Human life depends on many factors and culture plays an essential role. Speaking about culture, people usually think about the way of conduct, national peculiarities and other aspects which characterize one particular country. However, there are many aspects which characterize human culture. Considering culture as a factor which influences people and their decisions, health instances are to be discussed when cultural preferences lead to cases of disease. Cultural issues are closely interconnected with religion in some countries and with social opinion in other countries. However, in each case health care may be restricted depending on cultural directions. Speaking about anorexia and idiopathic seizures connected to culture, it is possible to notice dependence between the mentioned issues. Those who have faced these diseases in various cultures may notice the peculiarities. The main idea of this research is to present two specific cases concerning the cultural expression in these two diseases.
Anorexia is a nervous problem which results in abnormal and unregulated loss of weight which finishes with organism exhaustion. Looking at this problem from the cultural point of view, it is possible to state that Western countries have the highest rate of this mental disorder. Anorexia is not a nutrition problem, poverty and hunger because of it do not lead to anorexia. Being purely a mental disease, Western culture promotes it from day to day. What does the problem come from? Watching TV, searching for the information online and considering other mass media information, Western people come across the message given to the modern society. An ideal woman is a thin woman without extra weight. Watching fashion shows and similar arrangements, people (especially women) want to look like those at the stage. Different magazines are full of ideal women and the Internet presents hundred of diets and other ways to lose weight. Living under such cultural pressure, women appear in dependence from this opinion. Arnold (2012) states in his research that “viewership of such images is associated with low self-esteem and body dissatisfaction in young girls and women, placing them at risk for development of body image disturbances and eating disorders. These conditions can have devastating psychological as well as medical consequences”. However, there are a lot of women with low self-esteem in other countries, but the level of people who suffer from anorexia is still the highest in the Western countries. Isn’t it a reason to consider cultural aspects of the problem while battling the disease?
Many psychologists assure that self-esteem plays a central role in anorexia. It is impossible to disagree with the issue, but why do people have low self-esteem? The image of an ideal person created in the society makes people have a desire to correspond to that idol. Some people do not pay attention to their failure to be ideal, but others are ready for everything to meet the standard. It is society that imposes standards, therefore, the affect of culture is inevitable. Engel, Reiss, and Dombeck (2007) point to the fact that before mass media spread “plump, round, and soft” body was considered as an ideal one. So, this is one more fact that proves cultural influence on human consideration of ideal body and on anorexia as a result. The main problem of the modern cultural affect is the presentation of men and women on TV and in magazines as of their natural ideal weight. Much is said about Photoshop and constant restrictions in weight and style of life. However, many people are sure that ideal women and men on TV are born with such weight and they have to do nothing to support their shape. As a result, people are affected. Society and culture of the West supports such opinion and all people cannot ignore this point of view. Anorexia is purely cultural problem and the reconsideration of the social vision of ideal body may help solve this problem.
Speaking about idiopathic epilepsies Banerjee, Filippi, and Hauser (2009) refer it to the problem which has a genetic basis. This disease commonly begins in childhood. Considering the relation between this disease and cultural issues, it is possible to refer to life of people in society. Modern cultural considerations of people are rather contestable. Following the rule of human equality, there is still prejudice in relation to epileptic people. People with such diagnosis may have problems at school, at work, and in other places of social interaction. It does not mean that people with idiopathic epilepsy are restricted culturally, however, specific tension is felt. Considering cultural affect on the problem, it should be stated that Western philosophy mostly tends to physically and mentally healthy members of society. In theory, social opinion does not press those who have some problems or differ from others. However, a person with idiopathic epilepsy feels uncomfortable in modern society. As a result, the disease is developed due to constant tension and other similar factors.
People refuse from treatment being sure that if no one knows about their problem they would feel better. Still, idiopathic epilepsy is not a problem which may be easily solved. The same idea is confirmed by Jakovljević and Žarko (2006) who assure that additionally “to the ‘normal’ influences of demographics, cultural, cognitive and behavioral factors in their development, children and adolescent with epilepsy can experience social incompetence at school, with their peers and in other relationships, in sport and in obtaining part time jobs” (p. 530). Even though cultural aspects concerning this issue are not that common as the problems connected to anorexia, negative health outcomes because of cultural instability and absence of social support is great. People are unable to live in isolation. But modern society in most cases is based on the principle of survival, where the strongest people are able to live happy. Health problems people face have cultural imprint.
In conclusion, culture plays a very important role in all aspects of human life. Speaking about health care, it should be stated that some cultural visions and prejudice may cause many health problems which may lead to deaths. Anorexia and idiopathic epilepsy are such cases. Culture is not just religion and traditional considerations of a particular country. Culture is the way how people live and how they treat various issues. Mass media may be considered as the creator of human opinion. It is essential to consider anorexia and idiopathic epilepsy from the point of view of cultural approach as a closer discussion of this problem shows the affect culture has on people. Disease development is promoted by cultural considerations and only ruining cultural perspectives may improve the situation concerning anorexia and idiopathic epilepsy in Western society.
Reference List
Arnold, C. (2012). Is Anorexia a Cultural Disease? Slate. Web.
Banerjee, P., N., Filippi, D., & Hauser, W. (2009). The descriptive epidemiology of epilepsy- A review. Epilepsy Research, 85, 31 – 45.
Engel,B., Reiss, N. S., & Dombeck, M. (2007, February 2). Causes of Eating Disorders – Cultural Influences. MentalHelp. Web.
Jakovljević, V. and M. Žarko (2006). Social competence of children and adolescents with epilepsy. Seizure, 15, 528 – 532.
Genetic disorders remain a largely grey area due to the complexities associated with the studies of the human genome, yet drawing connections between known disorders and genetic dysfunction will allow understanding the mechanisms of some of the diseases significantly better. In her 2002 study, Cynthia Bulik (DeAngelis) considers the possible correlation between anorexia nervosa and an individual’s genetic makeup. The author effectively proves that the development of anorexia nervosa may occur not only due to the exposure to the social pressure of beauty standards, but also the presence of a genetic predisposition.
The study was conducted as a cross-sectional analysis and included the assessment of 192 family groupings. As the study progressed, the sample size was reduced to 37 participants, which were expected to represent the target population (DeAngelis). With the help of the further mixed method research and a combination of the qualitative and quantitative analysis, the presence of both genetic and sociocultural factors leading to anorexia nervosa in patients was proven.
