Anorexia Nervosa Eating disorders are a cause for serious concern from both a psychological and a nutritional point of view. They are often a complex expression of underlying problems with identity and self concept. These disorders often stem from traumatic experiences and are influenced by society`s attitudes toward beauty and worth (Eating Disorder Resource Center, 1997). Biological factors, family issues, and psychological make-up may be what people who develop eating disorders are responding to. Anyone can be affected by eating disorders, regardless of their socioeconomic background (Eating Disorder Resource Center, 1997).
Anorexia nervosa is one such disorder characterized by extreme weight loss. It is the result of self imposed and severe restrictions of food and fluid intake, a distorted body image, an intense fear of becoming fat, and a poor self esteem. Besides dieting to extremes, anorexics often over exercise to lose weight. Anorexics themselves are often the last to realize how undernourished and underweight they are.
Even after reaching a weight that is dangerously low, they feel good initially, about losing the weight. No matter how much is lost, anorexics continue to feel fat and desire to lose more weight. It is this denial that makes it so hard to convince anorexics to seek help (Eating Disorder Resource Center, 1997). This paper`s focus is to look in more detail at the psychological and societal factors contributing to anorexia nervosa, as well as the nutritional and physiological complications that arise for people on such severely restrictive diets.
Psychological and Societal Contributions Anorexia Nervosa was first described by an English physician by the name of Richard Morton in 1689. Until 1914, it was considered a disease that arose from a morbid mental state and a disturbed nerve force. That year, Dr. Simmonds, a pathologist, found one woman=s refusal to eat to be the direct result of an anterior pituitary lesion. This shifted the focus away from the emotional aspects of the disorder to more physiological and endocrinological terms.
It was not until 1938 that anorexia nervosa was once again considered a largely emotional disorder (Blackman, 1996). In fact, one of the criteria for the diagnosis of anorexia nervosa according to the manual of The American Medical Association (DSM IV) is an intense fear of gaining weight or becoming fat, even though underweight. Another clearly psychological requirement for diagnosis, is a disturbance in the way in which one=s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight (Blackman, 1996). Anorexia nervosa may be a primary disorder in which other psychiatric conditions are secondary, such as depression.
It may also be secondary itself to a disorder such as schizophrenia or co-morbid with obsessive compulsive disorder. As well, it can also be a component of a personality disorder (Blackman, 1996; Carlat, 1997). The anorexic sufferer is typically female. Ninety-percent of all cases occur among adolescent girls or young women but the number of males with the disorder is on the rise (Blackman, 1996; Carlat, 1997; Kinzl, 1997).
It is estimated that 1% of girls ages 12-18 meet the criteria for full blown anorexia and as many as 5-10% have milder forms of such eating disorders if the criteria is applied less stringently (Blackman, 1996). Anorexics are usually high achieving youngsters who may be heavily involved in sports (e.g. gymnastics, swimming, cheer leading, ballet, etc.). These people are often competitive, perfectionistic, with obsessive compulsive personality features.
Fears of growing up or discomfort toward sexuality may also be precipitating factors (Blackman, 1996). Studies have shown that 75% of American Women are dissatisfied with their appearance and as many as 50% are on a diet at any one time. Even more alarming is that 90% of high school junior and senior women regularly diet, even though only between 10%-15% are over the weight recommended by the standard height-weight charts (Council on Size and Weight Discrimination, 1996). The majority of these women do not develop eating disorders; however, 1% of teenage girls and 5% of college-age women do become anorexic or bulimic (Council on Size and Weight Discrimination, 1996). Perhaps these figures represent the women who are less able to cope with their bodily dissatisfaction and thus are the ones who take dieting to the extreme. The disordered eating behavior usually starts out with a pattern of dieting or particular food choices, such as avoiding certain foods which are seen as fattening.
As the disorder progresses, anorexics become resourceful in hiding their troublesome behavior and may start to avoid eating with their families. They may also attempt further weight loss by compulsive exercising. The condition can become well advanced before parents even notice, as anorexics may wear many layers of clothes to conceal their thinness. Often the diagnosis is not made until the person is brought to a clinic for problems such as physical weakness, lack of energy, excessive sleepiness, and recent poor performance in school (Blackman, 1996). Actually, certain familial relationships seem to be more prevalent among anorexic sufferers.
