by various factors such as environment, genetic and education; indeed a research study done by McIntosh et al Identifies a positive correlation between aneroxia nervosa and lifestyle as well as nature of profession (McIntosh, Clin and Jordan, 2005).

The Freudian psychoanalysis theory which is also used in analysis of personality disorders asserts that personality type is a function of two very important factors: sex and aggression. According to this theory personality types have three components: ego, id and superego that interact with other factors during a person growth period to determine a person character (Eysenck and Keane, 2005).

Diagnosis

Due to the broad nature of symptoms that are exhibited by various individuals suffering from aneroxia nervosa, there is no conclusive or a comprehensive list of all possible symptoms that cases might exhibit which can be described to be similar for all of them. Rather, a guideline has been adopted to provide psychiatrists with a framework on which to base their diagnosis.

The most commonly used framework of diagnosing most psychological disorders is referred as Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revision (DSM IV-TR) (AmericanPsychiatricAssociation, 1994). DSM IV-TR is an abbreviation that stands for a manual that was developed by American Psychiatrist Association (APA) (1994). It consist the most recent guidelines for classifying mental disorders having substituted the previous guidelines that were contained in DSM-IV.

DSM IV-TR is essentially a framework that is mostly referred by psychologists to categorize the various forms of mental disorders among other behavioral disorders. According to DSM IV-TR diagnosis guidelines there are four major criteria that psychiatrist relies on to assess whether a person is suffering from aneroxia nervosa (Klapper, Gurney, Wiseman, Cheng and HAlmi, 1999).

These are: consistently low or below average body weight that is largely a result of the person desire to be so, presence of fear associated with weight gain, biased personal perception and desire for a body image consistent with their effort to lose weight and interruption in menstrual flows for up to three months in women (Klapper et al, 1999).

Treatment

Any treatment protocol for aneroxia nervosa cases must address the both the physical condition and the mental disorder of the patient that makes them behave the way they do towards food intake and perception of body image. Currently there are several approaches that health practitioners use in treating aneroxia nervosa cases such as group therapy and family therapy among others (Tan, Hope, Stewart, and Fitspark, 2006).

The focus of treatment methods for aneroxia nervosa that we are going to discuss throughout the rest of this paper are two of these treatments therapies; group therapy and individual therapy. Generally the type of treatment therapy that is chosen by a therapist depends on several factors which include patients age, family background, duration of the condition, presence of co-morbidity factors and previous treatment protocols among other factors (Tan et al, 2006).

A study on Aneroxia nervosa cases noted that the traditional methods of treating aneroxia nervosa cases that involved “lengthy psychiatric hospitalizations” has been ineffective because it has become increasingly impossible to enable the patient to attain ideal body weight outside other treatment protocols such as family therapy (Treat, McCabe, Gaskill and Marcus, 2008).

The findings of this research study found that despite the fact that subject’s vital conditions were eventually stabilized; patients were still far from being healed from their depressive conditions and psychological tendencies of starving their bodies by the end of the hospitalization session. Outcomes such as this appear to justify the need for specialists to design other health interventions strategies for patients after they have been discharged.

Because the mortality rates and co-morbidity incidence of aneroxia nervosa remains critically high despite the array of various intervention strategies that are currently available to health professionals, it is justifiable to have a reassessment of the efficacy of two of the most commonly used treatment methods, which is the objective of this research paper.

Individual therapy

Individual therapy is common approach that is used in treating AN cases mainly because of its simplicity. It is also regarded as one of the keystone of an effective treatment approach of cases that do not have supportive close members who can be relied to promote the patients quick recovery. In individual therapy, a patient suffering from aneroxia nervosa is assigned a single professional therapist who acts as the case manager of the patient (Schaffner and Buchanan, 2008).

In this mode of treatment method the treatment program is structured around the patient and the “case manager” who is responsible for undertaking and implementing all aspects of the treatment program until the patient fully recovers. Since any treatment protocol of aneroxia nervosa cases must involve hospitalization, referred as inpatient, as well asoutpatient session, the patient therapist must play an integral part throughout this cycle (Schaffner and Buchanan, 2008).

The focus of individual therapy is mainly based on three aspects of the patient personality; self perception, perfectionist and personal control with the ultimate outcome of enabling a patient to go through a positive perception transformation process (Schaffner and Buchanan, 2008).

Treatment of aneroxia nervosa patients is further complicated by the co-morbidity nature of the condition with other personality disorders which is estimated to be as high as 20% among aneroxia nervosa cases and even much higher for all cases involving eating disorders (Hoek and Van Hoeken, 2003).

