Anorexia nervosa is defined as an eating disorder characterized by the fear of becoming fat, and refusal of food. Several factors – psychological, interpersonal, and social – contribute to this disease. Psychological factors consist of one feeling that one’s life is out of control, and having low self esteem. Interpersonal factors refer to one having discomfort in expressing personal feelings as family, and personal relationships are likely to be characterized by conflict, and criticism.
Social factors refer to the cultural pressures that place an emphasis on one’s appearance, specifically to be thin. Some of the main effects of anorexia are drastic weight loss, constipation, disrupted menstrual cycles or no period at all, dizzy spells, fainting, abdominal pains, muscle weakness, poor circulation, bloating, dehydration, brittle nails, osteoporosis, and dry skin, that is often yellow. The journal published by Laura Canetti, Kyra Kanyas, and Bernard Lerer highlights the relationship between parental bonding and anorexia nervosa.
It is proven that the severities of symptoms were associated with a controlling father and a less caring parent. Current studies show that an intergenerational effect was present among anorexic participants; parental characteristics of a maternal grandmother care may play a role in the development of eating disorders in granddaughters. The journal published by Grace Overbeke explains the content, impact and pressing concerns for the increasing popularity of pro-anorexia websites. She explains the power of influence the Internet has on society promoting anorexia.
Results showed that pro-anorexia websites were popular as it gave patients a sense of identity, and belonging, but the impact of the websites were negative so we must keep in mind that although the internet is beneficial, it also comes with harmful effects. The journal published by Araceli Gila, Josefina Castro, M. Jose Gomez and Josep Toro, compared social and body self esteem among adolescents. The journal pointed out the importance of self esteem and how it affects the way adolescents view their body image.
Results were assessed using the psychometric properties of the SEED (Self-esteem in eating disorder). Results showed that adolescents with eating disorders have lower social and body self esteem than adolescents in general population. A journal titled ‘Assessment of eating disorders’ consists of an objective data on the assessment and treatment outcome of clients, and has a brief summary aimed towards practicing clinicians regarding an assessment of those with eating disorders.
The results of the different stages show that it is ritically important to use a well validated and standardized assessment instrument while treating a patient in every phase. The journal published by Kevin D. Wu investigates the link between the symptoms of anorexia, bulimia, and obsessive compulsive disorder (OCD). It also looks at the link between panic, depression and general stress. Research shows that anorexia is closely related to OCD. Results show a) that none of the OCD scales significantly predicted anorexia, b) panic and depression significantly predicted bulimia, and c) no support for a strong association between OCD, anorexia or bulimia.
A study by Anastasia Kitsantas, Tammy Dew Gilligan, Akihito Kamata, investigates the importance of self-regulatory strategies and how it is related to eating disorders in college women. Results show that individuals with eating disorders scored lower on the life satisfaction and positive affect scales compared to individuals whom were at risk or healthy. Client’s background The client’s name is Amy Lyn; she’s a 21 year old female, who is a full time student. Her relationship with her family can be described as distant as she feels that nobody in her family understands her, nor takes the time to try.
She does not have a social relationship, apart from that in university, where she mingles with her fellow classmates. She describes her relationship with her classmates as on the surface, as they are more of casual acquaintances. She lacks a close group of friends, or even one good friend, to socialize with. The patient overdosed on pharmaceutical drugs – valium, and xanax – when she was 18 years old, and she has had a battle with alcohol addiction since she was 16 years old.
She sought for drug and alcohol rehabilitation 6 months ago, and has been on a good road to recovery. Prior to her anorexia, she was a healthy young female, but ever since this disease took over her life, she is at an alarming weight, complains of abdominal pains, appears weak, and has been hospitalized for dehydration. She has weak coping skills as she voiced out that she gets the urge to consume alcohol, or drugs when she feels sad, stresses, hopeless, or angry. Difficulties in her life involve her lack of a social life, and her distant relationship with her family.
Her goals in life consist of obtaining an art degree, pursuing a career in sculpting, and opening an academy for young and achieving artists. Clinical history The patient’s appearance was shocking as she is around 5”6, and looks like she weighs 40 kgs. She has disclosed that she constantly obsesses over food portions, and that her diet is very controlled as she has a list of foods that she cannot eat. She spends a lot of time thinking about food, yet she can barely bring herself to eat a spoon of rice. She religiously carries out rituals while eating that consists of chewing her food at least 20 times.
When she goes out with friends, or family, she tries to avoid eating by telling them that she is not hungry, or is not feeling well. The patient states that she often feels fat, but it is clear that she is underweight, and feels that she will never be thin enough so she constantly exercises excessively. Diagnosis According to DSM-IV, anorexia is found 90% in females. It states that individuals with anorexia have failed to maintain body weight of at least 85% of what’s expected, and they have a fear of losing control over their weight, or becoming fat.