The results of the study indicate that the approach toward treating anorexia nervosa in patients can be shaped to locate the problem at the earliest stages of an individual’s development, possibly, even before birth. Thus, the key threats that may serve as the causes of anorexia nervosa development can be removed from the patient’s setting. As a result, the threat of the eating disorder in question affecting the lives of people genetically predisposed to it will be minimized. Since eating disorders and especially anorexia nervosa affect a wide range of people and are reinforced by the current beauty standards, the introduction of a prevention and treatment model based on genome studies is a highly welcome change.
Work Cited
DeAngelis, Tori. “A Genetic Link to Anorexia.” APA.org, 2021. Web.
There is increased eating disorder on various groups of people and especially the middle aged adolescent group. The eating disorders cause great morbidity and premature mortality risks mostly to young adolescent girls and women. Currently there are no solid proofs for the real causes of the eating disorders.
The current high eating disorder prevalence among young adolescent men and women have triggered a need for the search for modifiable risks factors that will help in explaining the causes of the disorder and how it can be mitigated.
Psychologists have associated the eating disorder to some psychological, socio-cultural and biological factors. This eating disorder is referred as Anorexia nervosa. The disorder is characterized by self eating denial commonly accompanied by excess body weight loss.
Anorexia nervosa is identified when an individual weighs 15% less than his/her body weight (Klein, Schebendach, Gershkovich, Bodell, Foltin & Walsh, 2010).
There is no exact known cause of Anorexia nervosa. Nevertheless, researchers have associated the disorder to be a resultant of some environmental conditions, personality traits, emotions and thinking patterns or some biological factors. In summary, the causes of Anorexia nervosa have been categorized into three classes by researchers.
The causes are biological, socio-cultural or biological. Researchers attribute overlapping socio-cultural accounts to include the tripartite pressure and dual pathway. Research has shown that a lot of pressure from pears, family and mass media has a tendency to trigger body dissatisfaction and eating disorders directly and also through two mediating mechanisms.
These mechanisms involve internalization of unrealistic and ideal societal attractiveness. An example for this is where ultra-thinness is considered as the ideal beauty for women. This entails from the tendency for an individual to frequently compare his/her physical appearance with pears or media ideals.
The other mechanism is where one suffers from elevation in negative effect. It has been noted that appearances pressure from the mass media, family or pears has been caused by social sanctioned attractiveness ideals that cause one to be dissatisfied with her/his body.
Consequently, body dissatisfaction eventually leads to eating disorders symptoms over time. It is perceived that plumb girls that have internalized ultra-thin ideals for attractiveness for women are vulnerable to later increases in disturbances that will affect their eating habit.
Researchers have identified that women often engage in frequent appearance comparisons than men and this makes them suffer from body dissatisfaction more than their counterparts’ men. This reason explains why there are many women that suffer from eating disorders than men.
Weight and body dissatisfaction have been highlighted as the major causes of eating disorders. It is noted that majority of the people that suffer from anorexia disorder are those that suffer from low-self esteem.
This is because adolescent girls or boys that suffer from low self esteem will most likely have a tendency to compare their physical appearance with those of their pears or media models and often consider their appearances as being inferior.
Most TV models and particularly in western cultures associate ultra-thinness with beauty for women. Therefore those adolescent girls that are plumb and suffer from low self esteem may tend to being dissatisfied with their bodies hence developing eating disorders (Hoeken, Veling, Smink & Hoek, 2010).).
There are some psychologists that consider those people that suffer from Anorexia nervosa not to have emotions. They regard them not to have emotions because those people that suffer from anorexia nervosa appear at first to be confused and behave as though they are not sure of their emotions.
This condition is referred as alexithymia that denotes a condition of difficulty in recognizing and expressing one’s emotional states. Some researchers have linked the alexithymia condition with fluctuations in mood rather than eating disorders.
Nevertheless, researchers have pointed a very close relationship between alexithymia and measures of depression and anxiety. The research also reveals that alexithymia is common for many people that have depression and suffered from the eating disorder.
This assumption have raised a lot of concern since many scholars are questioning how people suffering from eating disorders can have a problem in identifying other emotions such as anger and fear. This concern has raised a lot of interest on the subject.
This dilemma has lead to some researchers linking the cause of Anorexia as a result of a means of escaping painful affects. According to Jackson & Chen (2011), there is a model developed by Cooper that postulates positive beliefs about eating.
The positive belief of vomiting was determined to help the self to dissociate from the emotional distress that is caused by existence of negative beliefs. However, further distress occurs because of the existence of the negative belief about eating that perceives eating will make one gain weight.
This causes a conflict in an individual that result to a cognitive dissonance which makes them belief that their eating disorder is out of their control (Fox, 2009).
There are two types of eating disorders which are primarily restriction of food that is considered as an emotional avoider and vomiting which is taken as a suppresser of the emotion. People suffering from eating disorder are known to suppress anger much more than controls.
It is believed that suppression of negative emotions predicts body dissatisfaction. Various researches showed that women who were diagnosed with anorexia norverso recorded higher anger scores and anger suppression scores than controls.
Researchers were unable to identify the reason why anger was a difficult emotion, but assumed that the anger was a means of protecting the participants’ relationships. Similarly, researchers also noted higher level of other emotions such as anxiety and fear among those people that suffer from Anorexia norverso.
Moreover those people that suffer from eating disorder were noted to be highly disgust sensitive and particularly for their bodies and food (Karatzias, Chouliara, Power, Collins & Grierson, 2010).).
Anorexia nervosa is mostly considered as a heredity disorder that runs in families. Many researches conducted reveal that many of those patients that suffer from the disorder have relatives who have ever had the disorder.
Anorexia nervosa has vital short time and long time physical, psychological and sociological affects. The eating disorder makes bodies of people suffering from Anorexia nervosa struggle to manage insufficient calories and nutrients.
Most Anorexia nervosa patients are known to experience constipations, abdominal pains, dry, yellow colored skin, dizziness and disrupted menstrual cycles. When the eating disorder continues over a long period of time, the patient can develop osteoporosis, infertility, heart problems, anemia, and neurological problems among others. Osteoporosis is a condition that makes the density of bones to reduce.
