Anorexia Nervosa: A Childhood or Early Adolescent Disorder - Term Paper Example

 Anorexia Nervosa: A Childhood or Early Adolescent Disorder Introduction Anorexia nervosa is an eating disorder that develops as a result of a person’s obsessive fear of gaining weight and thereby the refusal to food intake. This disorder is characterized by a distorted self-image. This disorder has a set of cognitive biases that influence how the affected individual thinks about her/his body, food and eating. Although the affected individuals continue to feel hunger, they control themselves and take very small quantities of food. A person with anorexia nervosa consumes approximately 600-800 calories per day and thus self-starvation happens in some extreme cases. This paper will mainly evaluate the history, symptoms, prevalence rates, age of onset, gender features, etiology, course, current treatment, and prognosis of this disorder. History of Anorexia Nervosa The history of anorexia nervosa begins with the Hellenistic era and continues to the medieval period. Many anorexia nervosa historic figures including Catherine of Siena and Mary, Queen of Scots are believed to be the victims of this ill health. It is also believed that some of the earliest medical descriptions of this disorder were prepared by the English physician Richard Morton in 1689. Until the late 19th century, anorexia nervosa had not been widely accepted as a recognized condition. In 1873, Sir William Gull published a seminal paper that introduced the term anorexia nervosa for the first time and the paper contained detailed case descriptions and treatments of the disorder. Subsequent to this publication, French physician Ernest-Charles Lasegue published a similar paper under the title De l’Anorexie Historique that also contained a number of cases of anorexia nervosa. Although a number of stories of young women who refused to eat were reported by American media, no one could explain the seriousness or psychological causes of this condition. The knowledge and awareness of this condition were greatly limited to medical practitioners until German-American psychoanalyst Hilde Bruch brought out her popular work “The Golden Cage: The Enigma of Anorexia Nervosa in 1978. This book was capable of creating a wider awareness of anorexia nervosa among the public especially, lay readers. The death of the popular singer Karen Carpenter in 1983 was another major event in the history of anorexia nervosa as it provided wide media coverage to this condition as well as other serious eating disorders. Symptoms According to Crow and Nyman (2004), an intense fear of gaining weight or becoming fat even when a girl is underweight is one of the major symptoms of this disorder. The affected girls will refuse to keep bodyweight which has been scientifically proved to be normal for their age and height. Another major symptom of this disorder is that the affected individual will not be ready to admit the seriousness of his/her weight loss. Individuals with anorexia nervosa often cut the food into small pieces or move the food along the plate instead of eating. Such individuals will not be willing to compromise with their exercising habit even though the weather is bad, they are ill, or their work schedule is very tough. A number of anorexia nervosa affected individuals tends to go to the bathroom just after the meals have taken. In addition, they often hesitate to eat around other people. Sometimes such persons use water pills or diuretics to make themselves urinated and diet pills to decrease their appetite. Depression, dry mouth, extreme sensitivity to cold, loss of bone strength, and loss of body fat are some of the physically observable characteristics of persons with anorexia nervosa. Yellow skin covered with fine hair is another commonly seen symptom of this disorder. Finally, the anorexia nervosa affected persons may exhibit confused or slow thinking along with poor memory judgment. Prevalence Rates and Cultural Factors Studies during the period 1930-1990 indicated that females aged 15 to 24 years are highly vulnerable to anorexia nervosa. Although this disorder is most prevalent among adolescent girls, recent studies suggest that even children in their childhood may be identified with anorexia nervosa. The prevalence rate of anorexia nervosa is higher in Norway (2.6%) while compared to Italy (1.3%). A population-based study of this disorder conducted in the United Kingdom indicates that the prevalence rate of anorexia nervosa among females aging between 15 to 19 years old was 0.1%. This data points to the fact that the prevalence rate of anorexia nervosa is lower in the general population than among students. A study conducted in Norway on psychiatric female outpatients reflected that the prevalence of anorexia nervosa was 5.7%. Another study of 517 girls aged between 15 and 19 years old in Norway reported a 2.6% prevalence rate. Population-based and age-based prevalence rates of anorexia nervosa in Western countries ranged from 0.1% to 5.7%. It has been estimated that the incidence rate of anorexia nervosa is approximately eight per 100,000 persons per year. However, a noticeable increase in the incidence rate of this disorder has been observed among females aged 15-24 years from 1935 to 1999. On the basis of reported cases of anorexia nervosa, the prevalence rate of this disorder is calculated to be 0.3%. Studies reflect that cultural variance can have a strong influence on the manifestations of the disorder. For instance, the extreme fear of weight gain may not be prominent in some cultures; however, they may also refuse food as a result of some other reasons such as epigastric discomfort or distaste for food. Age of Onset and Gender Features Although anorexia nervosa generally appears in