Mental Health: Anorexia Nervosa - Essay Example

MENTAL HEALTH (Anorexia Nervosa) Introduction: Mental health is a priority area in healthcare delivery systems. Abnormal mental health as a result ofneuropsychiatric disorders is one of the leading causes of disability. Experiencing 'mental health' or having a 'mental illnesses may appear as two distinct, separate states of being. 'Mental health' is in fact inseparable from 'mental illnesses. They do not exist independently of one another. 'Mental health' and 'mental illness' are terms of relation, not of reality, and the reality they describe is human experience. Psychiatric disorders or mental illnesses are not viewed as illnesses with disease-based aetiologies but as conflicts between different levels of mental functioning. Of critical importance here are the conscious and unconscious levels. Substantial amounts of mental activity that occur beyond our awareness are believed to determine much of our behaviour. Human development is important in this respect since a person's early experiences can produce a particular gestalt or view of the person and their world, which they will take with them into adult life. This gestalt will include mental tricks and mechanisms to protect the person's sense of self. This is what is called mental health or mental well being, and when problems arise in this gestalt that human being necessarily clings to, is at odds with the real circumstances, finds as adults, it gives rise to mental illness. The behavioural model of mental health on the other hand has a scientific basis in Learning Theory. Symptoms are considered to be learned habits arising from the interaction between external events or stressors and an individual's personality. Persistent, distressing symptoms are considered maladaptive responses rather than being markers for some underlying disease or illness. Mental disorders represent shades in the spectrum of human experience, which comprise a subjective and objective sense of self and a subjective and objective sense of community. Models of mental illnesses describe aetiology and treatment implications in relation to different levels of human functioning: biophysiological organism; the unconscious; thought processes; actions; and self in context. Absence of disorders in these models is considered as mental health. In this assignment, based on these definitions, some foundation information will be provided on anorexia nervosa as a mental illness in adults, so a portfolio work can be built with the objective to learn the health and social issues involving adults affected with these problems. Anorexia Nervosa: Eating disorders are one of the most common forms of mental health problem and are associated with increased risk to life. Anorexia nervosa (AN) is probably the better-known type of eating disorder, and also the easier one to recognize. Its core characteristic is an irresistible urge to strive for thinness. The most common mental health problems in clinical practice are depression, eating disorders and anxiety disorders. The mortality rate is very high for eating disorders. Anorexia, when it is simply a physical symptom, can be caused by a range of problems, not necessarily psychological, which is why when it is part of an eating disorder, it is often called anorexia nervosa, in order to distinguish it. The overwhelming majority of people with eating disorders are heterosexual women. Usually anorexia nervosa is associated with the fear of getting fat. This is an important feature of the differential diagnosis in the Diagnostic and Statistical Manual IV (DSM IV) for anorexia (World Health Organisation, 1992). History: The connections between the society we live in and the roles we are expected to play in it clearly affect how we think about ourselves and how we behave. Until the 19th century, "anorexia" was considered a symptom of several physical and emotional disorders. But for centuries, voluntary abstention from food was not primarily a pathological phenomenon; extreme fasting was part of the penitential or ascetic practice of many pious Christians. Ultimately, extreme or unusual forms of food abstinence were looked upon as signs of a mental disorder. Food avoidance and emaciation were common symptoms of well-known diseases such as hysteria, mania, melancholy, chlorosis, and all kinds of psychotic disorders. At the end of the 17th century, the English physician Richard Morton described the occurrence of "nervous consumption"-a wasting different from tuberculosis and due to emotional turmoil (Davey, 2008, chap 9). Cultural Issues: Eating disorders are believed to be on the increase and many commentators have puzzled about why that should be so. Many previous writers have tried to make some links with social processes in understanding eating disorders. In particular, there is a history of a feminist perspective, which has aimed not to split women who seek help from the rest of the female population for whom the body and food are an everyday preoccupation. It is not surprising that eating disorders have been taken up as a feminist issue since exposing the relationship of oppression, in various forms, to the vicissitudes of the female body has been one of the hallmarks of feminist activism. Feminists, who had been active outside the traditional medical frameworks, often working in the women's self-help movement and consciousness raising groups, challenged the pathologisation of women with eating disorders and linked their problems to the dominant patriarchal culture. This cultural situating of eating disorders has gradually become absorbed into mainstream health care and the British-based women therapists just mentioned have become highly respected world-class experts on eating disorders with a psychodynamic as well as a feminist perspective. Anorexia nervosa has been associated with body dissatisfaction, family dysfunction, and depression in the