Eating disorder - Research Paper Example

Eating Disorder Introduction Eating disorder is a broad term which encompasses a group of conditions characterized by eating habits classified as abnormal and may involve either the intake of inadequate or excessive amounts of food which mediates a detrimental effect on the individual’s physical and mental health. Research has revealed the evidence of genetic predisposition to eating disorders; however, such claims have undoubtedly been exaggerated by the media ("Eating Disorders"). History of eating disorder The introduction of the book Eating disorders: Obesity, Anorexia Nervosa and the person within, published in 1973, highlighted the extent to which the problem of eating disorders had impregnated modern society. With the book, the author Hilde Bruch targeted the medical professionals only and her book was not readily available to the general public. Bruch’s pioneering work of 1978, The Golden Cage, is considered to be the most compelling, passionate and empathetic source of information about the nature and development of eating disorders. The book particularly highlights the growing problem of Anorexia Nervosa. The knowledge of Anorexia Nervosa was brought to the average home by Steven Levenkron by his book and television movie The Best Little Girl in the World. In 1985, the death of Karen Carpenter from anorexia nervosa induced heart failure further fueled the growing concerns over eating disorders. The People magazine published the image of the emaciated singer on the cover page which haunted people around the world, and threw light over the fact the problem of eating disorders could no longer be shoved under the carpet due to societal stigmatization. Since the death of Karen Carpenter, numerous magazines and television shows have presented the world with thousands of stories of individuals from around the globe who have suffered from eating orders. Surprisingly, most of these victims are the individuals normally perceived as having power, fame, money, and success. The story of Cathy Rigby, an Olympic gold medalist gymnast, reveals how easy it is to become a victim of anorexia nervosa. Famous people such as Gilda Rudner, Princess Diana, Felicity Huffman, Tracy Gold, Sally Field, and more recently Portia de Russia and Mary Kate Olson have suffered from anorexia nervosa. This signifies the depth to which the problem of eating disorders has impregnated our modern society. The treatment of eating disorders is a growing business which is not restricted by territorial boundaries similarly like the treatment of chemical dependency; it has evolved into a fruitful and global business. The governments around the world are struggling to increase the number and variety of hospital and residential eating disorder treatment programs being offered to the victims. Market research has facilitated and encouraged large companies to invest in the development of programs and hospitals for the treatment of eating disorders. The growth of the treatment industry was further fueled by the introduction of the Federal Mental Health Parity Act which mandated the coverage of major mental illnesses by the insurance companies. Some states have classified eating disorders as a mental illness, thus, it has started receiving major attention both by the media and the health professionals after the passage of the act (Costin 117). Psychobiology of eating disorder Anorexia nervosa is characterized by a unique abnormality of disturbed eating behavior. Fairburn and Cooper (3) conducted a survey which revealed that the most common antecedent of bingeing behavior was none other than severe dieting. The most commonly reported complications associated with anorexia nervosa and bulimia nervosa are the chronicity and relapse rate of aberrant eating behavior (Halmi 5). Diagnostic Criteria The official diagnosis of eating disorder involves the meeting of the clinical diagnostic criteria mentioned in the current edition of the Diagnostic and Statistical Manual for Mental Disorders IV TR (25).However, the criteria mentioned in DSM-IV does not encompass all the eating disorders that the medical professionals are presented with in today’s modern society. In many ways, the mentioned criteria is perflexing, complicated, and has restrictive boundaries of the term “eating disorder.” The debate among health professionals on the fact that the current system of classification is severely defective and outdated is ongoing and chances are in the near future the classification would be subjected to a thorough revision. The diagnostic criteria for the following eating disorders are listed in the current version of DSM-IV: anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders otherwise not specifies (EDONS). The EDONS include “atypical” eating disorder presentations and binge eating disorder (BED). The current diagnostic criterion is defective for multiple reasons: for instance, it restricts the professional to judge the severity of the disorder with only one dimension which is based on how many of the listed symptoms the patient is meeting. However, this is not an appropriate way to judge the severity of the eating disorder because a patient might be severely affected but would not meet all the symptoms listed in the diagnostic criteria (Costin 125). Anorexia Nervosa The term ‘Anorexia Nervosa’ means ‘self starvation.’ Anorexics are often so thin that they are called “walking skeletons.” The term walking skeleton is used to define their pallor and frailty. The Greek word ‘Anorexia’ has a literal meaning of “loss of appetite.” However, this is a misnomer because the individuals do get hungry but they master the act of suppressing their hunger. The stubborn, vain, and appearance obsessed individuals are driven by their mental desire to be thin to the extent that it starts to mediate a detrimental effect on their physical health, particularly, the health of the cardiovascular system. The individuals are so obsessed with their appearance that they lose track of their dieting and are simply unable to draw a line between normal and abnormal eating habits. The problem of anorexia nervosa is not only complex but it has intricate roots as well. The problem of anorexia nervosa begins as a way to cope with difficult circumstances. The suffering individuals are severely hungry most of the time and these are only the last stages of the disease that the individuals experience what the name suggests “loss of appetite”. The intense fear of weight gain forces these individuals to suppress their hunger and deny eating. ("Anorexia nervosa – PubMed Health" 67).The formal diagnosis of anorexia nervosa requires referral to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In accordance with the latest edition of DSM, there are four criteria that an individual must meet before he can be diagnosed with anorexia nervosa. These four criteria are as follows: A. The maintenance of body weight which is 15% below the normal weight for that individual corresponding to his height, age, and body type B. The presence of an intense fear hunger despite being severely underweight. The fear intensifies with progressive weight loss C. The individual presents a distorted body image. Some individuals perceive themselves as being overall fat while others perceive their stomach and thighs as being too chubby. All anorexics deny the fact that they are severely underweight and their bodily systems are being adversely affected by their progressive weight loss and defiance of hunger D. The absence of at least three consecutive menstrual cycles is also a diagnostic criterion for women. Women who get their periods only after taking a hormone pill also fall into the category of anorexics. Types of anorexia nervosa According to the DSM-IV, there are two types of anorexia nervosa: “The Restricting type” and “Binge eating/Purging type.” The restricting type disorder is characterized by the individuals who lose weight through a reduction in the overall intake of food. The reduction in food intake is mediated through fasting, dieting, or exercising. On the other hand, Binge type disorder is characterized by individuals who do not suppress their hunger and consume large amounts of food in relatively short periods of time. After the consumption of excessive food, these individuals undergo purging through self induced vomiting in an effort to expel the food they have just eaten. Moreover, the individuals who do not indulge in purging mediate weight loss through the abuse of diuretics, laxatives, enemas, or exercising excessively. The confusion experienced during the diagnosis of anorexia in individuals who undergo purging has been facilitated through the delineation between the two types of anorexia nervosa. Before the delineation, the individuals who indulge in purging were diagnosed as having both anorexia nervosa and bulimia nervosa or only bulimia nervosa. Initially, the distinction in diagnosis was difficult because primarily purging was perceived as a bulimic characteristic and not anorexic. It is now clear that purging individuals are indeed anorexic and not bulimic. The anorexics only permit themselves to consume a small number of calories each day which are only sufficient to keep them alive but are not enough for a healthy survival. The disorder is more common among women than men and the incidence rises with westernization. The anorexic women consume calories which are only a quarter of their average daily requirements leading to progressive weight loss. Most anorexics religiously record the number of calories they consume during the course of the day and if they find out that they have accidently consumed more than a quarter of the calories of their daily requirement, then they experience anxiety and an overwhelming fear of getting obese. In an effort to eliminate the chances of surpassing their allotted quota of calories, many anorexics respond by increasing the number of hours they exercise or by indulging in excessive purging and using a combination of enemas, diuretics, and laxatives (Hall and Ostroff 49). Epidemiology of Anorexia Nervosa The prevalence of anorexia nervosa is low. However, the medical consequences of the disorder are quite high. The age of onset of the disorder is 15 years commonly, but it can range from 9 to 24 years. Females are ten times more likely to be affected with anorexia nervosa compared with males of the same age. The percentage of women that suffer from anorexia during their lifetime is 0.9-2.2%. On the other hand, the percentages of men who become victims of this vicious and deadly eating disorder are only 0.2-0.3% of the general public. However, one third of the cases of anorexia nervosa does not seek treatment and, therefore, are not included in the statistics. This shows that the problem of anorexia is far deeply rooted than it is perceived to be. Over the course of the last five decades, the overall incidence of the disorder has not increased and it has it been stagnant. However, the severity of the disorder and its incidence in adolescent girls has indeed shown a sharp rise. The mortality rate associated with anorexia nervosa is the highest amongst all of the psychiatric disorders. One of the half of the causes of death associated with anorexia is suicide while the other half is contributed by medical complications due to excessive starvation (Birmingham and Treasure 78). Medical Complications The severe medical problems that co-occur with the disorder constitute one of the major complications associated with anorexia nervosa. The well known short and long term medical