When co-morbidity is the case in the patient, professional therapists must restructure the treatment program further to address all underlying issues. One of the most widely used approaches as well as the most successful in individual therapy for aneroxia nervosa cases is Cognitive Behavioral Therapy (CBT).

CBT is a treatment method that attempts to address behavioral conditions by focusing on the root problems of the symptoms which emanate from the mind. Individual psychotherapy of anorexia nervosa cases are divided into three major stages that a patient must be taken through for an effective treatment program.

Stage 1 involve what Klapper et al describes as “psychoeducation” that is given to the patient with the sole goal of ensuring that a patient perception of food intake is positively influenced by educating the patient on the adverse health effects of their condition (1999). At this stage the therapist explores with the patient all possible alternatives that they should adopt to prevent or lessen the effects of anorexia nervosa.

Because the patients are now aware of the psychological process that takes place which makes them act the way they do, and are aware of the health effects, they are empowered to control their behaviors and urges (Klapper et al, 1999). The second stage involves taking the patient to another level of education regarding their condition, but in this case the focus is entirely on the process of cognitive distortions that trigger the undesired behavior (Klapper et al, 1999).

The patient is taught how their perception on food intake and their urges are influenced by the mind and how this habit takes roots in their mind over time, the intention in this phase is to empower the patient to think logically and overcome the ideas of these construed ideas and thoughts (Klapper et al, 1999).

Finally, the patient is taken through stage 3 assuming they have made progress in the previous stages. Stage 3 is described as the most important by Klapper et al because it is the phase that “emphasizes relapse, prevention and maintenance of healthy behaviors” (1999).

Throughout this process the patient is empowered to keep detailed records of food intake such as time of food intake, portion, amount, type and so on (Klapper et al, 1999). This is a key feature and a central approach of designing a treatment program for individuals suffering from aneroxia nervosa because it highlights the patient pattern of food intake and therefore the nature and seriousness of the condition.

Group Therapy

One of the ways that aneroxia nervosa manifests itself in individuals is through self denial which is the main reason why it is such a difficult eating disorder to diagnose or treat without the help of other close members who interacts frequently with the patient.

Unlike bulimia nervosa or binge eating which are easily identified through the tendency of subjects to excessively take food followed by episodes of vomiting which is attributed to feelings of guiltiness, as is the case in bulimia or just excessive eating, aneroxia nervosa exhibits none of this classical tendencies.

Because of this characteristic nature of aneroxia nervosa, group therapy is advocated as a more reliable method of treatment because it utilizes the support of other actors to enable the patient achieve desirable changes in food intake or body image perception (Grange, 2010).

In group therapy the same treatment protocol that involves CBT is used, but in this case treatment of subjects is done in a group context that is made up of patients with similar psychological condition, preferably of same age (Grange, 2010).

The idea behind group therapy is to create a motivation effect from other patients who are experiencing the same problem that will act as a source of inspirational to each and every group member. The role of a therapist in this case is minimal and includes moderating upon the group therapeutic sessions or during the various activities when members comes together (Grange, 2010).

However because of the high level of discipline and maturity required among patients undergoing group therapy this treatment method for AN cases is not suitable among adolescent patients (Grange, 2010). This is one of the various factors that we are going to closely investigate in the next section of this paper which will attempt to compare this two major treatment approaches with a view of identifying the most appropriate method.

Comparison of Individual and Group Therapy

The major different between these two forms of treatment therapies for aneroxia nervosa patients is the setting under which treatment is administered. In individual therapy as we have already mentioned the patient treatment protocol is implemented by one or several therapist while group therapy incorporates other players in addition to the therapist.

Because group therapy is very similar to family therapy in treatment of aneroxia nervosa cases, much benefit can be derived from it because of what Grange describes as the “collaborative effort” that empowers a patient to undertake and maintain decisive actions (2010).

Perhaps one of the most renowned research studies on AN is Maudsley Studies that was conducted in a hospital setting in London that sought to compare the difference between individual and group therapy between cases (Le Grange, 2005). In a cohort study that followed cases for a period of five years family-based treatment (FBT) therapy was determined to more efficient than individual supportive therapy by a large extent.

The result of the study summarized that “ninety percent of those who were assigned to FBT made a good outcome at five-year follow-up, while only 36% of those who were in the individual therapy made a good outcome” (Eisler, Dare, Hodes, Russell, Dodge and Le Grange, 2005).

In fact this research study analyzes other similar study that had been done on the subject and identifies a pattern on the efficacy of group therapy over individual therapy and thus concludes “irrespective of the type of FBT, 75% of patients have a good outcome, 15% an intermediate outcome and 10% have a poor outcome, (weight not restored and no menses)” (Eisler et al, 2005).