This is a very dangerous condition because it can make the victims vulnerable to painful fractures especially in the hip and spine. In addition, it leads to loss of height and continuous disabling pain.
People that suffer from Anorexia nervosa for a long period of time deprive their bodies essential nutrients and minerals such as calcium that are responsible for making bones to grow and become strong. The most affected people are adolescents since most eating disorders develops from age 13 through out the teenage period.
Eating disorder during this age is very serious since it is the period when the bones of the adolescents are developing and reaching their peak strengths. Therefore, denying the body necessary nutrients through Anorexia nervosa can lead to serious health issues as aforementioned above (Soban, 2010).
Eating disorder has been noted to cause disruption in the menstrual cycle. Prolonged Anorexia nervosa may lead to infertility. Infertility occurs in women suffering from anorexia nervosa when their body fats drops drastically, thus inhibiting the production of estrogen hormone that is needed to stimulate ovulation.
Most of those women that develop infertility as a result of Anorexia nervosa regain their fertility once they resume eating well and after gaining some weight. Anorexia nervosa is also known to cause heart problems and anemia.
The heart develops problems due to wearing out of the fat that protects the heart from injury. Severe anorexia nervosa results to weakening of the heart muscle that in turn weakens the heart. Consequently, the weakening of the heart muscles leads to low blood pressure and pulse which eventually leads to a slower rate of breathing.
People who suffer from severe anorexia nervosa can consequently develop nerve damage which will in turn affect the brain.
The damaging of the nerves can lead one to suffer from a state of confusion, seizures, numbness and peripheral neuropathy. Some people regain their normal status when they start eating well and after regaining some weight, although in some cases some damages is permanent (Sang, Jaussent, Raingeard & Bringer, 2010).
People that suffer from Anorexia nervosa are known to possess interpersonal distress. The interpersonal problems are believed to be caused by the physical and psychological problems that are associated with patients that suffer from anorexia nervosa such as low-self esteem, perfectionism and physical impairment.
For instance, some people that suffer from anorexia nervosa are noted to demand so much from others. Such situation makes people to pull away from them such that they are left in isolation. Such isolation makes these patients develop hostility towards other people and disaffiliation.
Alternatively, the isolation can lead them to develop a desperate need for others and intrusiveness. Both these two situations lead to strained relationships and social functioning impairment (Hartmann, Zeeck & Barrett, 2010).
Anorexia nervosa is heterogeneous. It affects both men and women. Nevertheless, there is a difference in the way men and women differ in the manner in which they view their body image, dieting and what motivates them to exercise.
The image relayed by the mass media about how ideal men should appear is totally different to the message the mass media give about how ideal beautiful women should look like. The media portrays ultra-thinness as the beauty for women, while it portals that men should be masculine in order to be liked by women.
One symptom of anorexia nervosa in men is excessive exercise. The effects of anorexia nervosa in men include the loss of approximately 20% of weight which is very dangerous to their health. This is because men possess less fat than women and therefore when they loss weight they loss more of their muscles than fat.
Men that suffer from anorexia nervosa have interpersonal problems and most of them opt to live single lives. Most of those that marry may opt not to get children. Severe anorexia in men is also noted to cause infertility in men since it greatly reduces the level of the testosterone.
Moreover, anorexia nervosa in men has been associated with lack of sexual identity in men. This can be linked to the reason why majority of those men that are diagnosed with the disorder are mostly homosexual or heterosexual (Lindblad, Lindberg, Hjern, 2006).
Reference List
Fox, J. (2009). A Qualitative Exploration of the Perception of Emotions in Anorexia Nervosa: A Basic Emotion and Developmental Perspective. Clinical Psychology and Psychotherapy,16, 276–302.
Hartmann, A., Zeeck, A. & Barrett, M. (2010). Interpersonal Problems in Eating Disorders. International Journal of Eating Disorders, 43, 619–627.
Hoeken D., Veling, W., Smink, F. & Hoek, H. (2010).The Incidence of Anorexia Nervosa in Netherlands Antilles Immigrants in the Netherlands. Eating Disorders Association, 18, 399–403.
Karatzias, T., Chouliara, Z., Power, K. Collins, P. & Grierson, D. (2010).General Psychopathology in Anorexia Nervosa: The Role of Psychosocial Factors. Clinical Psychology and Psychotherapy, 17, 519–527.
Klein, D., Schebendach, J., Gershkovich, M., Bodell, L., Foltin, R. & Walsh, T. (2010).
Behavioral Assessment of the Reinforcing Effect of Exercise in Women with Anorexia Nervosa: Further Paradigm Development and Data. International Journal of Eating Disorders ,7, 611–618.
Lindblad, F., Lindberg, L., Hjern, A. (2006).Anorexia Nervosa in Young Men: A Cohort Study. International Journal of Eating Disorders, 39, 662–666.
Soban, C. (2010).What about the Boys? Addressing Issues of Masculinity within Male Anorexia Nervosa in a Feminist Therapeutic Environment. The College of New Jersey.
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.
“I hate you because you’re taking over me,” cried Samantha White in her poem My Best Friend Ana to describe her true attitude towards anorexia. However, in the next line, Samantha White introduced a different opinion and confessed that she loves it “cause you’re making me the girl I want to be” (Smith). The rest of the poem confused and inspired me as a reader because Smith, as well as millions of people around the globe, proved the impossibility to have one particular definition of anorexia in modern life.
Anorexia generally associates with an obsessive desire to stay thin, a flawed perception of one’s own body, and a pathological fear of overeating. Although up to 2 percent of all women in Western countries have suffered from anorexia during their lifetimes (Burkert 29), most of them still embrace it and explore the mindset that encourages the development of this specified disorder.
What goes through the mind of an anorexia person when they looking in the mirror? The answers might be “I am fat”, “I am ugly”, “I won’t eat anymore tomorrow”, or “People might love me more if I weighed less”. By attempting at wrapping an anorexic person’s mind around how they come to the point of developing anorexia, numerous explanations have been offered, with some of those centering on the influence of the patient’s family. This raises a legitimate question of whether the anorexic family plays an important role in the development and treatment of anorexia, and, if so, what this role is.
