The Problem of Anorexia in Teens - Essay Example

Anorexia in Teens Anorexia nervosa is an eating disorder in which a person purposely starves him/herself in order to lose weight. More specifically, The Diagnostic and Statistical Manual of Mental Disorders describes the criterion for the diagnosis of anorexia as "the refusal to maintain a normal bodyweight as defined by weight of less than 85% of typical bodyweight for a given height as well as experiencing intense fear related to gaining weight" (Ray 2004). Anorexia is more common in women than in men, and usually manifests itself during adolescence, although some pre-pubescent children have been diagnosed with the disorder (Abrams and Stormer 2002; Manley, Rickson, and Standeven 2000). About 1 in 200 girls, ages 15-19 years, are said to have the disorder, making this illness "the third most common chronic condition" in this age group (Manley, Rickson, and Standeven 2000). Although the majority of sufferers of eating disorders are young adult females, there are indications that a significantly higher percentage of children with anorexia nervosa are boys (Manley, Rickson, and Standeven 2000). Anorexia is marked by a variety of physical and emotional symptoms. The physical effects include: metabolic changes, emaciation, constipation, thyroid difficulty, heart abnormalities, and death (Ray 2004). Psychologically, anorexics fall prey to a very negative self image, which causes drastic body-changing behaviors (Abrams and Stormer 2002). Anorexics may also be extremely perfectionist and may feel as if they lack control over many situations (Blank and Latzer 2004). Anorexics may exhibit a variety of emotional problems, including low self-esteem, emotional instability, and difficulty with interpersonal relations (Abrams and Stormer 2002). Feeling out of control in their everyday lives and feeling physically inadequate, the anorexic tries to take control over his/her eating, to the point where the anorexic may stop eating altogether. Sadly, an anorexic individual is usually unable to see how much weight he/she has actually lost, and so the starvation diet will continue until so much damage is done to the body that the individual must be hospitalized. Anorexia has serious consequences for both physical and mental health, and it is an alarming fact that treatment is not readily accessible to all sufferers, and it is not always successful (Abrams and Stormer 2002). At least 10 percent of all anorexia cases will prove to be fatal (Abrams and Stormer 2002). Anorexia can be linked to a variety of sociocultural factors, including race, social class, culture, and social environment, and the etiology and treatment of it can be fit into the Boundary Control theory of behavior (Abrams and Stormer 2002; Blank and Latzer 2004). It is important for health practitioners to be able to understand the theoretical model, and the interactions between these factors, so that more effective prevention and treatment methods can be created (Abrams and Stormer 2002). One very interesting study by Abrams and Stormer (2002) showed that there are, in fact, many sociocultural influences involved in anorexia. African American women have been shown to have a much more positive body image than do white or Hispanic women; therefore, it is less likely that they will develop anorexia (Abrams and Stormer 2002). Over 90 percent of severe eating disorders, including anorexia, are diagnosed in young white females (Abrams and Stormer 2002). Attitudes about body image have been found to be relatively stable across a wide range of ages, yet they vary widely across ethnic groups (Abrams and Stormer 2002). This variation in anorexia incidence rates among different ethnic groups may have more to do with "factors associated with ethnicity, such as acculturation level, self-esteem, or socioeconomic status (SES)" (Abrams and Stormer 2002). Several studies have found a positive correlation between SES and anorexia - young women who come from wealthier homes tend to be more likely to have anorexia (Abrams and Stormer 2002). However, this correlation is not widely established because there are a number of studies that have found conflicting results (Abrams and Stormer 2002). Further research has discovered a more complex interaction between ethnicity, SES, and anorexia (Abrams and Stormer 2002). Some research suggests that lower SES African American women find heavier bodies more attractive than do their higher SES racial counterparts and white women of all SES classifications (Abrams and Stormer 2002). Another study found that: the extent to which African American women identify with the dominant white culture may make them more vulnerable to body image distortions and eating disorders, introducing the idea of 'ethnic acculturation' (Abrams and Stormer 2002). Peer influences have also been found to play a part in young women's perceptions of their bodies, but even these influences may be mediated by ethnic and cultural factors (Abrams and Stormer 2002). Abrams and Stormer (2002) sought to examine all these relationships by administering the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) to a cross-section of female students from an ethnically diverse high school in California. Participants were also surveyed as to their ethnicity, the educational attainment of their guardians, the employment status of their guardians, whether they had any friends of a different race, and their age (Abrams and Stormer 2002). White females were more likely to score higher on the measures of dominant societal standards of appearance awareness (Abrams and Stormer 2002). SES was found to alter the influence of ethnic group membership on young women's body image perceptions (Abrams and Stormer 2002). It was discovered that African American young women who had white friends tended to have a more negative body image. This suggests that staying within their own ethnic context may help protect them from the unnatural standard of thinness that has been established in the popular media (Abrams and Stormer 2002). This study presented a very good overall view of the sociocultural influences on the development of an anorexia disorder. Its results emphasize the importance of looking toward cultural and social variable