Category: Anorexia

Eating disorders are serious illnesses, which affect all kinds of people, characterized by a disturbance with one’s body image, food and weight. Examples include Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. These disorders arise from a rejection to changes around the person, which becomes a rejection to food. These illnesses have a devastating impact and toll physically and mentally to the one affected. Eating disorders are complex and serious psychological illnesses known for disturbances with eating behaviors. There are numerous eating disorders affecting people worldwide.

Eating disorders are complex illnesses that can be characterized with a disturbance with eating behaviors. Eating disorders are both mental and physical disorders. These are life-threatening and have serious health consequences. They are characterized by a preoccupation with gaining weight. Eating disorders do not discriminate and affect people of all genders and races. This means you could be under or overweight, black, white, tall, small, and the list goes on, and still acquire this type of disorder. They affect people of all genders, races and body types. Eating disorders are often acquired as a coping mechanism. They could be described as a physical manifestation of anxiety and/or depression. Low self-esteem could also factor into this. Lastly, eating disorders are not a choice.

The psychological side of an eating disorder is crucial with its development and seriousness. As stated before, eating disorders’ main characteristic is having a disturbance with your own body image, and obsessing about food. This is usually related to a fear of gaining weight. The toxic stigma surrounding body image and bullying also take part in the development of these illnesses. The “need” for this unrealistic, perfect body image is met and fulfilled by creating a “rule book.” This is a way of controlling or taking responsibility of your weight, since you can’t fix or control problems or what’s going on around you. That overwhelming feeling leads to the search for something the affected can control: their weight. Since the affected can’t control or stop their parents’ fighting or why they’re feeling sad or lost, for example, something they can control and take responsibility over is their weight. The rule book consists of “prohibited” behaviors the person can’t do, such as snacking between meals and having dessert. Additionally, although eating disorders all have similar characteristics each case is unique. Another common behavior is being concerned with calories. They will often avoid eating with family and friends, to avoid their judgement towards their eating behaviors. People with eating disorders feel that when they start eating, they won’t be able to stop. This is the body’s instinct for the lack of energy it is receiving. Meals often are followed by feelings of guilt and regret. Eating disorders are among the psychiatric illnesses with the highest mortality rates, since they can affect every single system in the body, from the nervous to the cardiovascular system.

There are numerous types of eating disorders, Anorexia Nervosa is the most common and serious of all. Anorexia Nervosa is characterized by extreme, drastic weight loss and a fear of gaining weight. Once again, there’s no “look” nor stereotype. Everyone can be affected, including over and underweight individuals. Anorexics see a distorted image of themselves, which is larger than what it actually is. Behaviors include counting calories, constant weighing, and feeling helpless and useless while or after eating. They experience guilt many times after eating which leads, in some cases, to purging and exercising excessively prior to eating. Even though they are hungry, they deny it and convince themselves they are not. Additionally, even though some are underweight, they still feel fat. It all comes down and depends on the number on the scale. If that number is low enough, then they allow themselves to eat what they consider a normal amount of food. If not, they skip the meal or eat little food. Meals could be described as the reward for not gaining weight. The body also suffers, often developing lanugo, when the body grows thin hair throughout the body to warm the body temperature. They also may develop amenhorrea: loosing your menstrual cycle. Both of these are due to malnutrition and lack of body fat. Despite all of this, they deny the seriousness of their problem. Anorexia is the psychiatric illness with the highest mortality rate, due to the fact that it can lead to sudden cardiac arrest and electrolyte imbalances.

Another common eating disorder is Bulimia Nervosa, recognized for bingeing periods. Bulimia is known for periods of excessive calorie intake (up to 1000 calories an hour) followed by purging methods, excessive exercise or the use of laxatives to “compensate” their intake. During bingeing periods they feel no control over what they’re doing and feel guilt. Side effects include a stomach rupture due to vomiting too much. Bingeing periods are, in average, once a week. These periods are harmful both physically and mentally. People with this disorder avoid weight gain by purging. There’s often binge-eating evidence in the person’s behavior, like going to the bathroom straight after meals, and food disappearing from the kitchen. Bulimia can lead to electrolyte imbalances, dental decay, stomach rupture, and dehydration.

Although eating disorders are hard to go through, with the help of specialists and support from their families many are able to overcome these illnesses. It is important the stigmas surrounding body images are eliminated. Eating disorders have a greater chance of recovery the sooner they’re diagnosed, since they affect every organ in the body. They’re diagnosed by observing the person’s behaviors towards food and their attitude regarding eating, weight, body image, and more behaviors such as denying their problem and refusing to eat. Doctors will also look at anatomical symptoms, since systems like the gastrointestinal, cardiovascular, and endocrine are usually affected. Recovery is a cycle, and it is not linear — it is hard and usually includes relapsing. Recovery involves the cooperation of the patient and their family. The person starts to break the rule book slowly and it’s a journey of self-discovery. There are numerous types of treatments, two of these are In-Patient and Family Based Treatment. During In-patient treatment, the person is admitted to the hospital and monitored while eating and in some cases, fed through a tube. This is usually done in severe malnutrition cases. They are released when the doctors feel they are healthy both physically and mentally. Family Based Treatment is based on letting the family of the affected take full control of their meals, and monitor their meals every single day. The person with the eating disorder’s “job” is to eat what their parents put on the plate. This is more common with teens and children, but is also done many times with young adults. The parents take control of the meals to relieve the affected from some of the stress preparing food brings them. When the patient has restored their weight, the parents will start letting their child become more involved with their meals, little by little. Recovery is backed up by a huge team of people backing up the patient. Nutritionists make meal plans to ensure the patient receives at least their minimum calorie requirement, psychologists aid with appointments throughout the process, psychiatrists, pediatricians, and more.

Eating disorders are real and serious. They’re not just wanting to be skinny, nor a phase caught by someone for some time. They’re rejecting food, a punishment to yourself. They’re isolation, starvation, malnutrition and more. Every 62 minutes someone dies from an eating disorder, but also many people are able to overcome these illnesses and create a healthy relationship with food. Recovery is a long process but it’s very much possible. Look for the signs, and if someone is showing the behavior of eating disorders let them know and get them help. You could save a life.

In today’s society the topic of if individuals with anorexia nervosa should be able to withdraw from life sustaining treatment is still an ongoing debate. On one side you have to weigh the option of how much the patient’s autonomy and competence play into their decisions of being able to assess their quality of life. When an individual is deemed competent the clinicians and doctors much respect their autonomy and let them withdraw from life sustaining treatment is they see it is the best decisions for themselves. On the other hand, you have to think about the severity of Anorexia Nervosa and how it affects their ability to make rational decisions regarding their quality of life. No one suffering from Anorexia Nervosa is in the right head space to be able to make any decisions regarding their nutrition and feeding. With that being said it is smart to either have involuntary treatment done such as compulsory therapy. The clinicians and doctors have a duty to protect their patients from dying and doing mandatory treatment might be the best option for the greatest success of the patient. Overall there is evidence to support both sides of the argument about the legal and ethical aspects of individuals with Anorexia Nervosa withdrawing life sustaining treatment and if it should be allowed.

Anorexia Nervosa, AN, is defined as “ a serious psychiatric disorder characterized by body image distortion, an intense fear of weight gain, and self-induced weight loss leading to physical and mental abnormalities” (Douzenis & Michopoulos, 2015). According to the diagnostic criteria for Anorexia Nervosa set forth by the DSM-IV, there are four points to determine one qualifies for the diagnosis of Anorexia Nervosa. They include; refusal to maintain body weight or above a minimally normal weight for their age and height, intense fear of gaining weight or becoming fat, disturbances in the way in which one’s body weight or shape is experienced, and in postmenarchal females, amenorrhea, the absence of at least three consecutive cycles (Tan, 2016).