consequences of anorexia nervosa in adolescents are changes in the circulating levels of growth hormone, hypothalamic hypogonadism, bone marrow hyperplasia, structural abnormalities of the brain, dysfunctioning of the cardiovascular system, and severe gastrointestinal difficulties. A major difference in the effect of the illness in adults and adolescents is the severe growth retardation which cannot be compensated after the treatment of the illness. Other effects that are commonly associated with anorexia nervosa in teenagers are peak bone mass reduction and a delay or interruption in pubertal development. Half of the deaths associated with anorexia are due to suicide and the mortality rate associated with the occurrence of complications is 6-15% (Lock et al.). Treatment and Management A multidisciplinary approach is required in the effective treatment of AN. The treatment strategies are devised in accordance with the psychic and medical guidelines published by the American Psychiatric Association. The treatment strategies fall into two categories, namely: Inpatient Treatments and Outpatient Treatments. Inpatient Treatment Hospitalization plays a major role in the treatment of anorexics and over the course of the last decade, the role of hospitalization has dramatically transformed. In the United States, the treatment carried out in the hospital is limited to reseeding and restoration of weight within a short time. Admitted individuals are not discharged until they fall into a healthy weight category because low discharge weight has often resulted in a speedy relapse of the illness. The continued role of modality of treatment for severe cases is suggested by the studies conducted on individuals undergoing inpatient treatment programs. Studies on inpatient treatment settings by McKenzie reveal that approximately 40% of the individuals receiving hospital based treatments were more likely to show relapse and were readmitted at least once. Moreover, the studies also revealed the fact that the readmitted individuals spent more time in the hospital with each progressive admission which inevitably suggests that the illness is becoming more severe with each relapse (Lock et al.). Outpatient Treatment Outpatient psychosocial treatment strategies are more effective than inpatient treatment strategies because of the fact that they target the intricate roots of the problems with which the individual was coping resulting in the precipitation of AN. Such treatment strategies involve individual, family, and group therapies. The preliminary controlled and uncontrolled treatment trials conducted in the 1970s and 1980s yelled fruitful results which have facilities in the modern major exploitation of such treatment strategies. Recently, nine published trials on outpatient psychotherapy for anorexics showed the effectiveness of the treatment. The controlled trials were conducted on 300 patients and showed good weight gain and low relapse rates. The outpatient treatment plans involve counseling the patient, providing nutritional advice, providing different types of family therapies, and mediating the treatment through cognitive and behavioral approaches. These strategies are not implemented in the stressful environment of a hospital but are provided in a group or in a family setting (Lock et al.). Prognosis Approximately 80% of the treated individuals show recovery and the treatment is particularly good in modern treatment settings. The outcome is, however, not satisfactory for individuals who have been suffering with the illness for more than 3 years. There are a number of factors that lead to poor prognosis and, most frequently, these are lone duration of illness, low discharge weight, bingeing behavior, personality difficulties, and poor family relations. (Birmingham and Treasure 56). Conclusion Anorexia is a detrimental illness which not only affects the individual physically but also mediates profound effects on mental health. It has been observed that individuals with poor family relations, having an anxiety disorder as a child or individuals who try to be perfect, are more prone to the vicious cycles of anorexia nervosa. The delineation of the illness into two types has greatly facilities medical professionals in devising diagnosis and providing appropriate treatments. Over the course of the illness, various tests including albumin, bone density test, CBC, ECG, and Total protein levels are conducted in order to determine the level of prognosis. Early diagnosis plays a critical role in prognosis and it has been observed that earlier diagnosis ensures low relapse rates (Smith 24). Therefore, it has become essential to promote awareness about the illness in the general population because awareness will play a key role in the elimination of the illness which has been plaguing our society since very long time. Works Cited "Anorexia nervosa – PubMed Health." National Center for Biotechnology Information. N.p., n.d. Web. 11 July 2012. . Birmingham, C. Laird, and Janet Treasure. Medical Management of Eating Disorders. Cambridge: Cambridge University Press, 2010. Print. Costin, Carolyn. The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders. New York: McGraw-Hill, 2007. Print. "Eating Disorders." NIMH. N.p., n.d. Web. 11 July 2012. . Hall, Lindsey, and Monika Ostroff. Anorexia Nervosa: A Guide to Recovery. Carlsbad, Calif: Gurze Books, 1999. Print. Halmi, Katherine A. Psychobiology and Treatment of Anorexia Nervosa and Bulimia Nervosa. Washington, D.C: American Psychiatric Press, 1992. Print. Lock, James, Daniel LeGrange, W. Stewart Agras, and Christopher Dare. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York, N.Y: Guilford, 2001. Print. Smith, Erica. Anorexia Nervosa: When Food Is the Enemy. New York: Rosen Pub. Group, 1999. Print. Read More