for guidance in prevention and intervention strategies; however, it does not even begin to describe possible treatment options for anorexic teens. Blank and Latzer (2004) provide a very reasonable model for treatment of anorexia called the Boundary-Control Model. The Boundary-Control Model is an integrative approach to therapy that focuses on four basic psychological needs that shape the adolescent's sense of self-worth and enhance their beliefs that life is of value. These needs are: belonging, mastery, pleasure, and meaningfulness. The fulfillment of these needs is dependent on how the external and internal boundaries for behavior are set and maintained by four bio-psychosocial agents: the self, parents, school, and society (Blank and Latzer 2004). As long as these needs are met within the appropriate boundaries, an adolescent will grow up to be "strong, secure, and well-adjusted" (Blank and Latzer 2004). When an individual's needs are not being met, fear and anxiety result, and the anorexic focuses his/her attempts to control something on his/her own body by cutting off the food supply in order to achieve what is perceived as the ideal body (Blank and Latzer 2004). Therapy within the Boundary-Control Model consists of taking away the patient's control, thus eliciting extreme anxiety, and then controlling the anxiety by assuming authority and having the patient's parents or other close adults set extreme limits (Blank and Latzer 2004). The focus of the therapy is to help the patient organize his/her life by improving cognitive, motor, and social skills, encouraging the patient to advance academically, and lead him/her to accept his/her own limitations (Blank and Latzer 2004). The therapist must focus on reducing anxiety of the patient and the parent, help the patient and parent build a healthy relationship, teach the parent how to set up appropriate boundaries for their child, and help the patient build up their sense of self-esteem by showing them positive ways to channel their energies (Blank and Latzer 2004). One of the four agents through which the Boundary-Control therapy can take place is the school. Manley, Rickson, and Standeven (2000) discuss, in great detail, the roles teachers and school counselors can play in helping children and adolescents with eating disorders. These authors agree with Blank and Latzer (2004)'s assessment that these harmful behaviors: signal the distress the individual is experiencing and function as coping mechanisms. Treatment of eating disorders should involve early collaboration by the student and family and an interdisciplinary team of professionals Educational programming that is integrated, interdisciplinary, and individualized will enhance the opportunity for successful recovery for students with eating disorders (Manley, Rickson, and Standeven 2000). Teachers are cautioned to consult the school counselor or administrators if they feel a student is suffering from anorexia (Manley, Rickson, and Standeven 2000). If a teacher suspects that one of their students has anorexia, but they do not know whether or not the student has been diagnosed with the disorder, they should: express concern and express a willingness to help without violating the student's right to privacy; not force the student to eat; observe and document behaviors; and to consult with parents on an information-sharing basis (Manley, Rickson, and Standeven 2000). Suggested techniques for dealing with a student who has been diagnosed with an eating disorder are very similar (Manley, Rickson, and Standeven 2000). As the Boundary-Control model states, it is very important for the teacher to help meet the needs of the student by instilling a healthy view of the human body, not exposing them to embarrassing situations like weigh-ins or food discussions, and by encouraging a more balanced lifestyle of peer relationships, schoolwork, and extracurricular activities (Manley, Rickson, and Standeven 2000). Up to this point, the discussion has focused on female adolescents with anorexia and this mainly because there are more females with the disorder than there are males. Compared to the attention that has been given to female anorexics, male anorexics have basically been ignored in the scientific literature; however, Ray (2004) seeks to correct this omission by presenting a very good discussion about adolescent males and their experiences with eating disorders. Although they are a small segment of the anorexic population, for the sake of thoroughness, the plight of anorexic adolescent males must be examined. This is especially important because, as Ray (2004), states the incidence rate of anorexia among adolescent males is increasing. This has vast implications for school counselors, again, referring back to the Boundary-Control Model, because school counselors are the ones who will most likely have the responsibility of identifying anorexic students and referring them to the correct medical and support services (Ray 2004). Male anorexics account for about 10-15% of the eating disordered population, and it is interesting to note that the first diagnosed sufferer of anorexia was a man (Ray 2004). The average age of onset for the disorder is about the same for males as it is in females -between 12 and 26 years of age, with most cases beginning between the ages of 14 and 18 (Ray 2004). Adolescent males who are at an especially high risk for developing anorexia include those who are involved in athletic activities (especially those sports that have weight classifications or prefer a leaner body type), those who are struggling with their sexual identities (or to fit their alternative lifestyle in with the prejudices of society), those who have been diagnosed with other mental disorders (especially mood disorders, substance abuse, and personality disorders), and those who have a family history of eating disorders (Ray 2004). School counselors and other individuals working with anorexic adolescent males to try to help them should pay very close attention to these four warning signs (Ray 2004). The co-morbidity of anorexia with depression and anxiety disorders was further studied by Fornari, Kaplan, Sandberg, et al. (1992). This study investigated three aspects of the relationships between depression, anxiety, and anorexia: 1) It was hypothesized that depression is more common among anorexics than are anxiety disorders. The frequencies of both of these disorders in relation to anorexia were compared (Fornari, Kaplan, Sandberg, et al. 1992). 