Biological, Social and Psychological Factors of Anorexia Nervosa Disorder - Research Paper Example

Anorexia Nervosa -Psychological theory and associated methods of intervention Anorexia Nervosa (AN) - an eating disorder which involves a severe fear of leading towards obesity and thus possesses the traits of having low weight is the disorder that shares the criterion of what in broad terms might be described as an over-concern about body weight and size. AN holds many potent social and psychological forces that concerns and shape the way people deal with their lives. These social forces influence how such eating disorders manifest themselves. Yet each individual who develops anorexia nervosa does so in her own unique way just like each individual carries a unique psychology. The eating disorder evolves in a complex manner stemming from an individual's own unique biology, his/her innate personality, and life experiences. There are three reasons for which eating disorder has received little attention and considerable uncertainty. Firstly, there are inherent difficulties in measuring the subjective strength of hunger or appetite. Secondly, ratings of hunger are likely to be unreliable in people who have complex and distorting ideas about what they should be eating. This refers to psychological disorder. The sufferer may mislead others, and perhaps even herself, when putting her subjective experiences into words or in terms of a rating scale. On the other hand, for obvious reasons, what an eating-disordered individual actually eats cannot be taken as a simple behavioural indicator of the drive to eat. Lastly, clinicians and other experts may assume that they know about hunger and the like in eating-disordered subjects. Hunger or the drive to eat might be abnormal in being reduced or increased but the dilemma is that the diagnosis of any eating disorder is never considered. For instance, weight loss along with the physical illness with loss of appetite or depressive illness is not appropriately described as AN. The 'nervosa' implies that the relationship between the person's eating and their weight loss is more complex, more entangled with wider personal issues than that of being simply 'off their food'. Even those who would claim that AN sufferers do possess a diminished appetite may want to reserve the diagnosis for those people who seem to be not eating for broadly 'psychological' reasons and who have relevant and related ideas often about weight concern. For instance, a sufferer may couch her immediate aversion to eating in terms of bloating or discomfort, but also have wider ideas of guilt or whatever. At the extreme, it is certainly conceivable that a person could present at low weight that was without both 'weight concern' and motivated eating restraint and who seemed to have true anorexia. Factors - Biological, Social and Psychological Although patients with AN look and behave very much alike once their starvation is well advanced, there is no single cause. However research reveals that all causes emerge from a single psychological disorder of 'Depression'. Now, it varies and depends according to the antecedents of the illness, how one considers it. The interaction model suggests that three factors lead to the emergence of AN -biological, psychological, and social. Usually it starts with inappropriate dieting at the time of pubertal changes, when girls are rapidly gaining body fat. Each of these three factors has a greater or lesser impact on particular individuals in which AN develops. Some girls have a strong innate tendency to develop the disorder, but the genetic predisposition must be necessary for the disorder to occur. In most individuals AN (genetically) never develops, even though they are exposed to the same ecological burdens and social pressures that influence persons. Many environmental influences reinforce the vulnerability to the disorder that lead to dieting. Certain parent-children relationships are more conducive to the development of the disorder, but in and of themselves they do not cause it. Overemphasis on all aspects of eating, excessive concern by the patient about becoming overweight, and over controlling attitudes by parents in a patient's early childhood all have been considered as contributors. Events diverse as an illness, a sexual assault, or performance in sports can trigger weight loss and thus play a role in the developing disease. The social climate, where high value is placed on extreme thinness, reinforces any tendency to diet and to lose weight. Overzealous attention to preventive health practices that promote dietary restrictions or exercise may also reinforce the tendency to cause AN. (Lucas, 2004, p. 36) Research suggests that some genes also matter in the interaction of AN, certain theories suggest specific features are necessary for AN to develop. The way genes interact to determine character and temperament is highly complex and reflects both strengths and weaknesses. For example, anorexic patients display a great deal of persistence and compulsivity. These traits may reinforce the illness but the same traits can have a positive influence under other circumstances. Particular genes may enhance or protect against the effects of starvation. Interestingly, in terms of social support, Tiller et al. (1997) found differences in structural and functional aspects between eating-disordered subtypes. Women with AN, for example, reported fewer support gures than non-eating-disordered women but were equally satised with the support they received. 'Personality traits' is another widely researched topic in eating disorders that often leads to perfectionism. Physical illness may impact on children and increase their vulnerability to AN in a number of ways, particularly in adolescence when identity and self-image are developing. Having a chronic illness can get in the way of normal childhood activities such as playing sports, while thee disorders require adherence to a special diet, such as diabetes mellitus and cystic brosis, might be expected to inuence attitudes to 'healthy' or 'forbidden' foods. Adversities are usually classied as acute and chronic. The former usually have a rapid onset and are of short duration, while the latter, such as chronic parental ill-health, exert their inuence over time. While acute life events may result in depressive reactions or in extreme cases post-traumatic stress disorder, chronic stressors are thought to have a more lasting effect on psychological health (Compas, 1989). Negative events' influence is disturbing among individuals depending on the resources at their disposal. These include 'personal' factors such as intelligence, high self-esteem, and problem-focused coping skills. 