adolescent females. The psychosocial vulnerability factors are closely linked with it, and in the coming time, it has been predicted that there would be more weight control behavior and eating disorders. Another interesting feature is that these individuals have no fear of getting fat, but they refused food in order to express their worries or to assert themselves in the family (Giordano, 2005, 13- 21). Diagnosis: Anorexia nervosa is described as deliberate weight loss, induced and/or sustained by the patient by WHO (1992). It is present when body weight is maintained at least 15 per cent below that expected either because it has been lost or never achieved. Weight loss is achieved by avoiding fattening foods. One or more of the following self-induced strategies should be present: vomiting; purging; excessive exercise; use of appetite suppressants and/or diuretics. The diagnostic criteria for anorexia show how anorexia and bulimia are closely related, with only the overeating bouts as a clear distinguishing factor in bulimia (World Health Organisation, 1992). There is a body-image distortion with a dread of fatness experienced as an intrusive overvalued idea with resulting self-imposed low weight. There is endocrinal disorder leading to amenorrhoea in women and loss of potency or sexual interest in men. There may be elevated levels of growth hormone and cortisol, changes in thyroid hormone and abnormalities of insulin secretion (Davey, 2008, chap 9). Prevalence: The official statistics report a prevalence of 0.5-1 per cent for anorexia, and it is primarily a disorder of Western culture. It is to be noted that epidemiological data on the incidence and prevalence of eating disorders are not always consistent. There are many silent sufferers who would not appear in clinical estimates. Eating disorders are found nearly exclusively in Western or Westernized countries, although they have spread to other economically emancipated countries. Because of the alarming dimension of the problem, eating disorders are sometimes called 'a social epidemic'. Anorexia mainly affects young people. These are principally women between 16 and 19 years old, although some studies observe a rise in the age of the onset. The disorder is often found in secondary schools, colleges, and campuses. Also people in some professions seem to be particularly at risk, especially models and ballet dancers (Treasure, Schmidt, and van Furth, 2005, 90-102). 2. The Aetiology of Anorexia Nervosa Sociocultural Influences: Eating disorders seem to be a socially and culturally bound syndrome. They are found in Western or Westernized countries. As these diagnostic criteria indicate, the root of the disorder is an all-dominating, abnormal attitude towards nutrition, body size and weight. AN patients are so preoccupied by these issues that they spend large parts of the day counting calories, thinking about food and weight, and preparing meals for others. Food is selected according to its caloric value and/or conceptions about its effect on weight, which implies that sweets and fatty foodstuffs are taboo. In addition, social situations in which one is expected to eat together with others are carefully avoided. In association with the above symptoms, AN patients also suffer from a disturbed perception of their own body weight and shape. They typically perceive their normal weight for their age and height as 'much too fat', while their aspired weight level is far below the norm. To achieve and/or preserve an unusually low weight is considered as a form of self-mastery or self-control. However, the accomplishment of this goal yields only a temporary satisfaction: in spite of the attained weight loss the fear of growing fat remains, and the slightest weight increase is experienced as a terrifying sign of imminent loss of control (Polivy & Herman, 2002, 84-87). Experiential Factors: Eating disorders are understood as disorders of the self, where there has been a traumatic, long-term disturbance in the empathic connection between parents and child. The failure of parenting means the child does not internalise self-soothing and tension-regulating structures, and later in life tries to substitute for the lack by way of anorexic behaviour. Experiential factors are matters of considerable interest in playing a causative role in AN. A danger to the self and an effort at restoring it are re-enacted. Food is used as an archaic self-object (Treasure, Schmidt, and van Furth, 2005, 100-121). Biological Factors: Anorexia nervosa is approximately 10 times more common in females than in males. Biological factors such as different hormonal environments in utero, surrounding the fetus prevalent during the time of neurodevelopment, play important roles. Birth complications such as low birth weight and preterm birth are reportedly associated with increased risk of behavioural problems in childhood, including disorders predicting anorexia nervosa in later adulthood. IGF-1 is a hormone with widespread metabolic and mitogenic actions. In AN, there is evidence of changed pulsatility and entropy of growth hormone secretions due to decreased hypothalamic somatostatinergic tone. Regulation of IGF-1 activity appears to be crucial in AN adaptation to chronic starvation as well as in regenerative processes during nutritional restoration (Davey, 2008, chap 9). Psychological Factors: Patients with AN have been perceived as attempting to restore the mother-child bond; oral deprivation by the mother followed by gratification and closeness have been linked to it. The resulting ambivalence, which would undermine the maturation of the girl in all the phases that followed on, leads to a tendency to regress back to the oral/anal stage under stress. When these patients develop eating disorders, the family plays a fairly crucial part in creating an environment in which an eating disorder may grow to its fullest extent. While talking about the