adolescents, recent studies show that the age of onset of the disorder has decreased from an average of 13 to 17 years of age to 9 to 12. Although psychological researchers opine that this condition may affect men and women irrespective of age, culture, race, and socioeconomic background, recent experience indicates that anorexia nervosa is prevalent among females 10 times more than in males. Etiology According to Bernstein, “anorexia nervosa is a complex condition based on biologic, psychologic, and social issues” (Bernstein, 2011). According to Bernstein, it is a developmental disorder rather than a mental problem, and therefore it is recommendable to manage its actual causes instead of researching its perpetuating and precipitating factors. While addressing the etiology of anorexia nervosa, it is better to classify its causes into three such as predisposing factors, precipitating factors, and perpetuating factors. Bernstein (2011) tells that Family sex, genetic family history, perfectionistic personality, difficulty resolving conflict, and low self-esteem are the major predisposing factor that makes an individual more vulnerable to anorexia nervosa. The human developmental tasks will cause an intense feeling of anxiety related to ones’ developing into a mature sexual person, and such feelings constitute precipitating factors which in turn join physiologic and biologic factors. In individuals aged 10-14 years, the precipitating factors emerge from sexual development and menarche and this age group may fear becoming fat as a result of societal influences. In adolescents aged 15-16 years, these factors are highly related to independence and autonomy struggles. Identity conflicts are the root causes of the emergence of precipitating factors in individuals aged between 17 and 18 years. Finally, perpetuating factors play a crucial role in maintaining this eating disorder. Course It is widely observed that anorexia nervosa generally begins in mid to late adolescence and rarely the onset of this disease may occur in females over age 40 years. According to Strober, Freeman, Lampert, and Diamond (2007), the onset of the disorder is often associated with a stressful life event and its course and outcome may highly vary. In some individuals with anorexia nervosa, they fully recover after a single episode while others exhibit a varying weight gain followed by relapse. In contrast to these, some other affected individuals experience a chronically deteriorating type of the disorder over many years. It has been identified that individuals with Restricting Type of anorexia nervosa may develop binge eating over time, specifically within 5 years of onset. Such a situation will progressively lead to bulimia nervosa. In some extreme case of anorexia nervosa, hospitalization will be necessary to regain body weight and to maintain fluid and electrolyte balances. Clinical psychologists report that the long-term mortality from this disorder is over 10% and death occurs mainly as a result of starvation, suicide, and electrolyte imbalance. Treatment According to University of Maryland Medical Center, the most effective treatment for this disorder is “a combination therapy, family therapy, and medication”. For the fast recovery, active involvement of the patient is essential because the majority of the individuals with anorexia nervosa think that they need no treatment. It seems that affected persons remain vulnerable to relapse if they face stressful periods in their life. Cognitive behavioral therapy and complementary and alternative therapies may also be effective for treating eating disorders like anorexia nervosa. In addition, some lifestyle changes such as promoting regular eating habits are necessary for effectively treating anorexia nervosa. Although no medications have been approved yet for treating this disorder, clinical psychologists often prescribe antidepressants like selective serotonin reuptake inhibitors. Many researchers argue that herbs can quickly heal anorexia nervosa as it is a safe way to strengthen body’s systems. Finally, hypnosis and biofeedback methods can have a great influence on the treatment of this disorder. Prognosis The intensity of this disorder may be different from person to person and its recovery period may also vary from 4-7 years. Bailer, Narendran, Frankle, Himes, Duvvuri, Mathis, and Kaye (2011) argue that even the recovered patients have a chance of relapse in future. Recent statistical data show that almost 50-70% individuals with anorexia nervosa fully recover from their disorder. Researchers hold the view that this disorder is characterized by high lifetime mortality from both natural and unnatural causes. Differential Diagnosis As Fichter and Quadflieg (1997) define, bulimia nervosa is an eating disorder that may be characterized by increased eating habit and consumption of a large amount of food within a short period of time, followed by an attempt to get rid of the food consumed, usually by vomiting or excessive exercise. Experiences show that the rate of incidence of this disorder is more in women. Antidepressants like SSRIs are commonly used to treat Bulimia nervosa. The cycles of this disorder may often involve rapid and uncontrolled eating and it may be repeated several times a week or several times a day in some highly serious cases. Constipation, infertility, Boerhaave syndrome, delayed emptying, peptic ulcers, inflammation of the esophagus, dehydration and hypokalemia, calluses on back of hands, oral trauma are some of the symptoms of bulimia nervosa. Similarly, binge eating is another eating disorder that affects 3.5% of females and 2% of males in the United States. Surveys indicate that binge eating disorder is prevalent in 30% individuals who seek weight loss treatment in the US. This disorder