Individuals who are suffering from Anorexia Nervosa are characterized as ego-syntonic self-starvation, denial of illness, and ambivalence towards treatment (Guarda,2008). When it comes to treatment for those suffering most patients point towards wanting to change, but they don’t wish to gain weight and would rather end treatment then gain weight. When it comes to the idea of individuals having the right to end life sustaining treatment, many issues arise about who can ultimately make that call. Some believe that individuals with anorexia nervosa are competent and should be allowed to make the decision to stop treatment, even if death results from this decision. While others believe that Anorexia Nervosa doesn’t allow one to be able to make such a life alternating decisions such as ending treatment. Since they are in no mindset to make decisions regarding their feeding and nutrition, the physicians have the duty to protect their patients, which sometimes means using compulsory treatment. The ethical question remains, should individuals suffering from Anorexia Nervosa be able to refuse life-sustaining treatment (Werth,2003).

There are two sides of the debate about yes individuals should be allowed to refuse treatment or no individuals should not be allowed to refuse life sustaining treatment. There are positives and negatives to both sides, and each side has various points as to why their viewpoint is the right answer to this ongoing debate.

Looking at it from the point of view of those in favor of allowing individuals with Anorexia Nervosa to refuse life sustaining treatment, there are two points that push for this to be the precedent. First, some suffers of Anorexia Nervosa may be competent to refuse, and in those cases it would be wrong and unlawful to force them to undergo therapy that they competently refused (Harper,2000). The legal codes most places have in place are that individuals have the right to refuse medical treatment even if that refusal would result in or hasten an individual’s death (Goldner&Smye, 1997). With that being said a patient must be deemed competent in order to make these decisions, if a patient is deemed incompetent due to a mental disorder the right to refuse treatment will be denied and the legal decision making will be shifted to others. Additionally, minors are likely to be denied the right to refuse treatment, their parents would be their final decision makers, unless they fall under the criteria to be an emancipated minor (Goldner &Smye, 1997).

When it comes to looking at if it is right for a competent patient, who is suffering from Anorexia Nervosa to make the decision to refuse treatment, we need to look at the distinction between passive euthanasia and competent refusal of life-prolonging therapy. On the hand of passive euthanasia, some view it as wrong, or down right murder in a sense. In a way there is one core difference between passive euthanasia and competent refusal of therapy and that is who makes the final decision. With passive euthanasia happens when one person gives some a drug or medicine to another person with the intention that the person will die as a result of taking said drug or medicine. While on the other hand competent refusal of therapy or withdrawing therapy is when one person makes that decision for or to oneself. With that being said autonomy is a key word in that clinicians need to respect the wishes of their patients, when they are deemed to be competent and are making a decision for themselves, and one they see as the best decision. The example can be used that while clinicians have the moto of “do no harm” they must understand when they partake in euthanasia, it is almost the same as when a patient withdraws from therapy, both would result or mostly likely lead to one’s death. (Draper,2000). One thing that many tend to overlook is that when the individual wishes to forgo treatment it is likely because they are in extreme suffering and there is no other therapy, treatment, or forced eating that would help (Giordano, 2010).

A second point that should be made is that doctors and clinicians should respect individuals’ autonomy when deciding if they want to forgo their life sustaining treatment. A doctor or clinician should be able to accept and respect the patient’s wishes and know that they are responsible for the consequences of withdrawing their treatment (Draper,2000). As mentioned previously, competence is a main component when talking about refusal of treatment. Competence goes hand and hand with autonomy, the terms can in some cases be used interchangeably. For instance, we already mentioned that an individual deemed competent should be allowed to make the decisions regarding ending their treatment if they feel that is the best option for them. With that said the doctors need to respect their autonomy when they make these competent decisions.

Autonomy is the one thing that should never be taken away from and individual, but when it is, it’s like taking away one’s freedom. One makes an autonomous decision when they are a competent individual and can use rational deliberation (Wright &Matusek, 2010). When one is trying to make the ultimate decision to withdraw treatment, they are considering the hard facts and burden of knowing if they request to stop treatment they will be the sole one in charge of bringing upon their death (McKinney, 2010). The inviduals dealing with end-stage Anorexia have already dealt with trying numerous treatments that didn’t work and have been through enough suffering that they feel nothing would help them get to a sustainable weight, that they would be to live a happy life afterword’s.

Heather Draper has given the following guidelines for decision of a competent patient to decide to end their treatment. First the patient has been refusing or not on board with treatment beyond the natural cycle of the disorder, usually between one to eight years. Second they have already tried or have been forced feed prior to the decision to withdraw treatment. Lastly the patient has been previously deemed competent and able to make this decision regarding the quality of her life (Draper,2000). When it comes to respecting the wishes of a patient, clinicians must understand that sometimes an individual dealing with anorexia may be competent and deciding to withdraw treatment and that, “there is a difference between saving the life of a sufferer and curing them of their anorexia” (Draper, 2000). While there have been the approaches of forced feeding that some believe to work, we must understand that not everyone can be cured of anorexia and that sometimes the best option for the patient if competent to make the decision about their quality of life, is to withdraw treatment.

On the other side of this debate is the people who believe that there are no way individuals who are suffering from anorexia nervosa should be able to make the decisions to withdraw life sustaining treatment. One of the counterpoints is that individuals who are suffering from anorexia can be said to have “thought disturbances” and those disturbances can lead to one not being competent to make a decision about food intake and their overall wellbeing (Werth, 2003). While there is little information about how cognitive functioning can impair one while suffering from Anorexia Nervosa, it has been found that “self-starvation can interfere conceptualization, perceptions, and decision making” (Werth, 2003). The sole judgment about withdrawing life sustaining treatment is if the individuals feeling the treatments will not help them, which is ironic due to the fact that an individual with Anorexia Nervosa has no desire to gain weight, so the questions remains how could they make such a life altering decision.

When it comes to talking about the severity of Anorexia it can be very devastating, and even at times look like a terminal illness, but it can in no way be classified as a terminal illness. With that being said Anorexia is reversible, so the idea that we float around that we should allow individual with Anorexia to withdraw treatment is in a way crime like because they are basically killing themselves. To go into detail about the reversibility of Anorexia it means that the starvation can be cured, with eating or forced eating, and the psychological effects that may come with the disease can be changed to enhance one’s quality and outlook on life (Giordano, 2010). With this information there seems no plausible evidence that would support one ending their care, if it is recognized that most individuals with eating disorders can recover since it is known to be reversible (Giordano, 2010).

Another counterpoint is that experts believe individuals dealing with Anorexia are not competent to make decisions and when they recover they become grateful for medical intervention in the end (Werth, 2003). With this being said the patient might be grateful when treatment is over and there at home recovering but we must consider the effect the treatment has. For example, consume evidence has shown that more progress has been made for patients who are committed involuntary instead of who voluntary comply with treatment. The hardest thing for those struggling with the disease is that they are not willing to eat first due to the guilt and shame. While when eating is enforced by the doctors or clinicians in treatment they feel less guilty and more willing to comply (Wright &Matusek, 2010).