'Environmental' factors such as having a close, supportive family and good friendships have an additive effect in conferring resilience. Clearly, both personal and environmental factors are unlikely to be independent of attachment relationships. Obsessional features such as rigidity, neatness, conscientiousness and preoccupation with rules and ethics are also common. According to Serpell et al (2002) "If such traits are held to an extreme degree such that they result in marked impairment of social or occupational functioning over a considerable period of time, a diagnosis of obsessive-compulsive personality disorder (OCPD) may be warranted". (Serpell et al., 2002). In reviewing studies on personality and personality disorders in anorexia nervosa, Sohlberg and Strober (1994) conclude that obsession symptoms appear to be related to the state of starvation while obsession traits are stable personality features which are maintained after weight gain. Psychological Model of Intervention Psychological model that emerged from 'depression' uphold some of the most popular approaches to eating disorders that manifest disturbances in psychological development and functioning. Most of these approaches fall under one of three interpretive models: psychoanalytic, family systems, or cognitive behaviour. Pinel, Assanand and Lehman (2000) in their tentative theory of anorexia nervosa suggested that under-eating characteristic of the disorder exhibit a change of the usually positive incentive of eating towards the negative. (Treasure et al, 2003, p. 8) The psychoanalytic model generally views anorexia as pathological response to developmental conflicts, especially those related to childhood and adolescence. This model has been build on the work of Hilde Bruch, who was the first to move beyond Freud's belief that troubled eating is the cause of underlying sexual disturbances. Freud upholds behaviourist perspective on eating disorder and believed that eating disorder is among one of the most damaging behaviour. Eating disorder is often considered not to be in control of AN patient's behaviour, that is, they cannot exercise free will. Substance abusers cannot kick the habit, obsessive compulsives cannot stop carrying out their rituals, and bulimics cannot stop bingeing. This is similar to the example which refers to the notion that mentally disordered persons are not responsible for their crimes. Similarly behaviourist perspective reveals that AN patient's are unable to allow themselves to eat according to their will. Some writers have also objected that people make them somehow less responsible for their behaviour by providing an excuse. This can then be counterproductive, because they do not feel sufficiently in control to change the way that they behave. (Cave, 2002, p. 16) Like Freud, Bruch saw the typical age of adolescence as the key to understanding certain problems like the anorexic's desire to keep her body childlike signifies her fear of the demands of adult female sexuality. Unlike Freud, however, Bruch insisted that sexuality is only one aspect of an anorexic's refusal to eat and that such refusal also represents a desire for control, a desire that conflicts with the anorexic's need to comply with the perceived demands of others. Such conflicts between Freud and Bruch inhibit the development of the internal cues that enable a person to recognise hunger. In addition, Bruch noted the ineffectiveness and fear of ordinariness that anorexics typically feel, despite their above-average intelligence and achievement-orientation. (Lelwica, 1999, p. 22) The psychoanalytic emphases on adolescent development and identity formation are incorporated into a second psychological model: the family systems approach. This model sees eating disorders as family pathologies that are rooted in familial dynamics that impede a young individual's growth as an individual. Although the developmental theories of Freud, Werner, and Piaget all stemmed from a common organism of perception that eating disorder is the result of frustration or depression; however there are still important differences between them. One difference that contributes to an already existing schism between clinicians and researchers refers to the psychoanalytic theory focus primarily on emotions, whereas the developmental theories of Werner and Piaget emphasised cognition. As a consequence, psychoanalytic theory was influential among clinicians, and the Wernerian and Piagetian structural developmental theories had a profound influence on researchers. Conversely, the developmental theories that so heavily influenced the work of researchers and academicians had minimal impact on clinicians. Very few academics were conducting clinical research, which further perpetuated the division between the academic and clinical worlds. It is to this reason that clinicians percept eating disorder as 'hormonal imbalance' whereas psychologists link it to some personality disorder. This distinction also led to an artificial separation between psychoanalysts and developmental researchers: The former were seen as concerned primarily with dysfunction and patterns of disturbed sexual behaviour, whereas the latter were viewed as focused on expanding the knowledge base in normal developmental processes. (Levine et al, 1996, p. 5) In the case of depression, both lead towards severity and are the main cause of suicidal attempts and deaths particularly in teenage group. Under such circumstances how awful is the dilemma that eating disorders are still lying for the identification between the threshold of clinical importance and psychological disorder. There is a need to identify the real causes and measures for primary prevention. References/ Bibliography Cave Susan, (2002) Classification and Diagnosis of Psychological Abnormality: Taylor & Francis: New York. Compas, B.E. (1989) 'Risk factors for emotional and behavioural problems in young adolescents' In: Journal of Consulting and Clinical Psychology, 57, 732-740 Lelwica Mary Michelle, (1999) Starving for Salvation: The Spiritual Dimensions of Eating Problems among American Girls and Women: Oxford University Press: New York. Levine P. Michael, Smolak Linda & Moore Ruth Striegel, (1996) The Developmental Psychopathology of Eating Disorders: Implications for Research, Prevention, and Treatment: Lawrence Erlbaum Associates: Mahwah, N.J. Levitt L. John, Sansone A. Randy & Cohn Leigh, (2004) Self-Harm Behaviour and Eating Disorders: Dynamics, Assessment, and Treatment: Brunner-Routledge: New York. Lucas R. Alexander, (2004) Demystifying Anorexia Nervosa: An Optimistic Guide to Understanding and Healing: Oxford University Press: New York. Pinel, J.P.J., Assanand, S. & Lehman, D.R. (2000) Hunger, eating, and ill health In: Psychol., 55 (10), 1105-1116 Schmidt, U., Tiller, J., Blanchard, M., Andrews, B. & Treasure, J.L. (1997) 'Is there a specic trauma precipitating anorexia nervosa' In: Psychological Medicine, 27, 523-530 Treasure Janet, Schmidt Ulrike & Furth Eric Van, (2003) Handbook of Eating Disorders: John Wiley & Sons: Hoboken, NJ. Troop, N.A., Treasure, J.L. & Serpell, L. (2002) A further exploration of disgust in eating Disorders In: European Eating Disorders Review, 10, 218-226. Read More