Main body
In the essay There Once Was a Girl, Waldman, a recovering anorexic herself, discusses the probable causes behind the development of the disorder based on her own experience and scientific evidence. Waldman paid attention to her family and the way actually contributed to the development of anorexia problems. Trying to depict her emotions and feelings about her family, Waldman, as well as White, was challenged by doubts and ambiguity.
She could not get rid of the thought that “I was a miserable anorexic” but “convinced that the disease was deeply wrong for me yet unable to shake its influence” (Waldman). In the essay, Waldman tries to establish the moment “when the spores of anorexia first crept” into her. After consideration, Waldman finds these ‘spores’ in her childhood memory of comparing herself to her thinner and, supposedly, prettier sister.
In her situation, her parents did not accept the decision of her sister to eat less at first. But a few years later, they accepted it as something “normal-ish” (Waldman). Hence, Waldman rejects the idea that her parents exerted any pressure to be thinner or follow the established standards of beauty on her – she emphasizes they are “lovely and kind and interesting people.” Still, when asking herself whether her parents actually “enabled” her and her sister in their sickness, Waldman admits she has no definite answer. Waldman considers the possibility that her parents’ ill-chosen words may have accidentally convinced her that her anorexic sister’s behavior was “not really crazy”, and refuses to blame them.
By describing her own experience, Waldman reveals the danger of anorexia lies in its connection with family relationships. The problem is that Waldman believed that the anorexic behavior of her sisters is normal and required neither critique nor healthcare interference. According to Warin Megan, a famous researcher, “The desire to belong to a collective – be it family, community, or place – is a universal motivation” (71). Unfortunately, this universal law worked against a healthy sister who became motivated by the desire to be close to her twin (Waldman).
Considering family as a source of motivation and emotional support is a common concept in managing anorexia and similar disorders stemming from the lack of self-esteem. In There Once Was a Girl, the author laments that the state of being uninformed about the problems that her sister was facing led to the latter’s untimely demise (Warin 8). Thus, it is implied that the family would have addressed the issue adequately, providing a healthy alternative to the ridiculous standards that modern media pushes onto young women (Warin 8).
However, the specified scenario does not necessarily have to be correct. According to Warin, a range of families lack the knowledge and skills needed to support patients with anorexia (11). The described situation may aggravate the problem, causing patients to feel even more desperate and, thus, experience severe psychological trauma while continuing to develop anorexia-related eating habits. Indeed, in retrospect, the story told by Waldman portrays a classic case of a misunderstanding occurring in a family, where parents are unable to detect a developing problem of self-esteem that is likely to grow to reach the level of self-destruction. In her attempt at recalling the events that led to the tragedy, Waldman mentions that the presence of media influence presented an obstacle to understanding her sister’s problems:
But perhaps the myths of beauty girdling anorexia fed into how I idealized my sister, how I assumed that she presided over aesthetic secrets I’d never understand. And I certainly permitted the voice of the disease to mingle confusingly with my parents, so that I ended up ascribing to them the hate I sometimes felt for myself. (Waldman)
Therefore, the evident lack of awareness in both the narrator and her parents affected the situation adversely, causing the loss of the author’s sister. The described situation indicates that, while a family can be quite supportive and sensitive toward the needs of its members, the lack of understanding of how beauty standards and media affect young people, especially women, leads to drastic outcomes. However, it would be a mistake to believe that the lack of awareness and health education cannot be helped in the specified scenario. After noticing changes in the attitudes toward their bodies in a family member, it is critical to consult an expert to receive further instructions on handling the issue.
In addition, at the age when young people are most vulnerable, they tend to distance themselves from their parents and other family authorities: “As an example of family volatility, Julia described a Sunday family lunch. ‘They were horrendous,’ she said and rolled her eyes” (Warin 128). In moderation, the observed phenomenon is quite healthy and indicative of normal development. However, once there is a health issue that a patient fails to see, the authority of the family is critical in assuring the patient that the assistance of healthcare authorities is needed.
The problem of the lack of awareness within a family and the resulting inability to support their loved ones that experience self-image problems and face the threat of developing anorexia is amplified by the difficulties that healthcare experts have accessing the target demographic. Warin mentions in the reminiscence of her professional experiences: “Another major area that I did not have access to as people’s everyday relationships with family members” (Warin 37).
The absence of connection to families of the people that suffer from anorexia causes healthcare experts to fail to create an environment in which patients are inclined to recover. Moreover, the lack of access to families of anorexia patients implies that harmful myths and misconceptions about the disorder in question continue to affect patients, making their family members choose wrong behaviors and attitudes. In hindsight, the observed issue may be seen as the outcome of heavy stigmatization that anorexia patients experience.
The propensity toward silencing the issue can be explained by the presence of deeply seated misunderstandings and general misrepresentation of the problem of anorexia within society. As Warin explains, “More often, I was taken to a private space where doors could be closed (usually a bedroom or living room in family houses), or to the anonymity of public spaces” (75). The observed situation harkens back to the harmful influence of media, which imposes stereotypical ideas onto people without making them think of the outcomes of the suggested line of thinking.
Although family ties and extensive support that family members can provide are critical for a patient who is suffering from anorexia, it may not lead to recovery due to multiple complications that anorexia causes, as There Once Was a Girl shows very explicitly. Unless the signs and symptoms of anorexia are located quickly enough for family members to search for appropriate medical assistance and the help of a competent healthcare professional, the endeavors of parents and siblings in supporting their anorexic family member may fail to have any positive outcome. The observed phenomenon is not to be seen as the lack of support but the fact that the problem of anorexia is far too multifaceted to be approached outside of a clinical environment.
To enhance the role of a family in a patient’s recovery and ensure that family members provide effective support without inhibiting the recovery process due to stereotypes, one may need to consider guidance offered by healthcare experts. In their article, Marcon et al. mention the absolute necessity of parental involvement in situations that involve some form of an eating disorder in children. According to the results of the study, most people suffering from eating disorders were positive or neutral about their family members being involved in the process of managing their health issues (Marcon et al. 79).
The observed tendency indicates that the support of parents, siblings, and other relatives is crucial for the successful management of an eating disorder. The need for patients to receive family support and for parents and siblings to be aware of the health issue of their family members is justified by the influence that stereotypes have on young people in shaping their image of themselves (Marcon et al. 81).
