Anorexia Nervosa: Diagnosis and Treatment in Psychotherapy

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Introduction

The disorder under analysis is called Anorexia Nervosa. The disease is currently included in the DSM disorders list (Pomerantz, 2013). Nowadays, anorexia is a wide-spread psychological disease. The number of individuals suffering from this disease has skyrocketed in the last 30 years. Anorexia is neither a mania nor just a “bad” temper of patient – it is a real psychological condition. Anorexia is characterized by the constant desire of a patient to lose weight accompanied by a strong fear of obesity. A patient has a distorted vision of his or her own appearance and is worried about an imaginary increase of weight.

Symptoms

The condition under analysis has a clear symptomatic that simplifies the process of diagnosing. Thus, among the principle symptoms of anorexia, specialists point out the following attributes: the unwillingness to keep a minimum weight level; the constant feel of fatness; standup eating as a preferable manner of food consumption; sleep disturbance; society isolation; the panic fear of putting on weight (National Eating Disorders Association, n.d.).

Statistics

The analysis of the relevant statistic shows that there is a tendency for the sharp increase in people with the following condition. Specialists note that the number of patients with this diagnosis is rather high with developed countries being the leaders: every 2 girls out of 100 in the age from 12 to 24 suffer from this disease. In percentage correlation, 90% of patients are young girls in the age from 12 to 24, the rest 10% – older women and men (O’Donnell, 2001). The most concerning aspect of the relevant statistics resides in the fact that 5-20% of patients with this condition are likely to die, particularly in those cases where the length of the condition is substantial enough (National Eating Disorders Association, n.d.).

Suspected Causes

Specialists note that there are several reasons which can cause anorexia. In the majority of cases, one cannot point out the primary determinant – the patient is influenced by various factors: biological (genetic and biological predisposition), psychological (family influence and internal conflicts), and social (environmental influence, expectations, emulation) (O’Donnell, 2001).

Four Major Schools of Psychotherapy

It is crucial that the treatment of anorexia is provided by a licensed health care professional. The treatment process implies a complex multi-stage therapy. One might point out four basic approaches to the treatment: psychodynamic, humanistic, behavioral, and cognitive. In the framework of psychodynamic therapy, a specialist tries to identify the early conflict that provoked the condition. The patient is recommended to think of the past experience that might have had a negative effect on the current behavior. It is necessary to note that the effectiveness of this kind of therapy is still doubted (O’Donnell, 2001).

Another approach to the treatment focuses on the current thoughts and ideas instead of the past experience. The relevant approach is called behavioral; its primary aim is to identify the determinant of the condition’s development and encourage a patient to change those aspects of the life that have a negative influence.

The majority of specialists agree on the point that the concepts of a cognitive school of therapy are likely to be most effective in the treatment of anorexia (Phillips, McKeown, & Sandford, 2009). The relevant approach implies three stages: the identification of the unhealthy patterns that developed in the past, patient’s realization of the interconnection between these patterns and the current condition, and working out a strategy aimed at improving the situation.

Finally, humanistic approach lays a particular emphasis on a patient’s needs and the image of the targeted ideal. It is presumed that the major cause of the unhealthy behavior is the inadequate estimation of the real state of one’s body and the imaginary discrepancy between the reality and the expectancies. In the framework of the humanistic approach, the specialist tries to make the patient substitute the faulty assumptions about the body by an objective and critical assessment.

Preferable Treatment

One assumes that the cognitive approach to the anorexia treatment is apt to show the best results as the roots of the problem are evidently connected with the deeply ingrained unhealthy patterns. In the meantime, it is, likewise, vital to determine the cause of the condition’s appearance and point out the necessary alterations. Nevertheless, one might combine several approaches in the treatment process as their basic concepts do not contradict with one another. Therefore, the humanistic approach might represent an additional efficient tool that can be employed along with any other strategy selected.

Potential Resistance

One might suppose that patient’s resistance in anorexia, as well as in any other eating disorders, is likely to be rather high. The principal cause of the resistance is the so-called “safety behavior” that a patient adopts in order to avoid the outcomes he or she fears most of all. In the case of anorexia, the undesirable outcome is gaining weight; thereby, patients consider an unhealthy eating scenario to protect them from the fearful perspective.

Another factor that is apt to provoke resistance is a patient’s failure to recognize the eating disorder as a medical condition that does significant harm to the general health. Thus, a large percentage of people with the relevant disease tend to consider it normal and, consequently, show no desire to be treated. Most of these patients attend the therapy due to the external influence that has a negative impact on the therapy’s effect.

Lastly, a patient is likely to resist strongly because of the fear of the potential outcomes. Hence, a significant number of people might think that the therapy will result in their being overweight, so they prefer to avoid it. On the whole, all types of patients’ resistance are caused by particular psychological blocks; it means this point should be addressed by a professional before the main treatment process begins.