On must also consider that the clinicians and doctors have a duty to protect their patient and took an oath that they would do no harm to their patients. So in this sense it can be understood that clinicians see involuntary treatment as a good thing because it will allow the patient to be in an environment where they can get the help and treatment they need. Without any medical intervention it can be inferred that a patient will die from Anorexia that is why clinicians sometimes push for involuntary treatment because they are not competent and educated enough about what will happen if they ask to withdraw treatment. Sometimes individuals with Anorexia don’t know what they want or if treatment will help them but, “the goal of treatment is to slow progression of symptoms until the client is able to develop healthy coping mechanisms” (Werth, 2003). Individuals with Anorexia Nervosa may not be suicidal or even look to be underweight, but that does not mean clinicians and doctors have a right and duty to protect them from harm. It is better for clinicians and doctors to be proactive with a treatment so one will not want to withdrawal treatment seeing as it is not ethical or okay.

The topic of if individuals suffering from Anorexia Nervosa should be allowed to withdraw from life sustaining treatment is still a topic of discussion today. There are many points as to why it should or should not be allowed. Many people have different views based on their religion, values, and ethics. There is overwhelming evidence to support both sides of this argument therefor, it should be a matter that is left up for the patient, family, and physician to decided together as a group.

References

1. Douzenis, A., & Michopoulos, I. (2015). Involuntary admission: The case of anorexia nervosa. International Journal of Law & Psychiatry, 39, 31–35. https://doi-org.ezproxy.sju.edu/10.1016/j.ijlp.2015.01.018
2. Giordano, Simona. “Anorexia and Refusal of Life-Saving Treatment: The Moral Place of Competence, Suffering, and the Family.” Philosophy, Psychiatry, & Psychology, Johns Hopkins University Press, 22 July 2010, muse.jhu.edu/article/388720/pdf.
3. Wright, Margaret O’Dougherty, and Jill Anne Matusek. Ethical Dilemmas in Treating Clients with Eating Disorders: A Review and Application of an Integrative Ethical Decision-Making Model. Department of Psychology, Miami University, OH, USA, 30 July 2010, www.marshall.edu/psych/files/2012/06/Eating-Disorders.pdf.
4. Tan, Jacinta, et al. “Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values.” National Institute of Health, Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC2121578/pdf/nihms5623.pdf.
5. Guarda, Angela S. “Treatment of Anorexia Nervosa: Insights and Obstacles.” Physiology & Behavior, vol. 94, no. 1, 2008, pp. 113–120., doi:10.1016/j.physbeh.2007.11.020.
6. Goldner, Elliot M, and Victoria Smye. “Addressing Treatment Refusal in Anorexia Nervosa: Clinical, Ethical, and Legal Considerations .” Handbook of Treatment for Eating Disorders , edited by C. Laird Birmingham, 2nd ed., The Guilford Press , 1997, pp. 450–460.
7. Draper, Heather. “Anorexia Nervosa and Respecting a Refusal of Life-Prolonging Therapy: a Limited Justification.” Bioethics, U.S. National Library of Medicine, 1 Apr. 2000, www.ncbi.nlm.nih.gov/pubmed/11765761.
8. Werth, James L., et al. “When Does the ‘Duty to Protect’ Apply with a Client Who Has Anorexia Nervosa?” The Counseling Psychologist, vol. 31, no. 4, 2003, pp. 427–450., doi:10.1177/0011000003031004006.
9. McKinney, Cushla. To Treat or Not to Treat: Legal and Ethical Issues in the Compulsory Treatment of Anorexia. 31 Mar. 2010, ourarchive.otago.ac.nz/bitstream/handle/10523/5541/McKinneyCushla2010MBHL.pdf;sequence=1.

A life with anorexia can be very difficult, and if people do not seek help, they may lose their lives. As mentioned before, anorexia is the most common eating disorder, has the highest mortality rate (NICE Guidelines 2004), and is not exclusive to any age or gender. Being so common it means that there are many people suffering or have suffered from it. One of them is the famous singer Daniel Johns who admitted that anorexia almost killed him. During an interview from the daily news headlines “The Sydney Morning Herald” (2004), he shared that when battling with anorexia in his late teens, he was close to suicide saying, “There was three or four years of my life where I hated myself and you know, would have quite happily ended it”. The singer added that the food was his enemy and that he hated it and avoided even talking about it. The reason he started cutting food was to gain control. He did not start recovery until he was scared for his life saying, “I think I definitely got scared by the second or third time a doctor told me I was dying”. However, after more than 12 months of rehabilitation treatment, the famous singer made a full recovery.

Another case is with the famous actress Troian Bellisario who shared that she is in recovery from anorexia for 10 years now. In a recent interview from “Daily mail UK” (2017), she shared that she used to not eat or restrain herself from other privileges based on how well she did that day in school. She also talked about the days when she allowed herself just 300 calories a day, which with time became too much. She revealed that she restricts her food intake not only because she wanted to be thin but also because she was maintaining control. In addition, she shared that there was a voice in her head, which used to make her do things like the restriction of 300 calories per day and other unhealthy things. The famous actress also explained that when she was going through this difficult journey, she was very isolated. She shared “I couldn’t get anyone even the people who loved me the most, even my boyfriend or my mother or my father to understand what that experience was truly like for me”. She admits that surviving from anorexia “is rare” and she made it because of the hard introspection, intense medical and mental care, supportive family, friends, loving partner and patient. This inspired her to write and direct a movie called “Feed” to help young people with similar problems.

Very common among those suffering from anorexia is that they start restricting food in order to gain control. In these cases, they both seek help and went through rehabilitation treatments. However, anorexia nervosa is a complex eating disorder and can be highly subjective. An example for this is the voice that Troian Bellisario is hearing. This is not same with Daniel Johns. He did not hear a voice, but he thought about the food as his enemy. This suggests that people with anorexia can have both similar and different experiences.

Heighted Attentional Capture by Visual Food Stimuli in Anorexia Nervosa was a study done to test patients with anorexia nervosa and food stimulation. This study was done in 2017 to test the hypothesis that patients with anorexia nervosa are insensitive to the attentional capture of food stimuli. This means the researchers were testing to see how much participants with anorexia nervosa would avoid food. Since the participants have a fear of gaining weight the researchers wanted to test how much they are afraid. The article discusses what anorexia nervosa is and why this study is important. Anorexia nervosa is a mental disorder in which people with this disorder tend to fear gaining weight despite being underweight already. It then discusses how other studies have shown results that people who are hungry show a heightened attentional bias toward food cues.

The participants that were in this study were females who had been admitted to the Center for Eating Disorders who were restricted eaters who were anorexia nervosa patients. There were 66 participants that were AN patients. These patients ranged from ages 12 to age 23. For the control group they used 55 females that were within the same age range as the AN patients, who were symptom-free.

The researchers used several tests to begin with to see how much participants did not or did eat. They used three different scales to test hunger in the patients. The researchers then checked to see how much information was correct from the participant’s answers. The results showed that participants with AN were underweight and showed less cravings, liking, and frequency of eating. They also found that AN participants had reported that it was a longer time since they last had eaten.

There were several tests that the researchers had used to get the information they needed from their participants. The test the researchers used was the RSVP which is a task that is used for food-related disorders. The participants were presented with pictures that lasted 118 seconds and no intervention but the streams had a distractor and a neutral target stimulus. At the end of the task to help ensure differences i could not be a variable the researchers they had the final stream be present in the working memory. The participants had to do 3 similar blocked of 24 trials with a 30-second break. The break helped participants so they would not be fatigued and could concentrate better. After each trial the participants had to type what they saw on the picture with the blue frame aka the targets.

The participants also participated by doing questionnaires. There were three questionnaires that they did; Eating Disorder Examination Questionnaire, Visual Analog Scales, and Hunger Scale. The Eating Disorder questionnaire consisted on four subscales which included restraint, eating concern, weight concern, and shape concern. The Visual Analog Scale tested how much the participants craved something, liked something, and how much they ate the food items that were presented to them. This was tested by asking questions that related to each section. The Hunger Scale consisted of asking questions such as, time since last eating, subjective hunger, estimate of the amount of favourite food able to eat and estimate of time until next expected meal.