Studies have shown many anorexic families are enmeshed, overprotective, conflict avoidant, and as co-opting the anorexic in destructive alliances with one parent or another. The parents themselves tend to be more affectionate and neglectful than parents of non anorexic children. The father in particular is often controlling (Blackman, 1996). Physical and/or sexual abuse are also not uncommon features in families with anorexics (Carlet, 1996; Kinzyl, 1997). Even though these trends are trends often seen, there are many anorexic families that do not fit this profile.
One of the other major contributors to the disorder is society and its values. Anorexics are sensitive to society=s approval of what is an acceptable weight or body size (Blackman, 1996). Self worth is equated with a desirable slim appearance. This creates a vulnerability to eating disorders for people who are especially concerned with meeting this ideal. Western culture in particular has an obsession with looks.
Slim, attractive people are linked to beauty, success, and happiness. Our society teaches us to value such superficial standards and bombards us with images of the idealized female body through mediums such as magazines, films, and television (Blackman, 1996). One only has to watch television or read the latest magazines and take note of just how few overweight or average looking people there are appearing in advertisements to verify this fact. Anorexia nervosa in fact predominates in industrialized developed countries; yet is extremely rare in less industrialized and non western countries (Blackman, 1996). As well, immigrants who have migrated to a westernized country have been found to become more prone to develop eating disorders (Blackman, 1996).
For the sufferer of anorexia, the onset of the disease often begins with a chance remark by someone important to them, possibly a coach or a friend. They may suggest that they are getting fat, big, clumsy, or that their performance (if they are athletes) is suffering (Blackman, 1996). These remarks, as unintentional or innocent as they may seem to the person making them, only serve to reinforce society=s attitude that gaining weight is unacceptable. For others, it may will be the media itself that precipitates the development of the disorder. Some patients cite wanting to look like a favorite film star or model as their initial motivation to lose weight (Blackman, 1996).
Males With Eating Disorders Typically, dieting and eating disorders such as anorexia nervosa are associated with females at or near adolescence. A group that often gets overlooked in the studies are males. Eating disorders are not rare among males; 10-15% of all bulimic patients are male, while 0.2% of all adolescent and young males meet the stringent criteria for bulimia. These figures are similar for anorexia nervosa (Carlat, 1997).
Males are now being studied more frequently to determine whether or not they differ significantly from females with respect to eating disorders. If males are found to not differ significantly from females in this respect, then those who support a more biologically based view of the disease, gain support. Things such as schizophrenia or depression for instance could then be seen as major determining factors. If however, it is found that certain cultural and psychological risk factors are the same for both males and females, then the sociocultural view of eating disorder etiology gains support (Carlet, 1997). Males in fact do share some similar central features as females who suffer from anorexia; but they also have their own unique issues with regard to social pressures and vulnerabilities (Carlet, 1997).
Unlike females who typically Afeel fat@, males are often obese to begin with. Males are more likely to diet to attain goals in a particular sport like wrestling or swimming. Males also diet to prevent themselves from developing medical complications witnessed in other family members such as cardiovascular disease and diabetes (Blackman, 1996). In several cases involving males, their profession was found to be clearly related to the onset of the eating disorder (Carlat, 1997).
One patient studied by Carlat et al. reported taking appetite suppressing pills in an effort to keep slim for acting roles and within several months he began a pattern of binge eating and self-induced vomiting. In the same study, which involved 135 males with eating disorders, 22% had anorexia nervosa, 73% were single and 131 were Caucasian. The average age of onset was 19.3 years. The average education level was 1.6 years of college at the time of their first treatment (Carlat, 1997). This does not necessarily mean that this group is more susceptible to developing eating disorders as these results could have been influenced by how the sample was taken.
With regard to the core concerns about body image and weight, it appears that males with anorexia may be more similar to their female counterparts than to male bulimic patients (Carlat, 1997). Like females, Carlat et al. found that male anorexics clearly feared weight gain and desired a body weight of only 75% of their ideal body weight (Carlat, 1997). Perhaps the biggest finding with males is the high prevalence of homosexuality/bisexuality in those with eating disorders as compared to the general population. Recent data estimates 1%-6% of healthy males are homosexual and that only 2% of females with eating disorders are homosexual (Carlat, 1997). Homosexuality was found to have a 27% prevalence among male patients with eating disorders however.
Anorexic males in particu …