It appears individual therapies in treatment of aneroxia nervosa cases are not comparable to the benefits of group therapy, notably family therapy. One particular study by Eisler et al noted that “individual supportive therapy with no parental involvement leads to inferior results”, based on comparison of various treatment studies in four key research studies (Eisler et al, 2005).

While other research studies indicates there are no measurable differences in efficacy between the two treatment therapies, further research analysis indicates that group therapy has several subtle advantages over individual therapy.

One such study which randomly assigned aneroxia nervosa cases between two treatment groups, one of which included treatment in context of family support while the other had no family support showed that family therapy was crucial to rapid recovery of patients (Yager, Devlin, Halmi, Herzog, Mitchell, Powers and Zerbe, 2005).

The study findings concluded that “symptomatic change was more marked in the separated family group, whereas psychological change was more prominent in those receiving conjoint family therapy” (Yager et al, 2005).

This study provides us with the first indication that individual therapy has its inherent advantages over group therapy as described above probably because individual therapy involves close collaboration with the therapists and constant follow up unlike the case in group therapy. This is likely to be the main reason that results in patients in this group to have significant “symptomatic change” which in this case refers to attainment of desired body weight (Yager et al, 2005).

Indeed the advantages of any of this treatment approaches is at times a factor of the patient’s age and the severity of the condition at the time of diagnosis. Generally individual therapy is preferable among teenagers with AN compared to adult patients all other factors being equal; this is because adolescent do not have well developed mastery of their feelings compared to adults. In group therapy the most important determinant factor of success among cases is self discipline which is least developed among adolescents (Tan et al, 2005).

A very related factor to that of patients age is the severity of the condition at the time of diagnosis; based on the severity of the condition a patient suffering from AN will recover differently depending on the choice of therapy used. Again individual therapy is found to be most effective among adolescent cases with more deteriorated AN condition at the time of admission since this approach is more personalized because it is undertaken on one to one basis with the patient.

Conclusion

The analysis of this various research studies provides overwhelming evidence for applying group therapy in treatment of AN case. But then again it would appear that each treatment approach has it inherent advantages over the other which can be effectively utilized based on the characteristic profile of the patient.

Based on the same analysis of these studies it would appear the unique profile of the AN patient should be used as the factor of determination of the most ideal therapy to apply. Nevertheless, all factors being constant, group therapies appears to have higher efficacy compared to individual therapy.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association Publishers.

Chamberin, J., (2010). Mind Disorders. Web.

Eysenck, W., Keane, M. (2005). Cognitive Psychology: A students Handbook. London: Taylor & Francis Inc.

Eisler, I., Dare, C., Hodes, M.,Russell, G.,Dodge, E. & Le Grange, D. (2005). Family Therapy for Adolescent Anorexia Nervosa: The Results of a Controlled Comparison of Two Family Interventions. American Psychiatrist Association, 3: 629-640.

Grange, D. (2010). Family-Based treatment for Adolescents with Bulimia Nervosa. The Australian and New Zealand Journal of Family Therapy,31(2): 165-175.

Gershon, L. (2007). Wrong Diagnosis: Aneroxia Nervosa. Web.

Hoermann, S. (2009). Personality Disorders and Eating Disorders. Web.

Hoek, H. & Van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. Int J Eat Disord, 34:383–396.

Klapper, F.,Gurney, V.,Wiseman, C., Cheng, H. & HAlmi, K. (1999). Psychiatric Management of Eating Disorders. Nutritional in Clinical Care, 2(6):354-360.

Le Grange, D. (2005). The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4(3): 142-146.

McIntosh, V., Clin, D. & Jordan, J. (2005). Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial. American Psychiatrist Association, 162: 741- 747.

Schaffner, A. & Buchanan, L. (2008). Integrating Evidence-Based Treatments with Individual Needs in an Outpatient Facility for Eating Disorders. Journal of Eating Disorders, 16:378-392.

Treat, T., McCabe, E.,Gaskill, J. & Marcus, M. (2008). Treatment of Anorexia Nervosa in a Specialty Care Continuum. Int J Eat Disord, 41(1): 564-572.

Tan, J., Hope, T., Stewart, A. and Fitspark, R. (2006). Competence to make treatment decisions in anorexia nervosa: thinking processes and values. Philos Psychiatry Psychol, 13(4): 267-282.

Yager, J., Devlin, M., Halmi, K., Herzog, D., Mitchell, J., Powers, P. & Zerbe, K. (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Eating Disorders, 2nd Edition. American Psychiatrist Association, 3: 546-551.

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