The method of using scales and questionnaires helped the researchers to develop a better understanding of the participants and their disorder. They found out many things about the participants using these scales. The participants who have AN showed clearly that when a target is preceded by a food distractor then it is hindered. As the researchers hypothesised, the AN participants showed that there was a bottom-up attentional capture which interfered with the task they were working on. This means that people with AN have their attention taken away when a picture of food is shown to them. The longer a person is deprived of food, the stronger the attentional bias for food will be. AN participants seem to have a high self-regulation for resisting food when it is presented because of their goal to stay underweight. The study suggests that the higher attentional capture might be because there is a threatening aspect to eating food. The threat is because of food making people, especially people with AN gain weight, which is what they fear. The effect of the distractor in the RSVP seemed to work the most when it was close to the target.

The strengths of this article were that they did proper tests that were reliable and valid. They tested the correct items and helped to determine the hypothesis as well as additional information that they did not previously have. There are also plenty of limitations or weaknesses this study has which are that the sample size of the participants was small. This could have an effect on the results because it would not get enough information from a select few. For this study being done for the first time, there were good results but more research on the topic should be done and another study should be done. Even though they had many tests of eating disorders and eating in general, they also had a limitation on the scales and tests they did. This information could interfere with some of the results they found. One test they could have sought out was something to also predict if the participants have anxiety of depression. This could also change the results because it might differ in AN patients with anxiety or depression compared to AN patients who do not have anxiety or depression. Overall this was a good starting study on the topic of anorexia nervosa patients and their attentional capture of visual food.

Next steps that could be taken are to include some anxiety and depression testing in the patients in both the control group as well as the AN patient group. The researchers could include 3 groups in the study to determine if anxiety or depression have some hindrance on people with AN as well. This could show that people with AN and depression or anxiety could be worse when it comes to the want to eat but knowing they cannot eat. There could be more possible steps that are taken to improve this research and maybe find something that can treat it sooner in life.

Next steps that could be taken to improve this research is that they could go further into research on how to treat these young women earlier in life and trying to figure out how it comes about. Research could be done on how AN effects participants in daily life, what it does to hinder life in general and if anxiety and depression have any effect on making AN worse. There are many things that should be looked at when thinking about this topic and trying to help people with anorexia nervosa.

There is a need for more research involving people, including males, with anorexia nervosa to be able to treat it earlier in life. This research needs to done so people can catch it sooner than early teens and it can be treated properly. Males should be included in this study because it is not just females that suffer from this condition. Though it is a smaller percentage of males with anorexia nervosa, it is still relevant. If it is possible to be able to treat it better and faster with this research then it should be studied and with a larger sample.

Other research that would really help with learning more about anorexia nervosa is how much it hinders people with AN’s daily lives. Researchers could look into how much people are impacted by this disorder they have. Other ideas they could look into that would or could be included in this research would be anxiety and depression. This kind of research for this particular topic, anorexia nervosa would help people understand more of this disorder. It might also answer the question to why people with AN have more attentional capture towards food.

A better understanding of how people with anorexia nervosa function in their daily lives with this disorder will help researchers in treating it. It will give more of an understanding to the disorder and why people with AN see themselves this way. This article explores and explains how people with anorexia nervosa have an effect on attentional capture of visual food. It shows how much people with AN are affected by the disorder they have. It goes through a study that has a control group and a group of people with AN who are asked to do a bunch of scales and tests.

Abstract

Eating disorder is one among the common chronic conditions in the world today especially among adolescents. Eating disorder (ED) describe sicknesses that are represented by constant disturbance of eating patterns and extreme unhappiness or worry about body weight/shape which leads to poor physical and/or mental health. There is a huge misconception among some adolescents about “what is eating healthy” and they tend to skip meals and consume fad diets in order to be healthy and start developing eating disorder symptoms. Adolescents wanting to have a perfect body shape by following fashion models and celebrities pushes them to go into dieting, excessing exercises which intern leads to the development of eating disorders. Initially it starts just weight losing which in future transforms into excessive dieting, skipping meals and taking dietary pills or laxatives. Today, social media has become very common and easily accessible to everyone due to the technology. The internet is filled with pictures of ideal body shapes and youngsters without realising the digital alteration done in the pictures, compare them with their self-pictures and develop body dissatisfaction. The other reasons for developing eating disorders include, prenatal and early life stress, parental care and weight talks among friends/peers. This paper focuses on elaborating the above-mentioned causes that relate to the development of eating disorders.

Introduction

Eating disorder (ED) describe sicknesses that are represented by constant disturbance of eating patterns and extreme unhappiness or worry about body weight/shape which leads to poor physical and/or mental health. Over the past few decades there has been an increase in the prevalence of eating disorder especially among adolescents. Among young children below 12 years of age, eating disorders rose by 119% from 1999 to 2006 in the United States (Golden, et al., 2016). Around 3% of the world’s population is affected by eating disorder and it exists majorly among females than compared to males. Eating disorder is one among the most common chronic conditions among young youths after obesity and asthma. Eating disorder in teens and young youths is linked with high mortality risks, comparable with schizophrenia, bipolar disorder and autism spectrum disorders. There are several factors or reasons which leads young people to develop eating disorders, the most common being the social media like Facebook, Instagram, Twitter and Pinterest. The other reasons are parental care, prenatal stress, acute maternal stress, overvaluation or dissatisfaction of one’s body shape/weight and weight talks among companions. The problem being quite common among young people and seeing the problem up-close among relatives makes it an interesting topic.

Adolescence is a period where one develops from a child to an adult. It is the phase where there are a lot of changes occurring both physically and psychologically in the body. As the adolescents are highly sensitive, media displaying beauty ideals impacts the young mind and they start developing a dissatisfaction about their shape/weight. “Some adolescents may misinterpret what “healthy eating” is and engage in unhealthy behaviors, such as skipping meals or using fad diets in an attempt to “be healthier, ” the result of which could be the development of an ED” (Golden, et al., 2016).

Body image dissatisfaction

Weight/body dissatisfaction is found to be judging requirement for identifying anorexia nervosa and overvaluation of body shape/weight is found to be a solid criterion for diagnosing bulimia nervosa. Overvaluation is giving excessive importance to body weight/shape in determining self-worth on the contrary dissatisfaction is negative feedback on body weight/shape. Overvaluation is associated with gaining more muscles and dissatisfaction is associated with weight loss among adolescents. When compared, overvaluation has gained greater attention for body image disturbance indication while dissatisfaction is considered to be more “normative” than overvaluation. This comparison is found to be truer among females and studies have shown dissatisfaction (15% in men, 40% in women) is indeed more common than overvaluation (14% in men, 23% in women). However, both dissatisfaction and overvaluation are found to have significant effect on the quality of life. Studies have shown that dissatisfaction associating the quality of life impairment more in males than females and overvaluation is more in females than males (Mitchison et al., 2016).

An investigation by Mitchison et al., 2016 showed the significance of body weight/ shape dissatisfaction and overvaluation on eating disorders. 1749 students between the age 12 to 18 years of age attending schools in Australian capital territory were recruited as participants. They were handed out to fill a questionnaire including questions on eating disorder symptoms, psychological distress, dietary eating, objective binge eating and demographic information like age, first language, country of birth, height and weight. A total of 1666 students completed the survey and their data was used for the investigation. It was found that constant thoughts about weight and shape is the main source of distress and eating disorders in females and dietary restraints in males (Mitchison et al., 2016).