was first described by psychiatric researcher Albert Stunkard as “Night Eating Syndrome” in 1959. Binge eating disorder generally leads to obesity even though it has been observed in individuals with normal body weight. Researchers have proven that there is a genetic inheritance factor involved in this disorder and also a higher incidence of psychiatric comorbidity. Consumption of a large amount of food at one time, eating quickly at the times of binge episodes, eating when depressed, eating usually alone especially during binge episodes, feeling depressed after binge eating, and rapid weight gain include some of the major signs of binge eating disorder. In the words of Zucker, Losh, Bulik, LaBar, Kevin, Piven, and Pelphrey (2007), the distinction between the diagnosis of binge eating disorder, bulimia nervosa, and anorexia nervosa is often a complex task because there is a significant overlap between patients with these conditions. The authors also argue that slight changes in a patient’s overall attitude can change a diagnosis from anorexia nervosa to bulimia nervosa. Since an individual’s behavior and beliefs change over time, it may not be practical for a person with an eating disorder to pass through various types of diagnoses (Zucker, et al 2007). However, bulimia nervosa and binge eating disorder are different from anorexia nervosa on the ground of various factors. Both bulimia nervosa and binge eating disorder are characterized by excessive intake of food whereas individuals with anorexia nervosa refuse to take food. Binge eating disorder may occur in any individual irrespective of gender differences while anorexia nervosa most commonly affects adolescent girls. Researchers argue that binge eating disorder is closely connected to depression although they cannot clearly identify whether depression causes binge eating disorder or vice versa. In contrast, anorexia nervosa is developed as a result of obsessive fear of gaining body weight. In case of bulimia nervosa, the affected individuals are highly vulnerable to another set of diseases such as depression and general anxiety disorder; but, anorexia nervosa generally does not lead to other risky diseases. A close observation of patients may assist a clinical psychologist to accurately distinguish between these three eating disorders. Factors Affecting the Etiology of the Disorder Psychological theories say that a woman can effectively control her food intake habit and weight unless she is dictated by an overly involved family. According to experts in clinical psychology, individuals develop the disorder when they begin to perceive that they have lost control of their lives. Some biological components such as obstetric complications, genetics, and epigenetics also include the factors. It has been proven that different type of prenatal and perinatal complications may contribute to the development of anorexia nervosa. It is also believed that this disorder is related to heredity with estimated inheritance rates varying from 56% to 84%. In addition; serotonin dysregulation, brain-derived neurotrophic factor, leptin and ghrelin, and cerebral blood flow are other biological contributory factors to anorexia nervosa. Finally, some cognitive, as well as environmental factors, also play their role in the development of the disorder. Cognitive psychological studies point that conventionally thinness has been believed to be the ideal female form and this notion contributed to the development of anorexia nervosa. Similarly, dancers, models, and actresses are under the social pressure to be thin and they are more likely to develop this eating disorder. It has been clearly identified that the occurrence rate of anorexia nervosa is more likely in populations in where obesity is highly prevalent. Persons who have been sexually abused in their childhood also may gradually develop anorexia nervosa. Conclusion Anorexia nervosa is a conventional eating disorder that is found in adolescent girls. An intense fear of gaining weight or becoming fat is the most significant symptom of this disorder. A package of a combination therapy, family therapy, and medication would be the most effective treatment for anorexia nervosa. Bulimia nervosa and binge eating disorder are other two eating disorders which are very similar to anorexia nervosa. A number of biological, environmental, and psychological factors add to the etiology of the disorder. References Brailer, U. F., Narendran, R., Frankle, W. G., Himes, M. L., Duvvuri, V., Mathis, C. A & Kaye, W. H. (3 May 2011). “Amphetamine-induced dopamine release increases anxiety in individuals recovered from anorexia nervosa”. International Journal of Eating Disorders. Wiley Online Library. Bernstein, B. E. (14 September 2011). “Etiology”. Pediatric Anorexia Nervosa. Medscape Reference. Retrieved from http://emedicine.medscape.com/article/912187-overview#aw2aab6b2b3aa Crow S. J. & Nyman, J.A. (2004). “The Cost-effectiveness of Anorexia Nervosa Treatment”. International Journal of Eating Disorders. 35(2), 155-160. Fichter, M.M & Quadflieg, N. (1997). “Six-Year Course of Bulimia Nervosa”. International Journal of Eating Disorders, 22 (3). 361-84. Stober, M., Freeman, R., Lampert, C & Diamond, J. (2007). “The association of anxiety disorders and obsessive-compulsive personality disorder with anorexia nervosa: evidence from a family study with a discussion of nosological and neurodevelopmental implications”. The International Journal of Eating Disorders. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17610248 Zucker, N. L., Losh, M., Bulik, C. M., Labar, K. S., Piven, J & Pelphrey, K. A. (Nov 2007). “Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes”. Psychological Bulletin. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17967091 Read More