The observed propensity toward following the standards imposed on young people by modern media and ignored by parents supports the argument that Waldman makes in her tragic story: “’You girls were charming tonight,’ she said. ‘I’m so proud of my beautiful daughters.’ ‘Proud?’ I spat. “We were an hour late. And she didn’t eat anything!’ I stared into my dad’s face, now a disappointed dad face” (Waldman). Marcon et al. come to a similar conclusion, even though they approach the problem from a different angle: “Residents referred to addressing family’s views about food, for example, ‘parents also need direction in challenging their own assumptions about disordered eating behaviors’” (82).
Nonetheless, both Waldman and Marcon et al. outline the fact that people with eating disorders have misconstrued assumptions about the idea of proper eating caused by the distortion of the image of themselves. Furthermore, both authors prove that the support of the family members has a crucial impact on providing timely treatment and ensuring that the recovery process takes place naturally.
Conclusion
Therefore, it would be legitimate to state that the role of the family in managing anorexia concerns mainly providing emotional and psychological support while a healthcare expert provides an appropriate intervention. Specifically, it is the role of the family to shield a patient from the effects of media and the persistent, obtrusive promotion of the unattainable image of physical beauty that it promotes. A family has to create the setting in which a patient can recover properly and manage the concerns associated with one’s appearance, coming to terms with the fact that media creates an idealized version of people’s bodies.
Overall, the narrative of the family being the core of emotional support for a patient and the source for one’s self-esteem has been emphasized in There Once Was a Girl and Warin’s Abject Relations. Similarly, the argument made by Marcon et al. delineates the importance of parental involvement and the levels of health education within a family as the crucial components of recovery. Each of the writers explains that a family can become the source of strength as long as its members are informed, yet it may cause more harm than good without the assistance of a healthcare expert.
Works Cited
Marcon, Tamara Davidson, et al. “Parental Involvement and Child and Adolescent Eating Disorders: Perspectives from Residents in Psychiatry, Pediatrics, and Family Medicine.” Journal of the Canadian Academy of Child and Adolescent Psychiatry, vol. 26, no. 2, 2017, pp. 78-85.
Waldman, Katy. “There Once Was a Girl.” Slate.com. 2015. Web.
Warin, Megan. Abject Relations: Everyday Worlds of Anorexia (Studies in Medical Anthropology). Rutgers University Press, 2009.
There are different afflictions which affect millions of individuals throughout the country. Many of these afflictions are debilitating and cause problems not only for the patients but also for the significant persons near him or her. However, of these many conditions, some pose not only serious mental conditions but also grave physical problems as well.
One of these is anorexia nervosa. With regard to this, I have confronted with the question of what exactly is anorexia and how does it affect an individual, who should know about it. Moreover, what are the causes of anorexia and how it can be prevented from developing? In response to this, the writer wishes to state that the purpose of this paper is to present a brief outline of anorexia and its causes to the millions of Americans out there without knowledge about it.
Discussion
To understand the cause of anorexia, the reader must understand what anorexia is. Anorexia is a eating disorder characterized by severely low body weight and distortion of body image. Despite the fact that their appearances may be severely malnourished and skeletal, anorexic clients tend to believe that they are still fat. Moreover, anorexic patients are extremely afraid of gaining weight. To avoid this, they engage themselves upon weight-losing activities such as exercise, going insofar as to purge, vomit, drink slimming pills and diuretics, and self-starve which can lead to death. It primarily affects women though ten percent are known to be men. It is very complex as to involve psychological, sociological, physiological, and neurobiological aspects of living (Lask & Bryant-Waugh, 2000).
There is no single cause of anorexia and more commonly, it is the result of numerous factors in life. One of the presumed causes is on genetics. According to recent studies, genetics play a significant role in the inheritance of genes which may contribute to the development of eating disorders among individuals (Klump et al, 2001 p. 218). In addition to this, nutritional factors are also blamed for anorexia. According to nutritionists, a deficiency in Zinc may lead to the loss of appetite in people which eventually develops into anorexia nervosa.
However, despite the findings involving genetics and nutrition, psychosocial factors are still considered as the most contributing factor to the progress of anorexia in a client. Findings suggest that people with anorexia tend to have low self-esteems and believe that they are not attractive. Moreover, the society’s notion that fat people are not beautiful is also regarded as a contributing factor to the rise in number of anorexic clients. Anorexics are commonly high-achieving people and characterizes by perfectionism and an ability to resist temptation.
As stated, societal notions of the ideal body for a woman also affect anorexics. Since researchers believe that obsessive-compulsive disorder and depression is comorbid with anorexia, the continuous pressure to gain the ideal body prompts women to become obsessed with weight loss, especially among the high achievers. Furthermore, females from well-to-do white families are the ones at high risk of developing the disorder. Aside from this, women working on jobs demanding ideal bodies such as modeling and advertising are at risk of having anorexia due to popular demands for thin models.
In conclusion, anorexia nervosa, as well as other eating disorders, is an alarming condition in people which needs intense attention and treatment. Since no prevention can be used to delay or stop the disorder, early detection should be the priority. Moreover, social norms regarding the definition of beauty should never be emphasized. Instead, healthy lifestyle should be encouraged without regard of the trends in society which, more often than not, cause low self-esteem in many, especially in children and adolescents who are at the age of rapid assimilation of ideas and notions. Eating disorders such as anorexia nervosa affect each and every one of us. Therefore, it is best to promote health in lieu of clichéd and often wrong beliefs regarding the ideals of beauty among men and women.
Work cited
Lask, B., & Bryant-Waugh, R. (2000). Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence.Psychology Press.
Klump, K.L., Kaye, W.H., & Strober, M. (2001). The Evolving Genetic Foundations of Eating Disorders. Psychiatric Clinics of North America. Vol. 24, No. 2, pp. 215-225.
Anorexia Nervosa is a disorder that mostly affects young women at puberty age. It involves being obsessed with the fear of adding on weight and was first described by Sir. Williams Gull in 1868. Some people do believe that once one is anorexic, they can’t get back their lives and also that these group of people do not eat, all of which are not true. Studies have proved beyond any reasonable doubt the influence of the neurotransmitters in relation to this disorder. Those who are anorexic are associated with digestion problems, thin hairs, and dry skin. They over personalize their immediate surrounding and exhibit queer behaviors. Treatment of the disorder involves enlisting the services of nutritionist as well as psychiatrists. The patient is counseled by professionals together with their immediate family members and observed over a period of time for the gains made not to be reversed due to the influence of the external environment. History of Anorexia Nervosa Those people who deliberately deny themselves food out of fear of adding on weight are said to suffer from a disorder known as anorexia nervosa and is very popular amongst young ladies in the industrialized society where culture encourages thin bodies. This disorder, in many instances, start at puberty when the young people are rediscovering themselves and involves weight losses of up to 15% below the normal person’s body weight. The affected persons are so obsessed with the idea of losing weight to the extent that he/she ignores the body’s food requirement; those who suffer from this disease do have uncontrolled fear of adding weight (Grohol, 2006).