2) It was hypothesized that women who exhibited both anorexia and bulimia would be more depressed than women who only exhibited signs of one eating disorder or the other. The frequencies of depression in all three eating disordered subgroups were examined (Fornari, Kaplan, Sandberg, et al. 1992). 3) It was hypothesized that all three groups would exhibit the same rates of anxiety; therefore, the frequencies of depression in all three eating disordered subgroups were examined (Fornari, Kaplan, Sandberg, et al. 1992). The data analysis revealed that anorexics were, indeed, more depressed than they were anxious, but the other two groups (bulimic and anorexic-bulimic) did not significantly differ in their depression and anxiety scores (Fornari, Kaplan, Sandberg, et al. 1992). The expected result was obtained for the second hypothesis. Participants who were both bulimic and anorexic were more likely to score higher on the depression assessment than were bulimics or anorexics alone (Fornari, Kaplan, Sandberg, et al. 1992). Regarding the third hypothesis, no significant differences were found for the anxiety scores of any of the three groups, except in how the scores might have predicted an obsessive-compulsive disorder diagnosis later in life (Fornari, Kaplan, Sandberg, et al. 1992). It was found that the bulimic-anorexics were much more likely to exhibit this predilection than were either of the other two groups. This finding is especially interesting when viewed in the context of the Boundary-Control Theory and its focus on an anorexic's anxiety. This study has great implications for the field of social work and professionals when dealing with anorexic individuals. The social worker must be especially careful to refer the client to a psychiatrist or a medical doctor, who will be able to prescribe the necessary medication if the client is unfortunate enough to have a mood disorder, as well as the eating disorder. Another aspect of the Boundary-Control Model has to do with interpersonal relationships, and especially the relationship between the adolescent and the parent. In the early, formative, years of a child's life, this is known as an attachment. Kronner (2002) studied the relationship between attachment and eating disorders. In particular, proximity-seeking behaviors were analyzed (Kronner 2002). These typically include food restriction, binging and purging, and they result in physical closeness between the adolescent and her mother (Kronner 2002). Many families report becoming closer as a result of their daughters' eating disorder (Kronner 2002). As Kronner (2002) states: It seems that the close physical proximity that results from the feeding experience between infants and their mothers is re-enacted through the anorexic's refusal to eat and the myriad of feeding efforts many mothers will attempt to ameliorate this situation. Kronner (2002) attempted to examine this relationship in three groups of people: a group of anorexics, bulimics, and anorexic-bulimics; a group of individuals who had been diagnosed with other DSM-IV disorders, and a non-clinical control group. Each participants was asked to complete: the Inventory of Parent and Peer Attachment to assess their relationships with parents and friends; the Parental Attachment Questionnaire, to assess the individual's own perceptions of her relationship with her parents; the Proximity-Seeking Scale to "measure the degree of both physical and psychological closeness between the child and her parent(s)" (Kronner 2002); the Eating Attitudes Test; and a questionnaire to collect various demographic variables (Kronner 2002). The results were consistent with the hypotheses. The control group reported closer relationships with their parents than either clinical group (Kronner 2002). Adolescents with eating disorders reported feeling more disconnected emotionally from their fathers than both of the other groups (Kronner 2002). Conversely, the eating disordered group perceived their mothers as being better facilitators of independence than did the other groups (Kronner 2002). The belief that adolescents with eating disorders would demonstrate more proximity seeking behaviors than the other groups was corroborated by the data (Kronner 2002). These results suggest that the root of the problem of anorexia could be deeper than just the media images of thinness with which young girls are confronted every day. There are additional psychological forces at work within the minds of these young girls, and it is the social worker's duty to try to assess what these are, and to give their clients the help that they needs. The Boundary-Control Model is an excellent starting point for any individual who is trying to better understand the forces at work behind adolescent anorexia, and it provides more than adequate suggestions for treatments and recommendations for helping to change the adolescent's faulty thinking. References Abrams, L.S., & Stormer, C.C. (2002). Sociocultural variations in the body image perceptions of urban adolescent females. Journal of Youth and Adolescence, 31, 443+. Blank, S., & Latzer, Y. (2004). The boundary-control model of adolescent anorexia nervosa: An integrative approach to etiology and treatment The American Journal of Family Therapy, 32, 43-54. Fornari, V., Kaplan, M., Sandberg, D.E., Matthews, M., Skolnick, N., & Katz, J. L. (1992). Depressive and anxiety disorders in anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders, 12(1), 21-29. Manley, R.S., Rickson, H., & Standeven, B. (2000). Children and adolescents with eating disorders: Strategies for teachers and school counselors. Intervention in School & Clinic, 35(4), 228-231. Orzolek-Kronner, C. (2002). The effect of attachment theory in the development of eating disorders: Can symptoms be proximity-seeking Child and Adolescent Social Work Journal, 19(6), 421-435. Ray, S.L. (2004). Eating disorders in adolescent males. Professional School Counseling, 8(1), 98-101. Read More

 

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