Prenatal and Early Life Stress

Studies have also shown that prenatal stress and acute maternal stress is also involved in developing eating disorders. Prenatal stress due to losing a close relative can develop psychiatric disorders and increased chance of eating disorder in offspring’s (Su et al., 2016).

A study by Su et al., 2016 showed a correlation between parental and early life stress and the chances of eating disorders in young and adolescent females in Denmark and Sweden. “Data from the Danish Civil Registry System and the Swedish Multi-generation Register to identify girls born in Denmark from 1970 to 2000 (N = 1,034,539) and girls born in Sweden from 1973 to 1997 (N = 1,246,560)” (Su et al., 2016) was used. These participants were followed from the age of 10 years until they either reached 26 years old , death or developed an eating disorder. A division was done on the basis of prenatal and postnatal exposure to stress among young females who lost a close relative. Prenatal exposure refers stress during pregnancy till the birth of the child due to the loss of older child, partner or other close relatives and postnatal exposure refers to stress from birth until 10 years of age due to the same reasons. The information obtained was categorised into three sub types namely anorexia nervosa, bulimia nervosa and mixed eating disorders. The results of the study were that there was an increased chance of eating disorders in adolescent girls who were exposed to stress either prenatal or postnatal type due to death of a close relative. Bulimia nervosa and mixed Eating disorder were found to be prominent among the young females due to maternal bereavement than compared to anorexia nervosa.

Parental Care and Weight Talks

Most adolescents who develop eating disorders were not initially overweight or underweight and it is very common for eating disorder to develop with a teenager trying to eat healthy. There is a misinterpretation among some teens and parents about obesity prevention and they start to eliminate foods which they believe to be “bad/unhealthy” and in this process of losing weight they may adopt behaviours of eating disorder (Golden et al., 2016). The start with tries to lose weight further develops to extreme dieting, skipping suppers, lengthy period of starvation, use of self-induced vomiting, diet pills and laxatives. Few studies in the past have showed, dieting was related to increase in weight gain and increase in the attitude of binge eating among both boys and girls during adolescence period. A study showed that among girls who dieted in 9th grade were 3 times more likely to be overweight by the time they were in 12th grade and students who restricted their food intake were 18 times more likely to develop an eating disorder (Golden et al., 2016). It was also found that family meals showed an improvement of dietary intake when compared to the food chosen by teens themselves as parents made healthier choice in food. Also, initial attempts to do physical exercises to burn the calories may turn to into compulsive and excessive exercising. The companions and family members also have a hand in developing eating disorders. Weight talk by family members and friends can encourage adolescents into the path of weight loss/gain. Girls who were teased or bullied during adolescence were 2 times likely to be overweight in a span of 5 years. Also, approximately 50% of the girls and one third of the boys in teenage were dissatisfied by their body image. Dissatisfaction of body image are majorly linked with excess dieting and unhealthy weight control behaviours, less physical activity and more binge eating among both boys and girls.

Social Media

One of the major reasons for body image dissatisfaction and eating disorders is the excessive use of social media. Social media can be described as an electronic platform where users create online networks to share data, thoughts, individual messages, and other content. The use of social media has become very popular and around two thirds of the internet users and one third of the whole population actively use social media (Kircaburun et al., 2019). Many researches have been done to show that social media is the major cause for developing an eating disorder. Adolescents wanting to be popular and trending keeps them actively participated in the social media. The newer social networking sites are coming up with constant updates and features and this enhances the active participation. In social media, interaction with people and interest takes place through likes which is seen as an indicator for popularity. These assist transmitting ideals about beauty and body shapes in adolescents. Adolescents understand the pictures with more likes and comments as socially accepted and compare the pictures which in turn leads to body dissatisfaction (Santarossa & Woodruff et al., 2017). The body dissatisfaction makes adolescents turn towards dieting or improper eating patterns which intern leads to eating disorder. A recent study showed that individuals receiving higher number of likes and comments in negative feedback style on Facebook were reported with higher attitudes of eating disorder and weight/shape concerns. A study in Australia showed the relation between Facebook usage and body image concerns is majorly due to appearance comparisons. Today the internet is filled with pictures of celebrities and the negative comparisons occur when the users start comparing their pictures to them without having any idea whether the pictures have been digitally altered (Santarossa & Woodruff et al., 2017).

Sociocultural model (Santarossa & Woodruff et al., 2017) says that media, companions and family are the roots through which messages about beauty, body shape/weight is transmitted. The model describes that the desire to be thin is the cause for body image disturbances among females and ideal body structure to be tall and muscular are the main causes in males. As per the model, social networking sites are the platform for transmitting the messages about appearances as one can easily interact with friends, family, members of the media (celebrities, athletes and models) which further encourages body dissatisfaction. Studies in the past have found significant correlation between body appearance concern and the number of friends of a social media user.

An investigation in this regard was done by Santarossa & Woodruff et al., 2017 which showed the effects of social networking sites on body image and eating disorders. A total of 212 first year undergraduate students from a Canadian university were chosen as participants for the investigation. The participants were asked to bring Wi-Fi enabled devices to class and were provided with the access to Wi-Fi. The participants had to fill an online survey which took around 30 minutes to complete. Out of the ones who completed the survey and after removing the outliers a total of 147 students between the ages 18 to 19 years were considered for the studies among which 55% were females. The questionnaire had questions relating to body image, self-esteem, eating disorder attitudes and use of social media. The findings of the investigation suggested that greater use of problematic social networking sites is associated with low body image and self-esteem and increase in eating disorder symptoms (Santarossa & Woodruff et al., 2017).

Another study in Turkey by Kircaburun et al., 2019 showed a correlation between excessive social media usage and body image dissatisfaction among adolescents. A total of 385 adolescent participants from a high school, aged between 14 and 18 years, being active in social media were chosen for the study. They were handed out questionnaires with questions relating to childhood trauma, body image dissatisfaction, social media usage and eating disorders. The results showed that problematic social media use is directly or indirectly related to body dissatisfaction among adolescents (Kircaburun et al., 2019).

Conclusion

This paper focussed on the causes that are responsible for developing eating disorders in adolescents. From the discussions so far, it is evident that social media/networking sites, body image/shape dissatisfaction or overvaluation, weight talks, parental care and prenatal stress are the major reasons for the development of eating disorders may it be anorexia nervosa or bulimia nervosa. Social media portraying ideal beauty and body shape though digital alteration has led to high level of body dissatisfaction in young adolescents especially among females and increases eating disorder symptoms. Various new websites and applications are entering into the market and also continues updates of these media further encourages the body image dissatisfaction. Today, there are common scenarios of bullying and weight talks among families and friends which are pushing the adolescents to develop habits leading to eating disorders. Prenatal and postnatal stress followed by tragic shock of losing a close personal is found to be related with risk of eating disorders mainly bulimia nervosa among young adolescents. The current studies were based on self-reported data and future studies should examine in a more mediational way and should include adolescents from all around the world to see if eating disorder development accounts for regional changes. The critique would be whether eating disorder is a genetic component which passes from generation to generation which can also be taken as a future scope of work.