It has been observed that this disease has been on the rise in the modern days than it used to before, and this has been attributed to many factors like fashion whereby people associate thinness as the fashionable way to look like and therefore many people adopt different ways to slim while in the process start to avoid food in spite of the body’s desire. Other reasons include modern technology whereby most work is done while sitting down thus people tend to eat less. Lastly, the media has ‘over-emphasized’ on exercise and sport thus one can strain the body to unreachable ideal levels. The disease was first described in the seventeenth century (1868) by Sir William Gull, but it was up to until 1870s that it was not only identified but also described together with its diagnosis. Even though the existence of the disease has been known by the medical practitioners for such a long time, it was not known to the public until later years in the 1970s, approximately three centuries after it was first described. In 1984, one of the comedians hosting the ‘‘Saturday night live’ comedy show was heard making a joke of the disease, showing a proposal about the way anorectic cookbook would look like. Currently, people have come to appreciate the seriousness of the disease. While tracing the history of the disease, many authors have come to the conclusion that the disease is to some extent due to the living styles that people have adopted over the years and also due to the societal social structure.
Myths and Misconceptions about Anorexia Nervosa
Anorexia has been known to affect people both mentally and physically. The greatest myth people have had is that those who suffer from the disease can never get cured. Statistics however show that over 80% of the patients have successfully recovered from this condition and have their lives back in track within a desirable time period. For this to be a success, the disease has to be discovered in good time and prompt action taken. Some people have also believed that anorexics don’t eat. The truth of the matter is that they restrict a lot whatever they eat and usually keep strict diets so as to achieve their target of slimmer bodies. They tend to keep of fatty foods rich in calories and instead heavily rely on the vegetables, but they occasionally go over board by consuming abnormally large amounts of food. People also tend to perceive any thin person to be anorexic, and this is not usually the case as others might have been caused by other diseases rather than failure to eat enough food quantities for fear of adding on weight.
Signs and Symptoms and Diagnosis of Anorexia Nervosa
Symptoms of the disorder are normally categorized into three broad classes that include the physical signs, psychological and behavioral signs: Physical signs include such features like dry skin and thinning hair, swollen or cold feet and hand, bloated stomach as well as absent or fewer menstrual periods, constant headaches, nerve deterioration in extreme circumstances, brittle fingernails and the person easily get bruised. The eyes sunken as well as tooth decay and dry lips. Extreme weight loss may make movement a little difficult. Those who suffer from this disorder don’t usually behave normally; they are preoccupied with the size of the body and weight control especially through dieting, they have compulsive exercises and portray unusual eating or food habits. Generally these people are depressed with clear signs of loss of interest in the activities they were doing previously and even keep off from their friends and even reduced interests in sexual activities. They develop poor judgment with chronic inability to remember issues while at the same time are obsessed with the need to have control over their personal environments. Most of the times, they fail to recognize or rather appreciate the gravity of their illness; they are simply in denial. Also, they develop a completely different perception of themselves such that there is a sharp contrast between their physical outlook and their perception of the same and constant mood swings.
During diagnosis of the disorder, the doctor would first have to assess whether the anorexia exists by formulating a number of questions. The most commonly used set of questionnaire is the SCOFF (was formulated in Great Britain). Here, a “yes” answer to any two questions provides a very strong indication as to the presence of the disorder. The questions include:
the patient is asked whether he/she feels sick because of being full;
the doctor asks if the patient does lose control of how much they eat;
here, the patient is asked if he/she has lost body weight as much as 13 pounds recently;
the doctor inquires whether the patient believes that she believes that she is fatter than what other think;
the patient is asked whether food and thoughts of food dominate his/her life.
If the results of the questionnaire are positive, the doctor then conducts several tests in the laboratory so as to ascertain the levels of blood count for any signs of anemia, electrolyte levels for any signs of magnesium, potassium, and calcium deficiencies, amylase since its levels usually arise in cases of frequent vomiting, protein and thyroid, kidney and liver functions. The doctor may also decide to carry out electrocardiogram to get the graphic record of the heart’s electrical activity. If the diagnosis is made, then the doctor will be required to make frequent visits to the office so as to closely monitor the conditions.
Neurotransmitters Associated with Anorexia Nervosa
According to Kaye (2005), from his reviewed scientific literature, anorexia is closely being associated to a disturbance on the serotonin system, a neurotransmitter that controls such factors as one’s appetite, moods, sexuality, vomiting, and anxiety. This has been identified to occur within the brain, in the 5HT1A receptor. It has been deduced from the available evidence that disturbances to the serotonin system and personality features like trying to be a perfectionist and anxiety still persist even after the person has recovered from the disorder, fueling speculation that they could be the risk causal factors (Kaye, 2005).
Suggestions have been floated to the effect that starvation is as a response to the effects of anxiety and moods since it has an effect of lowering steroid hormone and tryptophan metabolism. This has an effect of lowering the levels of serotonin in the sites thereby eliminating anxiety. Those who are underweight and suffer from anorexia do have relatively low levels of leptin, a hormone which is responsible for fat storage in the body tissues. Also, high serotonin levels have been found to be responsible for the rigidity and perfectionism behaviors that are observed in the anorexics (Walsh, 1998). Treatment and Influence of the Environment Before any kind of treatment commences, there are a number of factors that are looked at. They include the patient’s age and the duration over which the person has had the disorder, the living standards at present, and the medical situation of the person including the body weight, the seriousness of other related mental symptoms as well as symptoms of other eating disorders. While treating the disorder, an approach that takes care of both the psychological and physical phases is addressed. During treatment, the doctors do try to treat any conditions that might have resulted from the disorder. In this regard, emphasis is laid on the results of the previously conducted test results. Such medications like anti anxiety and anti depressants or simply anti-psychotic drugs can be administered. The services of a nutritionist are also employed so as to help the patient take the recommended healthy foods. This way the patient will get to learn about the nutrient requirement of the body and the minimum healthy body weight to maintain. This is commonly referred to as nutritional therapy.