role of the family it means transition of stress response patterns related to anorexia nervosa, its transmission in the family, parent characteristics, parent-child attachment and interactions, phenomena of whole family systems, and the prognostic importance of family characteristics. It has been postulated that parental overinvestment and overdirectiveness leads to a situation, where a vulnerable daughter may become more concerned with external parental approval that with her own internal satisfaction. Not surprisingly, in the majority of eating disorder patients, the relation between the family and the patient gets disturbed at the onset. In some cases the attachment between the oversolitious mothers and daughters play a key role (Van den Broucke, Vandereycken, Norr', 1997, 2-13). Dispositional Factors: Disposition plays important role in aetiology of AN. An obsession with food and weight can be an effective way to disappear from unhappy family situations or, in contrast, to take the focus away from other problems at home. In most cases, the patient uses symptoms as a way of staying out of relationships and hiding the coexisting deep yearning for connectedness. Many survivors of sexual assault feel unsafe in their bodies and consciously or unconsciously reason that a body resembling a preadolescent is no longer sexually desirable. Thus, losing weight becomes a viable means of protecting oneself and feeling safer. Another widely accepted theory proposes that people who were sexually abused had no emotional control over what happened to their bodies; thus, they develop eating disorders as a way of regaining that emotional control. Restricting food intake and/or purging become viable ways to alleviate immediate feelings of discomfort and powerlessness (Davey, 2008, chap 9). 3. Treatment and Support for Anorexia Nervosa Family Therapy: Studying family and family therapy have been strongly advocated for AN. Apart from showing the common modalities of functioning of eating-disordered families and societies, this approach provides an explanation of AN. This concept is based on the idea that the reason why people develop eating anomalies is to be found among other things in the dynamics within the society and the family. The majority of these families adopts a puritan ideal of self-control, and therefore considers fatness as a sign of indolence and self-indulgence. Truly affective bonds are seldom found in these families. They appear overall as extremely rigid in their beliefs and behaviours. In most instances, family therapy or parental counseling forms the mainstay of therapeutic input (Davey, 2008, chap 9). Pharmacotherapy: It is not the first choice of treatment in eating disorders. Medication such as neuroleptics, tricyclic antidepressants, cyproheptadine, cisapride, have been used but they may even be harmful by increasing the sometimes already prolonged QT interval. This does not mean that there is completely no role for pharmacotherapy in the treatment of anorexia nervosa. Pimozide and sulpiride respectively have been tried with an initial beneficial effect on daily weight gain especially in the first treatment period, but also that the changes in eating behaviour and in attitude towards the body were limited. The selective serotonin reuptake inhibitors (SSRIs) are more tolerated and are relatively safe, and many patients with anorexia nervosa show features of affective disorders and/or of anxiety disorders and a proportion fulfil the full diagnostic criteria for affective disorder. Other drugs such as cyproheptadine and fluoxetine have shown promising results, but current protocols do not recommend use of pharmacotherapy in uncomplicated AN (Shipton, 2004, 1-44). Cognitive Behavioural Therapy: Cognitive models focus on the variables that initiate and maintain anorexic symptoms rather than on remote etiological factors. According to cognitive theories, the core disturbance is a characteristic set of beliefs associated with the desire to control eating and weight. A fundamental premise is that the worth of the self is represented in the size and shape of the body. This dominant idea influences individuals to engage in stereotypical eating and elimination behaviours, to be responsive to eccentric reinforcement contingencies, to process information in accordance with predictable cognitive biases, and, eventually, to be affected by the physiological and psychological sequelae of starvation-all of which strengthen the underlying premise. Cognitive-behavioural therapy for anorexia nervosa is based on the approach for the treatment of depression and anxiety, with adaptations to address specific features of this disorder. These include the ego-syntonic nature of symptoms; the interaction between physical and psychological elements; and specific beliefs related to food and weight; and pervasive deficits in self-concept (Shipton, 2004, 1-44). Reference List Davey, G. (2008). PSYCHOPATHOLOGHY: Research, assessment and treatment in clinical psychology: Eating Disorders (part 9). Wiley Blackwell. New York. Giordano, S., (2005). Understanding Eating Disorders. Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa. Clarendon Press. Oxford. London. 13-87. Polivy, J. & Herman, C.P. (2002) Experimental studies of dieting. In C.G. Fairburn & K.D. Brownell (Eds), Eating Disorders and Obesity:AComprehensive Handbook. (2nd edn) (pp. 84-87). Guilford Press: New York. Shipton, G., (2004). WORKING WITH EATING DISORDERS: A Psychoanalytic Approach. Palgrave MacMillan. New York. 1-44. Treasure, J., Schmidt, U., and van Furth, E., (2005). The Essential Handbook of Eating DisordersJohn Wiley & Sons Ltd. England. 90-190. Van den Broucke, S., Vandereycken, W., Norr', J., (1997). Eating disorders and marital relationships. Routledge. London. 2-13. World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO. Read More

 

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