Prochaska Model of Change

While carrying out the treatment of anorexia, one might employ the Prochaska Model of Change. The relevant model implies five stages: precontemplation, contemplation, preparation, action, and maintenance (O’Donnell, 2001). Therefore, the primary concern of a specialist that decides to implement the relevant model is to help a patient realize the unhealthiness of the current patterns of his or her behavior.

The next step will imply working out a precise strategy that should include all the changes necessary to implement in order to turn the unhealthy patterns into the healthy ones. After that, the specialists is supposed to assist in the patient’s carrying out the targeted plan, helping him or her to follow all the recommendations and avoid the temptation to return to the “safe” behavior.

Finally, the specialist needs to see to the fact that the targeted patterns have become the main behavioral standards and have replaced the unfavorable lines of conduct completely.

Specialists note that the described model is particularly effective from the perspective of treating any disease that implies undesirable patterns of behavior: smoking, alcohol addictions, anorexia and bulimia (O’Donnell, 2001).

Manualized Approaches to Therapy

Although the question of manual-based therapy’s efficiency remains ambiguous, one assumes that some of the relevant approaches might be effectively employed in the treatment process. The major benefit of the relevant approach, in the framework of anorexia’s treatment, is the strict time limits that it implies. Thus, numerous specialists note that the precise deadlines, which a specialist sets for a patient, motivate the latter to carry out the necessary actions more intensively (Mansfield & Addis, 2001).

Therefore, the treatment of anorexia is likely to become more productive with the introduction of a munualized approach. Moreover, the implementation of the relevant method will ensure that the specialist assigns effective interventions as manualized therapies are normally empirically based. In the meantime, one has to admit that translating a manual-based approach into a practical treatment might turn out to be problematic as it requires extra efforts on a specialist’s part. According to the recent research, 47% of practicing psychologists prefer to avoid the implementation of manual-based treatments as the former require particular creativity and innovative strategies (Mansfield & Addis, 2001).

Potential Dual Diagnosis

While planning the treatment of anorexia condition, one should necessarily take into account the fact that some dual diagnoses are likely to accompany the relevant disorder. Among the most common disorders, which are apt to be present in a patient with anorexia, one might, first and foremost, point out the anxiety. Specialists note that the relevant disorder might have various subtypes including panic disorders, phobias, to name but a few (Phillips, McKeown, & Sandford, 2009).

Another condition that is likely to appear before anorexia, simultaneously with it or as its outcome, is depression. In most of the cases, this mood disorder serves to be the initial cause of anorexia’s development.

Some specialists, likewise, include trichotillomania on the lists of disorders that typically accompany eating disorders. Meanwhile, the direct interconnection between the relevant conditions is not scientifically proved (Phillips, McKeown, & Sandford, 2009).

Lastly, one of the most probable diagnosis, that one is apt to identify along with anorexia is the obsessive-compulsive disorder. The relevant condition is, in fact, a part of anorexia disease as it implies obsessive thoughts, irrational fears and repeated behavioral patterns (Phillips, McKeown, & Sandford, 2009).

Specific Populations to Consider

Statistics shows that the anorexia risk group is mainly comprised of the teenagers aged between 12-13 years. The disorder is more typical of a female population particularly in the developed countries (National Eating Disorders Association, n.d.). The relevant phenomenon might be explained by the fact that the teenage period shows the highest level of emotional instability and the distortion of the reality’s perception. The influence of mass media is also vital as the instant access to the Internet, and other types of mass media prompt teenagers to follow unhealthy patterns of life.

Some specialists also point out the interconnection between the addiction to drugs and the development of anorexia. Thus, it is presumed that drug addicts compose a significant part of the potential risk group due to both physical and psychological changes that occur under the drugs’ impact (Phillips, McKeown, & Sandford, 2009).

Reference List

Mansfield, A., K., & Addis, M.E. (2001). Manual-based psychotherapies in clinical practice: Part 1: assets, liabilities, and obstacles to dissemination. Evidence-Based Mental Health, 4(3), 68-69.

National Eating Disorders Association. (n.d.). Anorexia Nervosa. Web.

O’Donnell, M.P. (2001). Health Promotion in the Workplace. New York, New York: Cengage Learning.

Phillips, P., McKeown, O., & Sandford, T. (2009). Dual Diagnosis: Practice in Context. Oxford, United Kingdom: John Wiley & Sons.

Pomerantz, A.M. (2013). Clinical Psychology: Science, Practice, and Culture, Third Edition: DSM-5 Update: Science, Practice, and Culture. Thousand Oaks, California: Sage Publications.

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