The patient also requires psychotherapy whereby the services of other people close to the person like family members and friends are enlisted. During this process, the focus is shifted towards such issues like self belief and the misplaced thinking and the wayward behavior they are associated with. This is really emphasized one on one with the patient, otherwise called individual therapy. Family therapy shifts to address any conflict within the family, and is most important especially when the patient is still living with their family’s members. It helps the parents to appreciate the patient and come to terms with her condition. Group therapy help provide confidential environment when the patient interacts with others like her. This gives her the morale boosting feeling that she is not unique and the only one that suffers from the disorder. For those who do not require the usually intensive inpatient care, a package called day treatment program is used. This is n normally tailored to meet the patient’s treatment targets and needs. To restore the wholeness and balance in the patient, she is taken through a period of regular meditation (Maria, 2008). It has also been suggested that herbs, to a large extent help to tone down the systems of the body. Theses herbs are often used as tinctures, extracts of glycerin or dried extracts. This can be conducted together with body massage and physical therapy as well as homeopathy.
During the recovery process, in ideal circumstance, the patient should be placed in an ideal environment from where they get the desired support, which includes the moral support. The recovering anorexic can easily fall back into the old practice due to pressure from the surrounding, especially friends whose views impact on her decision making patterns. The success of the recovery process therefore requires that it gets the much needed positive impact from the people surrounding the patient at all the times. Moreover, the family therapy, to some extent, is aimed at making the family members to understand the anorexic and also get to know how to help her best. Over the years, the approaches that have been given towards the recovery of anorexic have not witnessed much transformation since the basics have been maintained all through.
References
Erica Smith (1999). Anorexia Nervosa: When Food is the Enemy. The Rosen Publishing Group. 2008. Web.
Kaye WH, Frank GK, Bailer UF, Henry SE, Meltzer CC, Price JC, Mathis CA, Wagner A. (2005). “Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies”. Physiol Behav, 85 (1), 73-81. PMID 15869768.
Kaye WH, Bailer UF, Frank GK, Wagner A, Henry SE. (2005). “Brain imaging of serotonin after recovery from anorexia and bulimia nervosa”. Physiol Behav, 86(1-2), 15-7. PMID 16102788.
Maria, S. (2008). “Eating Disorders-Anorexia Nervosa.” Break Free Beauty-Love your body, live your dreams. Web.
Walsh BT, Devlin MJ. (1998). “Eating disorders: progress and problems”. Science; 280(5368):1387-90.
Julia appears to be suffering from chronic depression otherwise known as dysthymia. As the narration unravels, it becomes clear that the girl also shows signs of anorexia nervosa – a mental disorder distinguished by an unhealthy low weight and destructive dietary patterns.
Potential Disorders and Matching Symptoms
Julia’s symptoms match those of persistent depressive disorder (dysthymia) DSM-5 300.4 (F34.1) and anorexia nervosa DSM-5 307.1 (F50.01) (F50.02). Such symptoms as low appetite, poor eating, insomnia, fatigue, and poor concentration justify the first diagnosis (Reynold & Kamphaus, 2013). As for the second diagnosis, distorted body image, excessive dieting, and weight loss explain the choice (American Psychiatric Association, 2013). DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) serves as the principal authority for diagnosis in the field of psychiatry.
The Likelihood of Comorbidity
In the case of Anorexia nervosa, comorbidity is considered the norm (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). It is safe to assume that Julia suffers both from the said eating disorder and persistent depressive disorder, and the two illnesses aggravate each other.
Theoretical Orientations and Perspectives on Anorexia Nervosa
Within the framework of the cognitive-behavioral approach, Julia’s illness may be described as a set of behavioral patterns. In psychoanalysis, resistance to food is linked to resistance to psychological and sexual maturation. From the historical perspective, such behavior could also be praised for the purity and “holiness.”
Risk Factors: Age and Gender
There has been found evidence that young and adolescent women are more susceptible to anorexia nervosa. Since Julia is a college-aged girl, she is at risk.
Social Factors
Among other factors is stress at school or work and critical comments about weight, shape, and eating habits (Machado, Gonçalves, Martins, Hoek, & Machado, 2014). Anorexia nervosa has also been found more prevalent in western countries due to the idealization of thinner bodies (Zipfel et al., 2015).
Psychological Factors
From the anamnesis, it is seen that Julia experienced parental pressure to succeed. Like many other people with anorexia nervosa, Julia showed signs of perfectionism.
Biological Factors
As for biological factors, anorexia nervosa is considered to be familial, and its heritability range is rather high – from 28% to 74% (Zipfel et al., 2015). There is not enough information about Julia’s sexuality; however, if she is bisexual, she is at risk (Shearer et al., 2015).
Treatment for Anorexia Nervosa: Evidence-Based Practices
Evidence-based practices for treating this mental disorder are primarily behavioral (Goff, 2016). First, a patient should change dietary habits and maintain a healthy weight. Addressing destructive thinking patterns is only possible when a patient is back to normal physically (Zipfel et al., 2014). Another evidence-based practice would be family-based therapy with the involvement of all the relatives whose opinions matter to the girl (Madden et al., 2015).
Treatment for Anorexia Nervosa: Non-Evidence-Based Practices
Non-evidence-based practices would include medication: no medications have been yet approved for treating anorexia nervosa (Goff, 2016). Julia could also try positive affirmations and coping strategies such as self-convincing.
Treatment for Depression: Evidence-Based Practices
Julia should retake her sports classes as physical activity was found to be relieving for depressed patients (Hallgren et al., 2015). Cognitive-behavioral therapy may also be of great use in treating chronic depression (Gautam, Jain, Gautam, Vahia, & Grover, 2017).
Treatment for Depression: Non-Evidence Based Practices
As in the case of anorexia nervosa, Julia could try to adopt positive thinking. She could check if daily affirmations work for her and stabilize her mood.
Predicted Treatment Outcome
Success in treating anorexia nervosa and depression is highly individualized, and the likelihood can only be predicted on a case-by-case basis. Julia shows mindfulness and awareness of the problem, so the expected outcome is positive.