Individuals also have a distorted body image as they see themselves as overweight, even though they are underweight. Based on the criteria, the client has been diagnosed with anorexia. Treatment goals and Planning The goal of this treatment is for the client to improve her eating habits, overall health, and self esteem. As well as that it is important for her to identify the emotional triggers, and create awareness of healthy ways to respond to stress, anger, and a sense of hopelessness. Lastly, she must earn to develop confidence in the potential to make healthy choices one day at a time. The treatment will be carried out in an office setting that has a warm feeling to it so the patient feels comfortable, and experiences a living room environment rather than a doctor’s office. The duration of the treatment is set for 4 months. Treatments will occur every Sunday at 1pm, for an hour, but as the patient starts to show improvements, this will be reduced to once every two weeks, until it leads up to termination of the counseling session. The treatment plan consists of 16 sessions.
Session 1, and 2 will be the assessment where the patient will be given time to discuss her difficulties thus allowing the counselor to gain some insight as to how the patient experiences these difficulties. Information will be gathered and noted down to build up an understanding of the problem. The amount of sessions needed will be determined during this time. Session 3 and 4 will be ice breaking where the patient will be able to explore her feelings in a nonthreatening manner, and overall develop a level of comfort, a sense of support, respect, and honesty.
A questionnaire will be given to the client during session 3 to assess her condition, and the same questionnaire will be given to her after every 3rd session. Session 5 to 8 will be focused on introducing, and reviewing an emotional diary as well as a food log. The patient will be given a few suggestions to healthy meal plans, and asked to incorporate them into her daily intake of food. The emotional diary serves as a key of keeping track of how the patient felt during encounters of stress, anger, or sadness, and how she dealt with it.
The food log is to keep track of what the patient is eating, and to ensure that she is on the road to a healthy lifestyle. Session 9 to 12 will be focused on building a healthy relationship with her family, and widening her social circle. Counseling sessions with her family members will be incorporated if the patient agrees. Patient will be asked to join a social group in order to make new friends, and feel a sense of support outside of therapy. Session 13 to 16 will be focused on prepping the patient for the upcoming termination of the counseling sessions.
Techniques, and strategies learned in therapy will be reviewed so the patient feels confident to use those tools without the therapists help. As well as that, follow up sessions after the termination will be discussed. Discussion This treatment plan is expected to allow the client to live a healthy and normal life without constant treatment. As long as she follows the techniques learned in therapy, she should be able to go on without a relapse. An alternative treatment would include for the patient to be checked into a rehab facilitation to undergo nutritional treatment where she can learn about healthy eating and proper nutrition.
A meal plan will be developed for her, and she must follow this until she reaches, and maintains a healthy weight. The same questionnaire will be given to the client after every 3rd session in order to gauge if there has been any changes, and if therapy is working. A month after termination, there will be a follow up session to see how the client is coping, and if she is maintaining a healthy lifestyle. The next follow up session will be a month and a half after that, if the client is happy and coping well, then no plans for another follow up session will be made.
References
1. (N.A) Anorexia nervosa – causes. (2012, May 5). Retrieved from http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Causes.aspx
2. Anderson, D.A., Lundgren, J.D., Shapiro, J.R., Paulosky, C.A. (2004) Assessment of eating disorders. Retrieved from http://www.addiction.umd.edu/classlinks/anderson.pdf
3. Canneti, L., Kanyas, K., Latzer, Y., & Bachar, E. (2008). Anorexia nervosa and parental bonding: The contribution of parent–grandparent relationships to eating disorder psychopathology. Retrieved from http://psychology.huji.ac.il/.upload/articles/Canetti.pdf
4. Gila, A., Castro, J., Gomes, M.J., Toro, J. (2005). Social and body self-esteem in adolescents with eating disorders. Retrieved from dialnet.unirioja.es/descarga/articulo/1180944.pdf
5. Franko, K. M. (2012, March). Eating disorders. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eating-disorders/
6. Kitsantas, A., Giligan, T.D, Kamata, A. (2003). College women with eating disorders: Self -regulation, life satisfaction, and positive/negative effect. Retrieved from http://www.katharinenewman.com/Research/EatingDisorders/bs0.pdf
7. Simon, H. (2009, January 22). Eating disorders – complications of anorexia. Retrieved from http://www.umm.edu/patiented/articles/how_serious_anorexia_nervosa_000049_5.htm
8. Smith, M., & Segal, J. (2012, July). Anorexia nervosa. Retrieved from http://www.helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm
9. Smith, M., & Segal, J. (2012, September). Eating disorder treatment and recovery. Retrieved from http://www.helpguide.org/mental/eating_disorder_treatment.htm
10. Overbeke, G. (2008). Pro-Anorexia Websites: Content, Impact, and Explanations of Popularity. Retrieved from http://www.wesleyan.edu/psyc/mindmatters/volume03/article05.pdf
11. Wu, K.D. (2008). Eating disorders and obsessive–compulsive disorder:
