Negative Self Beliefs in Anorexia Nervosa - Assignment Example

Anorexia Nervosa Topic and Bibliography: The topic I am interested in covering in this research paper is anorexia nervosa. I would like to explore the cause of this disease related to nutrition, and deal specifically with its psychological causes. Anorexia Nervosa is not a disease commonly found in earlier periods of history, but it has become widespread now, especially among young adolescents and particularly women. This leads me to an assumption that there may be psychological factors or factors in the environment that play a contributory role in the disease. I would like to explore such causal elements especially in the context of how they may be relevant among adolescents and young people in the present day. On this basis, the topic I propose for this research paper is the nutritive disorder, Anorexia nervosa. In exploring the topic of anorexia nervosa, I find the following sources likely to be extremely useful in contributing reference material for my paper. Source No: 1. Web Page Title: ANOREXIA NERVOSA http://www.renfrewcenter.com/eating-disorders-anorexia-bulimia/anorexia-nervosa.asp This does not appear to be a personal site. It is the official website of the Renfrew Center – a mental health facility, which has centers in various states throughout the United States and a nationwide professional network. This Center specializes in the treatment of eating disorders. The author of the website, i.e, the Renfrew Agency, itself appears to be the sponsoring agency that has put out the information on Anorexia Nervosa which is contained in this site. The credentials of this organization are also evident on the site, because it has acknowledged that it is the owner of copyright and therefore the producer of the material on this specific webpage. This does not appear to be an educational site, it is a commercial site. There is no contact email address provided, but there is a direct link titled “Contact”, where a user has the facility to enter personal contact information, so that a representative of the Renfrew Center can get in touch. In addition, there is a toll free number that has been provided on the site, for contacting the Renfrew Center. This site appears to have been created as a promotional tool to generate business for the Renfrew Center. There are no advertisements on this site. There are several links provided for different sections of the community, i.e, for schools, for family/friends and for professionals, and the major focus appears to be the promotion of the package of health care services offered by the Renfrew Center. This web page is useful because it contains information on the disease. It also describes anorexia nervosa as a life threatening condition which usually “stems from underlying emotional causes.” This supports my thesis that the causes of the disease may be psychological. Source No: 2: A Google book available electronically, which is titled ANOREXIA NERVOSA and its authors are Lindsey Hall and Monica Ostroff. A large section of this book is available online and the link to the first Chapter (at page 17 of the book) is: http://books.google.co.in/books?id=ciwN1TZtF3YC&printsec=toc&dq=anorexia+nervosa&source=gbs_summary_s&cad=0#PPA17,M1 This source is not partly commercial and partly educational. Several pages from the book are accessible online as common source material and these pages are actual copies of the textual matter in the book, which was published in 1998 by Gurze Books. Although the intent behind providing extracts from the book is to persuade a reader to purchase the book, nevertheless the book is a very useful source of information. I believe it will be useful in my study because it contains case studies of individual patients of anorexia nervosa and their experiences. It also contains information on the disease, its causal factors and symptoms and measures and treatment that can be instituted. In particular, one area of interest is the thoughts and feelings associated with the disease, which is covered at page 35 -36 of the book. The authors suggest that anorexia nervosa commences as a means for the individual to gain self esteem, and to control one aspect of their lives, i.e, their intake, when they seem unable to control everything else. Source no: 3: An article titled “ANOREXIA NERVOSA” from the American Journal of Psychiatry, Volume 164, Issue 12, dated December 2007. This article has been authored by Dr. Evelyn Attia from the Eating Disorders Research Unit, New York State Psychiatric Institute, New York, and Timothy Walsh, from the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York. Support for the research for the findings in the article was provided to Dr. Attia by Pfizer and Eli Lilly, while Dr. Walsh received research support from Walsh Pharmaceuticals. This article is very useful for my study. It includes the specific case study of a 19 year old freshman student Rachel and her case history. It provides the diagnosis of her symptoms and identifies one of the most clear symptoms of anorexia nervosa – the unwillingness to out on weight, even when such weight is below the norm for the patient’s age and height. This article clearly details the background of the disease, the diagnostic challenges and the course of the illness as well as the risk factors associated with the disease. One important aspect mentioned in the article is the increased focus that is being directed towards the psychological and neurobiological undercurrents of the disease, because of the behavioral symptoms that are associated with it. This is an important aspect from the perspective of my topic, because it could support a thesis that the primary causes of the disease may be emotional and psychological. Source No: 4: An article titled : EPIDEMIOLOGY AND COURSE OF ANOREXIA NERVOSA IN THE COMMUNITY, from the American Journal of Psychiatry, Volume 164, Issue 8 dated August 2007. This is a journal article that has been authored by Anna Keski-Rahkonen, Hans W Hoek, Ezra S Susser, Milla S Linna and others. These authors were drawn from different departments in New York (Epidemology, Public Health) as well as different departments of different hospitals in the Netherlands, notably the departments of psychiatry and nutrition. They appear to be well qualified to write this article and in a position to provide authoritative information that is not necessarily geared from a commercial standpoint but rather written for research purpose to add to the understanding and knowledge of the disease. I found this study particularly useful for my study because it contains the findings of the study carried out by the authors on discovering the lifetime prevalence of anorexia nervosa among the general population. This is a significant study because it is a long term follow up study which also examines and assesses outcomes after clinical recovery from the disease. The authors found a much higher incidence of anorexia nervosa than what had been reported in earlier studies and that most patients took a period of five years to fully recover from the effects of the disease. Source No: 5: My fifth source is yet another journal article that was published in Cognitive Therapy research in 2006 and is titled: “A preliminary study of negative self beliefs in Anorexia nervosa : A detailed exploration of their content, origins and functional links to “not eating enough” and other characteristic behaviors.” The authors of this article are Rachel A. Woolrich, Myra J. Cooper and Hannah M Turner. These authors are doctoral research students. Rachel Woolrich contributed to this article from the Oxford Doctoral Course in Clinical Psychology at the University of Oxford, while H.M. Turner was from the Community Clinical Sciences, School of medicine in Southampton. This appears to be a good valid source to use, because it has been carefully prepared and researched by doctoral students and accepted for publication in a research journal. This article is one of the major sources used in my study because it specifically explores the emotional causative factors of anorexia nervosa. The specific objective of the study that was conducted by these authors was to discover the link between a negative self image and beliefs, as related to the eating habits of the participants in the study. The findings in their study are significant in the context of establishing that causal factors for anorexia nervosa may be primarily centered in the emotional and psychological state of the patient rather than caused by other factors. Source no: 6: The last source which I referred to was the Diagnostic and Statistical Manual of Mental Disorders (4th edn) published by the American Psychiatric Association, in order to gain information on how exactly the condition of anorexia nervosa has been defined in this manual. Thesis Statement: Based upon my examination of the above sources, as well as other books and journal articles, I realized that there are several theories that have been advanced to explain the causes of anorexia nervosa. Biological theories seek to explain the disease on the basis of socio cultural factors, since more girls than boys tend to suffer from it. Feminist theories suggest that it is the changing role of women that has caused stress due to the need to manage several different roles and often translates into disturbed eating patterns. The cognitive basis of the causal attributes of the disease lie in the perception of the individual that he or she is fat. The bipsychosocial model takes into account all of the factors that may be responsible for the condition – ranging from the familial, social, cognitive as well as personality factors among others. However, a common factor that seems to underlie all theories that seek to explain anorexia nervosa is the emotional or psychological state of the patient. Therefore, the thesis statement for my research study is as follows: The most probable causes of Anorexia Nervosa are emotional/ psychological. Research Paper Outline: I. Thesis Statement: The most probable causes of Anorexia nervosa are emotional/psychological II. Argument I: refusal to maintain body weight at normal due to an intense fear of getting fat, hence it is primarily the fear that prevents good nutrition and leads to the condition. A. The symptoms as stated in the DSMMD also list this intense fear of putting on weight B. The article by Attia and Walsh also suggests that their case study desisted from eating due to a fear of getting fat and losing the appreciation she was getting for her toned body III Argument 2: Feelings of inferiority about self image may contribute to the condition. A. Images being propagated in the mass media of very thin persons may contribute to the feelings of lack of self worth and destructive thinking patterns leading to anorexia nervosa, as suggested by Hall and Ostroff IV Argument 3: The patient seeks to control eating patterns as a means to gain control over the single aspect that he or she is able to control in an otherwise chaotic environment. A. Feelings of powerlessness, failure and unattractiveness were found among most of the participants in the study conducted by Woolrich et al (2006) V Conclusion: The arguments above suggest that the primary trigger for the disease is centered in the patient’s emotions and feelings of loss of control so that s/he seeks to gain control by disrupting eating patterns. Rough draft Part I: Working Thesis: The most probable causes of Anorexia Nervosa are emotional/ psychological. According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV), the symptoms of anorexia nervosa are (a) fear of fat (b) extreme weight loss and (c) the loss in menstruation. Anorexia nervosa is a self imposed starvation (www.remnfrewcenter.com) and the reason why the person tends to starve herself is due to an unreasonable fera of getting fat and a distorted perception about one’s own body weight or shape. The cognitive perceptions of the individuals about their bodies are altered and they suffer from an unjustified fear of getting fat. Their perceptions about their own bodies may differ from those of others who may not actually find them to be fat, but because of this feeling which the patient has, she may seek to deal with this fear of getting fat by not eating at all. These Patients are generally preoccupied with food, calories and nutrition all the time but will deny they are hungry and feel fat even when she is actually thin or underweight (www.remnfrewcenter.com). Anorexia nervosa serves as a way for these patients to keep their feelings of fear at bay. They get an artificial high when they lose weight and this changes into a fear of losing that control which only perpetuates the starvation behavior (Hall and Mokika, 1998, p 38). This provides a clear indication that the factor propelling the abnormal eating patterns could be the intense fear that these patients have about themselves as being too fat. In an examination of the causes of the disease, its diagnostic factors and risk factors, Attia and Walsh have described a young 19 year old freshman patient Rachel, who began running several mornings a week and cut out junk foods in order to avoid getting fat, because she had stopped playing hockey when she joined college. But as the patient history demonstrated, once she had lost some weight and received some compliments from her family about looking fit, she began to continue the weight losing practices, even after the need for them had ceased. One of the important factors that aided in the diagnosis of her condition was her reluctance to restore her weight to its previously healthy level. The undelrying cause for such reluctance lay in her fear of gaining weight and was a direct result of her emotional and underlying psychological state. Another aspect of this emotional/psychological component of anorexia nervosa lies in the feelings of self inferiority the patient may have about herself. As Hall and Ostroff (1998) point out, anorexics have an “underlying belief in their own worthlessness, which is inextricably tied to the size of their bodies.” (Hall and Ostroff, 1998: 37). Adolescents spend at least five to six hours a day in television viewing and in the absence of other influences, notably from their parents or elders advising them that beauty can come in a wide range of shapes and sizes, teenagers tend to accept the traditional notion of beauty as propagated through the American media - tall, slim and blonde. Teenage fashion magazines contribute to this gender bias by setting the standards for what constitutes fashion. Digital technology further contributes to this myth of perfect beauty since it is possible to outwardly present blemish free, perfect photographs of models, whereas the reality may not be as it seems. The image of the ideal body image is a too thin, mannequin like model, who does not present a realistic picture of the average body image that may be considered normal. Thus adolescents are comparing themselves against an ideal, which is false and does not really exist but which generates a perception within them that they are fat and causes shame. This results in a negative body image, as a result of a comparison with those considered “ideal” in society wherein the person falls short in some aspect and therefore perceives herself to be ugly or fat. Anorexics believe that they are fat and being fat is bad. Such beliefs are very deeply ingrained, although the anorexic may not actually be fat. By desisting from eating, these individuals may feel more pure, cleaner and healthier. In effect, all their painful or unacceptable feelings are translated into feelings related to food and their bodies. Thus what appears to be an intense fear of fat” may in fact be “hiding deeper feelings such as anger, rejection or depression.” (Hall and Ostroff, 1983:37). As a result, exerting a superhuan control and refusing to eat bring some level of feelings of success. But this feeling of success becomes tempered with self doubt and anorexics never feel sure that they are thin enough, especially in a society that values and admires thinness. Hence this further substantiates the underlying emotional and psychological causes of anorexia. Anorexia is more prevalent among young females than males, which also suggests that one of the causal factors may be the inability of the female adolescent to deal with her changing role in modern society. There is a greater deal of pressure on the modern woman because she is expected to cope with her responsibilities and take care of others while at the same time, she is also expected to take control of her own life and become more competitive with others. As a result, a modern woman is expected to be slim and glamorous and in full control of her own life. However, for the growing adolescent, the biological changes taking place within her body lead to a feeling of loss of control and may cause feelings of helplessness or anxiety. Seeking to gain control over her own life makes a young girl seek control over her food habits. The power to overcome her hunger and to control her eating may be a way to cope with the feelings of loss of control. Since anorexia is also beginning to affect men (www.remnfrewcenter.com), this suggests that they may be experiencing similar feelings of loss of control in modern society. Keski-Rahkonen et al (2007) have conducted long term studies that reveal that anorexia nervosa is a much more widespread problem than was originally conceived, suggesting that it is important to recognize the emtional and psychological trigers of the disease in order to ensure favorable clinical outcomes in dealing with these patients. In a significant study conducted by Woolrich et al (2006) on anorexic patients, six major themes were identified in the findings. The most important of these was a feelig of powerlessness, followed by feelings of failure, defectiveness, unattractiveness, worthlessness and emptiness. Powerlessness and feelings of failure were consistently found among all the participants. Based upon their findings, the authors have concluded that there is a definite funcitonal link that exists between begative feelings of self worth and the practice of not eating enough. They seek to punish themselves because they perceive themselves to be unworthy and this results in self imposed starvation that is characteristic of anorexics. Rough Draft Part II: Introduction: Anorexia nervosa is a potentially fatal condition, because the self imposed starvation practices of the patient can lead to a plethora of health problems and ultimately death, if not arrested in time. There are several theories that have been advanced to explain the incidence of the disease. Biological theories examine the family background and childhood eating habits of the patient to explain the disease, while according to cognitive theories, the root cause of the disease may lie in the thinking patterns of the patient. Other theories hold environmental factors such as the impact of the media as being responsible for the causaiton of the disease. On an overall basis however, the common factor underlying most of these theories is the emotional and psychological state of the patient, which may be the prime mover driving the onset and continuance of the disease. Unhealthy eating patterns in an anorexic patient have a great deal to do with her or his underlying emotional state. Hence, it appears that the most probable causes of Anorexia Nervosa are emotional/ psychological. Conclusion: Based on the arguments proferred above, it may be noted that the underlying cause of the disease appears to be centered in the emotional state of the anorexic patient. Feelings of fear, helplessneess, loss of control, negative body image, powerlessness, etc are all associated with the emotional state of the patient. Favorable clinical outcomes can be assured only in those patients who are able to learn to cope with their emotions and deal with their own negative self perception. This can sometimes be a long drawn out process as Keski-Rahkonen et al (2007) have shown, which further reinforces the underlying psychological triggers in the patient that need to be addressed before a cure can be achieved. It must also be noted that anorexia nervosa is a condition that has been recognized for centuries and Dr. William Gull coined the term as far back as 1873.(Attia and Walsh, 2007). Despite the rising incidence of the disease in recent times, the fact that it has existed for so long suggests that emotional feelings of helplessness, fear and powerleness that lead to control of eating habits may be the chief triggering factors leading to anorexia. Conditions in the modern world and the tensions and pressures, coupled with the bombardment of thin images in the media may have served to worsen the negative feelings of self worth in individuals. When an anorexic individual feels out of control, feels a negative sense of self worth and experiences feelings of inferiority, then he or she seeks to exert control in the only region he or she can – eating habits. Starvation and staying thin becomes associated with improved feelings of self worth and this may be increased, especially when anorexics receive compliments from other son how thin they are. This may be the only means they have to control their own feelings of negative self worth. But it is also vital to treat the condition before it becomes fatal, because it can produce a range of life threatening health problems (Attia and Walsh, 2007). If the disease is to be cured, then it can obly be achieved by dealing with its underlying emotional and psychological component – the feelings of negative self worth, helplessness and the wrng perception that they are too fat. Bibliography * American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, (4th ed). Washington, D.C: American Psychiatric Association, 1994. * Anorexia Nervosa. http://www.renfrewcenter.com/eating-disorders-anorexia-bulimia/anorexia-nervosa.asp; Accessed September 14, 2008 * Attia, Evelyn and Walsh, Timothy. “Anorexia Nervosa” America Journal of Psychiatry, 164 (12), p 1805-1811 (2007) * Hall, Lindsey and Ostroff, Monika. “Anorexia Nervosa”, Gurze Books, 1998. * Keski-Rahkonen, Anna, Hoek, Hans W, Susser, Ezra S, Linna, Milla S, et al. “Epidemiology and course of Anorexia Nervosa in the Community”, The American Journal of Psychiatry, 164(8): 1259-1266 (2007) * Woolrich, Rachel A, Cooper, Myra J and Turner, Hannah M. “A preliminary study of negative self beliefs in Anorexia nervosa : A detailed exploration of their content, origins and functional links to “not eating enough” and other characteristic behaviors.” Cognitive Therapy research, 30, 735: 748 (2006). 3. Research Paper Outline 4. Rough Draft 1 5. Rough Draft 2 6. Final Read More