Draft
DSM-5 serves as the principal authority for diagnosis in the field of psychiatry. Hence, further evaluation of the patient’s symptoms will be based on the theoretical framework provided in this guidebook. If the framework of DSM-5 is applied to Julia’s case, it is possible to point out numerous symptoms that justify the diagnosis of anorexia nervosa. First, her weight loss is self-induced and not caused by any other factors such as serious diseases.
The patient shows clear signs of the body dysmorphic disorder: despite the significant weight loss, Julia is not satisfied with the result and plans to continue dieting. Lastly, both Julia and her roommate describe her avoidant behavioral patterns such as making excuses for not eating enough.
The humanistic approach outlines nuances deemed as negligible in behavioral therapy and seeks to establish underlying motives. Thus, Julia’s experiences show the need for self-actualization, as she matures. She may be devaluing her former life priorities such as studies and sports, especially if they were imposed by the family. The patient seems to be trying to take control of her life by controlling her body, even in the most radical ways. Humanistic therapy in Julia’s case will be based on respect, empathy, and comprehension of her motives.
References
American Psychiatric Association. (2013). Feeding and eating disorders. Web.
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice Guidelines for the management of Depression. Indian Journal of Psychiatry, 59(Suppl 1), S34-S50.
Goff H. (2016). A Review of: Evidence Based Treatment for Eating Disorders: Children, Adolescents, and Adults (Eating Disorders in the 21st Century), 2nd ed., edited by Ida Dancyger and Victor Fornari and The Oxford Handbook of Child and Adolescent Eating Disorders: Developmental Perspectives, edited by James Lock. Journal of Child and Adolescent Psychopharmacology, 26(1), 84–87.
Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y. (2015). Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: Randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D…. Touyz, S. (2015). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological Medicine, 45(2), 415-427.
Machado, B. C., Gonçalves, S. F., Martins, C., Hoek, H. W., & Machado, P. P. (2014). Risk factors and antecedent life events in the development of anorexia nervosa: A Portuguese case‐control study. European Eating Disorders Review, 22(4), 243-251.
Shearer, A., Russon, J., Herres, J., Atte, T., Kodish, T., & Diamond, G. (2015). The relationship between disordered eating and sexuality amongst adolescents and young adults. Eating Behaviors, 19, 115-119.
Reynold, C. R., & Kamphaus, R. W. (2013). Persistent depressive disorder (Dysthymia). 300.4 (F34.1). Web.
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: Aetiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111.
Zipfel, S., Wild, B., Groß, G., Friederich, H. C., Teufel, M., Schellberg, D…. Burgmer, M. (2014). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): Randomised controlled trial. The Lancet, 383(9912), 127-137.
“Skinny boy: A young man’s battle and triumph over Anorexia” is an autobiographical book by Gary A. Grahl, which depicts the struggles of an athletic and popular young man over the internal doubt and perception of his weight in the eyes of himself and others. Grahl suffered from anorexia in his youth, and the book is a memoir-like account of the event, serving to open the door to the psychology of the disease in the male populace – a vulnerable population subgroup that is frequently ignored in scientific accounts (Murray et al., 2017). The author’s account of his suffering is very personal and disturbing, seeking to awake the world to a problem millions of men around the world suffer every day.
The book is split into three parts, the first one describing the family dynamics and the underlying motivations behind Gary’s efforts to become thinner, the second part is his attendance the Unit 13 while trying to hide one’s illness from doctors to get out quicker, and the final parts dedicated to his overcoming of the inner voice through patience and unconditional love and acceptance received from the nurses and doctors (Grahl, 2007).
The book starts with the disease already being inside of the young boy’s mind, constantly berating him, demanding more exercise, and less eating. His anorexia is demonstrated through the skewered perceptions of one’s own body – at 5’8”, Gary weighs around 110 pounds, which is 40 pounds below the normal BMI for an individual of his height and age (Grahl, 2007). In his mind, the loss of weight is somehow connected to pleasing his parents, which is perceived as a duty.
During the hospital visits, the struggles between Gary and the inner voice of anorexia become more prominent. The voice seeks to undermine his efforts and cast the doctors in a bad light by commenting on their perceived slights. It seeks to portray others as insane, with Gary being the only same person around. Initially, it succeeds, driving the boy deeper into his anxiety, resulting in his hospitalization. The boy seeks to stealthily undermine the progress made by the doctors by performing stealth exercises, acting cooperatively when observed, and staying quiet during group therapy sessions (Grahl, 2007).
The real breakthrough occurs only when Gary regains his voice, which is done through the support of parents, nurses, and other members of his therapy group. He begins to question the twisted logic of the voice inside of his head, contradict it, and dedicate more time to living his life in full, rather than following the bizarre agenda of anorexia inside of his head (Grahl, 2007). By the end of the book, Gary feels that the voice is all but gone, but is still anxious and aware that it might return, and readies himself for the challenges that lie ahead (Grahl, 2007).
The book’s main strength in helping the audience understand addictive behavior lies in the visceral account of the psychological mechanisms inside of the afflicted person’s mind. It allows the readers to feel themselves in the skin of the person that has Anorexia, and understand the logic behind it, however strange and outlandish it may be. The fact that the author experienced the disease first-hand offers credibility to his statements.
At the same time, there are a few weaknesses to the book. First, it does not cover the birth of the disease inside of the person’s mind – the chronology of the first chapter starts well into the later stages of the affliction and does not demonstrate the appearance and growing influence of the voice. The events that led to it are not sufficiently covered either. Finally, the second half of the book does not seem like an honest accounting of one’s feelings during treatment, as it borrows directly from self-help books on the subject. This contrasts with the overall picture Grahl tried to paint and breaks the immersion. Nevertheless, it is one of the best accounts of male anorexia currently available in the literature.
References
Grahl, G. A. (2007). Skinny boy: A young man’s battle and triumph over Anorexia. Clearfield, UT: American Legacy Media.
Murray, S. B., Nagata, J. M., Griffiths, S., Calzo, J. P., Brown, T. A., Mitchison, D.,… & Mond, J. M. (2017). The enigma of male eating disorders: A critical review and synthesis. Clinical Psychology Review, 57, 1-11.
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, 4th 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.
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