References

1. Golden, N. H, et al., (2017). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics 2016;138 DOI: 10.1542/peds.2016-1649
2. Kircaburun, K, et al., (2019). Childhood Emotional Maltreatment and Problematic Social Media Use Among Adolescents: The Mediating Role of Body Image Dissatisfaction. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-019-0054-6
3. Mitchison, D. et al., (2017). Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents. International Journal of Eating Disorders, 50(2), 118– 126.
4. Santarossa, S., & Woodruff, S. J. (2017). #SocialMedia: Exploring the Relationship of Social Networking Sites on Body Image, Self-Esteem, and Eating Disorders. Social Media + Society. https://doi.org/10.1177/2056305117704407
5. Su, X., et al., (2016). Prenatal and early life stress and risk of eating disorders in adolescent girls and young women. European Child & Adolescent Psychiatry 25: 1245. https://doi.org/10.1007/s00787-016-0848-z

There are three main eating disorders which are all an abnormal attitude towards food and the intake of it. All will have a negative impact on an individuals life, including their physical and mental health. A sufferer may have a distorted view of their weight or body shape and so will either under or over eat. Eating disorders are a mental illness in their own right but can also be caused by depression and stress. Eating disorders can quickly spiral out of control which means the sufferer may require professional help and support, sometimes even being admitted to hospital.

Anorexia

Anorexia is a disorder where the individual will restrict their food intake, they will usually start to wear clothes that hide the fact they are losing weight and may even lie to friends and family should their weight loss be noticed. They may over exercise and use laxatives to help keep their weight as low as possible. An anorexic will often have a distorted view of how they look, believing themselves to be over-weight. This eating disorder can cause individuals to become under-nourished and if severe enough may cause them to be admitted to hospital, where usually they will be placed on a food and fluid chart.

Bulimia

Bulimia is where a person may let themselves eat fairly normally but then use self-induced vomiting and laxatives to keep their weight as low as possible. Like anorexia, the individual may have a distorted view of their weight and body size which causes them to purge after eating. This can quickly become a vicious cycle for the sufferer but their weight is often within healthy guidelines. An individual will often hide their secret from friends and family, sufferers do not often readily seek professional help but once they are an inpatient they will usually be placed on a food and fluid chart.

Binge or compulsive overeating

This eating disorder is where the individual will consume large amounts of food, even when they’re not hungry over a short space of time. Unlike anorexia or bulimia the sufferer won’t usually use laxatives, excessive exercise or self-induced vomiting. Many people who suffer from binge eating are over weight or even obese, and usually binge in private. The individual may even purchase special foods to binge with usually once a week or more. Like anorexia and bulimia the sufferer will often have a poor image of themselves and their weight but find comfort in eating. A binge eater puts themselves at a higher risk of diabetes, heart problems and high blood pressure and cholesterol because of their increased weight and body size.

No matter which specific eating disorder the individual is suffering from there are things which can be done to help and support them such as enabling them to talk about their feelings. While helping a person who is suffering from an eating disorder it is important not to judge or criticise them. Avoid dwelling on their weight or eating habits but staff will need to closely monitor. Give them time to talk, be supportive and really listen to them to make them feel valued as a person. Give the individual genuine compliments and help them see what is good about them. Once the individual feels ready or discharge is being discussed encourage them to find local support groups, assist them on this task and even suggest a friend could to go with them. Make suggestions rather than give instructions about how they can change as instructing, confrontation or being highly critical will not help the individual and may even break the cycle of support being offered. Learning more about eating disorders could be beneficial to both the supporting person and the sufferer because learning could give more knowledge and help towards a better understanding of the specific eating disorder. As recovery from an eating disorder or mental health illness can be a lengthy progress there will need to be a long-term commitment towards helping the person suffering the eating disorder. Over the course of recovery, there could even be times of relapse, it is important to remember to be supportive as relapses do not mean failure on either side and so long as the person suffering from the eating disorder still has a strong desire to want to manage better and recover as best as they can then treatment and support will still be beneficial.

After the patient’s urine is analyzed using dipsticks and based on the information and results obtained during the test, the disease that the patient is suffering from can be diagnosed as anorexia nervosa. In this report, I will explain how I made this diagnosis.

The first indication that led to this decision is from the patient information received prior to the test. It can be seen that the patient is greatly underweight, weighing in at 43kg. Including her height of 165cm, a BMI test can be done which shows that she has a BMI of 15.7, which means she is underweight. Some symptoms that the patient is experiencing include fatigue, bloating, dry skin, and discoloration in her hands due to poor circulation.

The results of the urine analysis test will be discussed. In the urine test, the following substances were tested: glucose, ketones, specific gravity, blood, pH, protein, nitrites, and leucocytes. The result of glucose received was negative, this is normal as glucose should not be in the urine, giving no cause for concern for this patient. A positive result could indicate diabetes, kidney failure, or pregnancy. However, there were large levels of ketones present in the urine, 80. Ketones are not usually found in urine. They are produced when glucose is not available in the cells of the body as a source of energy. They can form when a person does not eat enough carbohydrates, suggesting fasting or starvation, or when a person’s body cannot use carbohydrates correctly. This was the second indication that led to the diagnosis of the disease. In terms of specific gravity, it measures urine concentration. A specific gravity of 1.015 was received for this test, suggesting normal kidney function, yet results above 1.010 show signs of dehydration. Therefore, the patient might not be drinking as much fluids as she should be. Dehydration is caused by not drinking enough fluids and can lead to kidney failure. This is another reason that led to the diagnosis. The result of blood present in the urine was negative, showing that there is no internal bleeding. A negative blood result is common. Blood in urine, known as hematuria, could be caused by urinary tract infections, kidney infections, or possibly cancer. The pH level of the urine was 6, which is slightly acidic, but is average and normal for a urine sample. If the pH level was lower, it could indicate dehydration, acidosis, or diabetic ketoacidosis. If the pH was higher, it could mean the patient has kidney failure, respiratory alkalosis, or a urinary tract infection. The results were negative for protein in the urine, also known as proteinuria, again, this is normal as protein molecules should be too large to pass through the kidneys. The nitrite levels in the urine were negative, which is normal. Lastly, leucocytes were tested for in the urine, and like most other results, the outcome was negative. And like the other results, it is normal for this to be a negative result. Overall, the two substances that led me to my conclusion that the patient was suffering from anorexia nervosa were the high levels of ketones and the specific gravity levels.

Anorexia nervosa is an eating disorder that affects both men and women, but mostly young women. People suffering from the disease try to keep their weight low, usually by not eating enough or by exercising too much. These actions can lead to them becoming sick as they begin to starve. Sufferers usually have a distorted image of their body, believing that they have more weight when in reality they are underweight. Some signs of anorexia include having a low body mass index, thinking your weight is healthy when you are underweight, skipping meals or not eating any food, having dry skin, and feeling tired.

As a pharmacist, several treatment options can be recommended to help a patient who has anorexia. Firstly, cognitive behavioral therapy can be offered, which involves talking to a therapist to design a personal treatment plan, which will help with your feelings, understand nutrition, the effects of starvation, and make healthy food decisions. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) and Specialist Supportive Clinical Management (SSCM) are other treatments where the patient talks to a therapist to discover what is causing the eating disorder. Advice about a healthy diet will be provided, but therapy is usually needed also. According to Anorexia & Bulimia Care, statistics from sufferers of anorexia show that “50% recover, whereas 30% improve and 20% remain chronically ill”.

To conclude, this laboratory report is an example of how urinalysis using dipsticks can be used to diagnose a patient’s illness, in this case, anorexia nervosa. In order to successfully recover and improve her condition, the patient needs treatment.

References

1. Anorexia & Bulimia Care. 2014. Statistics. [ONLINE] Available at: http://www.anorexiabulimiacare.org.uk/about/statistics [Accessed 6 March 2019].
2. Eating Disorder Hope. 2018. Dehydration and the Treatment of Eating Disorders. [ONLINE] Available at: https://www.eatingdisorderhope.com/information/bulimia/dehydration-and-the-treatment-of-eating-disorders [Accessed 1 March 2019].
3. Healthline. 2016. Urine pH Level Test. [ONLINE] Available at: https://labtestsonline.org/tests/urinalysis [Accessed 24 February 2019].
4. Healthline. 2018. Urine Specific Gravity Test. [ONLINE] Available at: https://www.healthline.com/health/urine-specific-gravity [Accessed 24 February 2019].
5. Lab Tests Online. 2016. Urinalysis. [ONLINE] Available at: https://labtestsonline.org/tests/urinalysis [Accessed 24 February 2019].
6. Lab Tests Online. 2018. Blood in Urine (Haematuria). [ONLINE] Available at: https://labtestsonline.org/conditions/blood-urine-hematuria [Accessed 4 March 2019].
7. Medline Plus. 2017. Glucose in Urine Test. [ONLINE] Available at: https://medlineplus.gov/lab-tests/glucose-in-urine-test/ [Accessed 1 March 2019].
8. NHS. 2018. Anorexia Nervosa. [ONLINE] Available at: https://www.nhs.uk/conditions/anorexia/ [Accessed 3 March 2019].
9. NHS. 2018. Treatment – Anorexia Nervosa. [ONLINE] Available at: https://www.nhs.uk/conditions/anorexia/treatment/ [Accessed 3 March 2019].

‘To the Bone’ focuses on a twenty-year-old college dropout named Ellen (or Eli) who is struggling with anorexia nervosa (AN). Her stepmom is out of treatment options until Ellen meets an unconventional doctor who accepts her into his program, which consists of staying in a group home for six weeks and recovering from eating disorders. The drama is centered around the physical and mental effects of this eating disorder. ‘To the Bone’ was written and directed by Marti Noxon and released in 2017; the duration of the movie is approximately one hour and forty-seven minutes. Anorexia nervosa will be discussed in reference to ‘To the Bone’.

Summary

‘To the Bone’ begins with Ellen leaving an inpatient rehab center after failing to make improvement in her recovery; she moves back in with her stepmom, sister and absent father. With the help of her stepmom, Susan, Ellen meets with a specialist, Doctor Beckham, who recommends that she stays at a treatment home with six others, who are attempting to recover from eating disorders, as well. Ellen is reluctant to do so at first, but after talking with her younger sister, Kelly, she follows through. At a family counseling session led by Beckham, Ellen’s recovery declines after her stepmom and mom focus their attention on their grievances against each other, as well as their own personal problems, and are not sympathetic towards Ellen. She begins to make some progress at one point, but it comes to a halt, once again, after Luke begins expressing his feelings for her and Megan miscarries her baby due to her resumed purging after the twelve-week mark of her pregnancy. As a result, Eli leaves to go live with her mom in Phoenix. On her first night there, her mother expresses her guilt over not bonding with her daughter as much as she should have, and suggests that she bottle feeds Eli to attempt to solve both problems. Eli reluctantly agrees and afterwards, goes on a walk. She passes out and has a nightmare that she sees Luke again and she also sees another version of herself dying. Waking up, Eli decides to head back home, where she sees Susan and Kelly again before returning to Beckham’s program.

Analysis

Noxon’s purpose of writing and directing this film is to show the damaging effects of AN and the recovery process through an inpatient group home. She achieves this purpose by casting “individuals who have struggled with eating disorders” in the past themselves (‘To the Bone’, 2017). She also bases the film off of her own experience with AN. Acting is powerful in this movie, given that Lily Collins (Ellen/Eli) also suffered and recovered from AN herself and is able to empathize with the character she is portraying. Personally, I believe that the writing was done really well in some areas, but there are other scenes where Noxon could have improved the storyline. For example, she could have left out the subplot with the romance between Eli and Luke and instead, focused more of the screenplay on Ellen recovering from AN. The music was effectively incorporated into the movie, as well.

Some other strengths within the movie consist of how Noxon showed Eli’s eating disorder. For example, she smokes to curb hunger and at mealtimes, she mainly only pushes her food around on the plate in front of her. Noxon was successful in capturing a potential environmental factor of AN because a broken home could be part of the reason for a condition like hers. The movie also gives some insight on Eli’s family life, including her father not having much of a presence in her life, her mother moving away to be married to someone else and both her mom and stepmom being self-centered at her family therapy session. Some side effects of AN are also shown and discussed, such as Eli’s period stopping because of the amount of weight and body fat she lost, she constantly wraps her middle finger and thumb around her upper arms and she faints at one point. Noxon also captures the main character’s bony figure to emphasize the problem of AN.

The weaknesses mainly involve the lack of treatment for the disorder. Doctor Beckham does not discuss the subject of food or ask Eli to take small steps by eating a little more each day. The portrayal of the treatment does not seem realistic because according to Kristen Armbrust, in her writing, she states that patients are “typically monitored by a physician, therapist, psychiatrist and dietitian” (Armbrust). Specialists do not play much of a role in the recovery process because “there is often an individualized meal plan and supervision to prevent behaviors from occurring”, but neither of those things are present throughout the movie (Armbrust). One other weakness is that the audience gets some insight on Eli’s home life, but she never once discusses the reason why she developed AN, nor does she express a desire to be thin. Something else I have noticed is that Eli’s specialists treat her AN as they would an addiction. For example, a counselor at Eli’s facility notes that “Starving [herself] can make [her] feel euphoric, like a drug addict or an alcoholic” (‘To the Bone’, 2017). Treating the disorder as an addiction could be a strength, considering that AN is similar to an addiction. However, this method might not be the best approach because personally, I believe that Doctor Beckham and one of the counselors could have asked her to eat a little more each day, as previously mentioned. Beckham tells Ellen’s stepmom that an issue with the treatment is that he and the other specialists will not let the young teens hit rock bottom because it is “too hard to watch”, but notes afterwards that “for Eli, the bottom’s critical” (‘To the Bone’, 2017). This line implies that AN is not considered an issue until an individual as thin as they can be without dying, which is not true. The movie shows Eli going back to the group home after a nightmare where she sees herself dead, but Noxon fails to include the results of her time at the facility.

Personally, I found the movie to be interesting because of how well the negative effects of the disorder were portrayed throughout the movie. However, it had dull moments when it came to Eli’s progress with her treatment. Overall, I have mixed feelings about this movie. I would not recommend it to anyone struggling with AN because it could possibly alter their views on the process of overcoming their eating disorder.

Discussion

‘To the Bone’ accurately depicts the physical and psychological effects of AN. As said previously, the treatment of the disorder is not carried out as well as it could have been. Overall, the drama receives a C grade.

References

1. Armbrust, Kristen. “‘To the Bone’ and Eating Disorder Treatment: Did Netflix Get It Right?”, 22 Aug. 2017, http://www.nationwidechildrens.org/family-resources-education/700childrens/2017/08/to-the-bone-and-eating-disorder-treatment-did-netflix-get-it-right.
2. Noxon, Marti, director. ‘To the Bone’. To the Bone, Netflix, 2017.

Beauty is a state of mind. As adolescent girls and boys grow and develop, they have to learn to accept and love their bodies. The process of loving oneself is arduous, and being insecure can last into adulthood. However, some children’s insecurities may turn into serious disorders. One condition that is related to body dysmorphia is anorexia nervosa, which is defined as an eating disorder in which one, typically a female, obsesses over how they look and turns to restrictive eating. From my perspective, young women and girls may be suffering from anorexia nervosa mainly because of media portrayal, increased usage of social media, and the need to be in control.

The media portrays women and girls as being perfect and having a certain idealistic figure. This figure is most similar to being skinny and 5’7”-6’0” with long legs. This standard of beauty is unattainable for most females in the United States. However, the media has started to include more women with different body sizes in their portrayal of beauty. Because the idea that women need to have an idealistic figure has previously been ingrained, women now will continue to compare themselves to the beauty standard that they know. Young women and girls may compare themselves to the ‘perfect woman’ that is portrayed in the media and decide that they want to more closely resemble that body image. This search for idealism results in the development of anorexia nervosa in extreme cases. For example, an average female may see an ad for Victoria’s Secret in the media and feel insecure about her body. Victoria’s Secret models are traditionally characterized as being skinny (around 132 pounds), between 5’8”- 6’0”, with long legs, and being slightly more voluptuous than a traditional runway model. On the contrary, a young average female would most likely be around 165 pounds, in the 5’4”- 5’6” range, be rather proportional in limb length, and is most likely still developing. To see the models that are portrayed as ‘angels’ or ‘perfect’ can damage the self-esteem of the young girl watching. This girl may want to more closely resemble the model’s body shape and start to restrict her diet and exercise excessively to lower her body weight and define her muscles. These actions are characteristics of anorexia nervosa. This disorder is a fast but destructive way to lose weight. If the young girl likes the results of placing restrictions on her diet and exercising excessively, she may continue to engage in these destructive behaviors. It will be very difficult for young women and girls, who feel similarly to the young girl in the previous example, to regain confidence without feeling the need to restrict their diet or exercise excessively. Young females are very impressionable, and because the media portrays women as having idealistic body types, they are more likely to develop a disorder such as anorexia nervosa.

Next, I want to talk about our lives in the age of technology where social media has become a more prevalent danger. Social media only shows the most flattering aspects of someone’s life, meaning no one is going to post a picture where they do not look their best. Filtering social media means an influencer will post a picture in which their body looks ideal. This false portrayal of body shape may discourage young women and girls who are viewing these photos and lower their self-esteem because their bodies do not resemble the bodies of the influencers they look up to. Because young females are impressionable, social media has inadvertently convinced them that they need to have the ideal body. Young women and girls may start to restrict their diet and exercise more to obtain the ideal figure. This behavior can become more extreme and result in the development of anorexia nervosa. Social media’s toxic portrayal of the ideal figure can lead to the gradual development of anorexia nervosa due to the fact that young females are impressionable.

Lastly, some females struggle with anorexia nervosa because they need to feel in control. Having a difficult home life is an example of a situation where a young female may feel out of control and lost. Children are unable to control their poverty level, their parent’s aggression, or anything other than their behavior. These characteristics make for a difficult home life due to either the struggle for necessities or abuse in the home. Sometimes when life feels out of control, there needs to be one thing that can be controlled, and for a lot of young women and girls, it is what they eat. By controlling what they eat and how much they exercise, these females can feel in control of their weight. These young, impressionable women and girls may feel as though if they lost weight or had an idealistic figure, then they would attract more positive attention from their peers. This attention can be a driving factor in addition to needing to feel in control. Needing to feel in control is normal, however, developing an eating disorder to feel this way is unhealthy and dangerous.

Anorexia nervosa is a result of the media’s portrayal of women, the increased usage of social media, and the need to be in control. The media portrays women as being skinny and tall, which can result in restrictive eating and excessive exercise. In addition, social media results in the reduction of self-esteem levels due to the idea that young females need to have ideal bodies. Lastly, young women and girls may need to feel in control of what they eat and how much they exercise due to the influx of factors outside of their control. Thankfully, society has started to include different body types in their portrayal of beauty, which will help young females feel confident in their bodies and not feel the need to conform to an unrealistic beauty standard.

Beauty is a state of mind. As adolescent girls and boys grow and develop, they have to learn to accept and love their bodies. The process of loving oneself is arduous, and being insecure can last into adulthood. However, some children’s insecurities may turn into serious disorders. One condition that is related to body dysmorphia is anorexia nervosa, which is defined as an eating disorder in which one, typically a female, obsesses over how they look and turns to restrictive eating. From my perspective, young women and girls may be suffering from anorexia nervosa mainly because of media portrayal, increased usage of social media, and the need to be in control.

The media portrays women and girls as being perfect and having a certain idealistic figure. This figure is most similar to being skinny and 5’7”-6’0” with long legs. This standard of beauty is unattainable for most females in the United States. However, the media has started to include more women with different body sizes in their portrayal of beauty. Because the idea that women need to have an idealistic figure has previously been ingrained, women now will continue to compare themselves to the beauty standard that they know. Young women and girls may compare themselves to the ‘perfect woman’ that is portrayed in the media and decide that they want to more closely resemble that body image. This search for idealism results in the development of anorexia nervosa in extreme cases. For example, an average female may see an ad for Victoria’s Secret in the media and feel insecure about her body. Victoria’s Secret models are traditionally characterized as being skinny (around 132 pounds), between 5’8”- 6’0”, with long legs, and being slightly more voluptuous than a traditional runway model. On the contrary, a young average female would most likely be around 165 pounds, in the 5’4”- 5’6” range, be rather proportional in limb length, and is most likely still developing. To see the models that are portrayed as ‘angels’ or ‘perfect’ can damage the self-esteem of the young girl watching. This girl may want to more closely resemble the model’s body shape and start to restrict her diet and exercise excessively to lower her body weight and define her muscles. These actions are characteristics of anorexia nervosa. This disorder is a fast but destructive way to lose weight. If the young girl likes the results of placing restrictions on her diet and exercising excessively, she may continue to engage in these destructive behaviors. It will be very difficult for young women and girls, who feel similarly to the young girl in the previous example, to regain confidence without feeling the need to restrict their diet or exercise excessively. Young females are very impressionable, and because the media portrays women as having idealistic body types, they are more likely to develop a disorder such as anorexia nervosa.

Next, I want to talk about our lives in the age of technology where social media has become a more prevalent danger. Social media only shows the most flattering aspects of someone’s life, meaning no one is going to post a picture where they do not look their best. Filtering social media means an influencer will post a picture in which their body looks ideal. This false portrayal of body shape may discourage young women and girls who are viewing these photos and lower their self-esteem because their bodies do not resemble the bodies of the influencers they look up to. Because young females are impressionable, social media has inadvertently convinced them that they need to have the ideal body. Young women and girls may start to restrict their diet and exercise more to obtain the ideal figure. This behavior can become more extreme and result in the development of anorexia nervosa. Social media’s toxic portrayal of the ideal figure can lead to the gradual development of anorexia nervosa due to the fact that young females are impressionable.

Lastly, some females struggle with anorexia nervosa because they need to feel in control. Having a difficult home life is an example of a situation where a young female may feel out of control and lost. Children are unable to control their poverty level, their parent’s aggression, or anything other than their behavior. These characteristics make for a difficult home life due to either the struggle for necessities or abuse in the home. Sometimes when life feels out of control, there needs to be one thing that can be controlled, and for a lot of young women and girls, it is what they eat. By controlling what they eat and how much they exercise, these females can feel in control of their weight. These young, impressionable women and girls may feel as though if they lost weight or had an idealistic figure, then they would attract more positive attention from their peers. This attention can be a driving factor in addition to needing to feel in control. Needing to feel in control is normal, however, developing an eating disorder to feel this way is unhealthy and dangerous.

Anorexia nervosa is a result of the media’s portrayal of women, the increased usage of social media, and the need to be in control. The media portrays women as being skinny and tall, which can result in restrictive eating and excessive exercise. In addition, social media results in the reduction of self-esteem levels due to the idea that young females need to have ideal bodies. Lastly, young women and girls may need to feel in control of what they eat and how much they exercise due to the influx of factors outside of their control. Thankfully, society has started to include different body types in their portrayal of beauty, which will help young females feel confident in their bodies and not feel the need to conform to an unrealistic beauty standard.