Anorexia Nervosa A Complex Disorder Both

Both eating disorders have a significant impact on psychological and nutritional aspects. These disorders are complex manifestations of underlying problems related to identity and self-perception, often influenced by traumatic experiences and societal ideals of beauty and value (Eating Disorder Resource Center, 1997).

The Eating Disorder Resource Center (1997) states that eating disorders can be caused by biological factors, family issues, and psychological make-up. These disorders can impact individuals from any socioeconomic background. Anorexia nervosa is a disorder marked by severe food and fluid restrictions, distorted body image, fear of weight gain, and low self-esteem. Individuals with anorexia often engage in excessive exercise and extreme dieting to shed pounds while remaining unaware of their own malnourishment and underweight condition.

The aim of this paper is to explore the psychological and societal factors that contribute to anorexia nervosa, as well as the nutritional and physiological issues that arise from extremely restrictive diets. Despite reaching a dangerously low weight, anorexics initially feel satisfied with their weight loss but still view themselves as overweight and want to lose more weight. This denial makes it difficult to convince anorexics to seek help (Eating Disorder Resource Center, 1997).

In 1689, Richard Morton, an English physician, initially described Anorexia Nervosa as a disease caused by mental and nerve dysfunction. However, in 1914, Dr. Simmonds discovered that the refusal to eat in women was due to an anterior pituitary lesion. This finding shifted the perspective on the disorder from emotional aspects to physiological and endocrinological components. By 1938, anorexia nervosa was primarily regarded as an emotional disorder once again (Blackman, 1996).

In the diagnosis of anorexia nervosa, the DSM IV, which is the American Medical Association’s manual, provides specific criteria. These criteria encompass a persistent fear of gaining weight or becoming fat, regardless of already being underweight. Additionally, there must be a distorted perception of body weight or shape that significantly impacts self-evaluation. The denial of the seriousness of being underweight is also taken into account when making the diagnosis (Blackman, 1996).

There are multiple manifestations of anorexia nervosa. It can be the main disorder, accompanied by secondary conditions like depression. Alternatively, it may originate from a disorder such as schizophrenia or coexist with obsessive-compulsive disorder. Additionally, it can be associated with a personality disorder (Blackman, 1996; Carlat, 1997).

According to various studies, the majority of individuals affected by anorexia are females (Blackman, 1996; Carlat, 1997; Kinzl, 1997). Although historically more common among adolescent girls and young women, there has been a rise in the number of males impacted by this disorder. It is estimated that 1% of girls aged 12 to 18 meet the criteria for full-blown anorexia, while up to 5-10% exhibit milder forms of eating disorders when less strict criteria are used (Blackman, 1996). Anorexic individuals typically include high-achieving youngsters who often participate in sports such as gymnastics, swimming, cheerleading, ballet, and others.

According to Blackman (1996), the individuals described in this passage often exhibit traits such as competitiveness, perfectionism, and characteristics of obsessive-compulsive personality. These attributes can be influenced by concerns about growing up or discomfort related to sexuality. Research indicates that approximately 75% of American women feel dissatisfied with their physical appearance, and up to 50% are actively involved in dieting at any given time. It is alarming to note that an astounding 90% of high school junior and senior women regularly partake in dieting practices, despite only 10%-15% being above the recommended weight according to standard height-weight charts (Council on Size and Weight Discrimination, 1996).

In 1996, the Council on Size and Weight Discrimination reported that there is a small percentage of women who experience eating disorders. Specifically, about 1% of teenage girls and 5% of college-age women develop either anorexia or bulimia. These statistics indicate that certain women face challenges with body dissatisfaction and turn to extreme dieting.

Typically, disordered eating behavior starts with dietary restrictions or selective food choices, such as avoiding perceived fattening foods. As the disorder progresses, individuals with anorexia become skilled at hiding their problematic behavior and may begin to skip meals with their families. They might also engage in excessive exercise to further their efforts for weight loss. Anorexics often wear multiple layers of clothing to conceal their thinness, which can delay the recognition of the condition by parents until it reaches an advanced stage. Diagnosis is usually delayed until the person is taken to a medical facility due to issues like physical weakness, lack of energy, excessive sleepiness, and declining academic performance (Blackman, 1996).

Research suggests that families of individuals with anorexia commonly exhibit certain characteristics. These traits include enmeshment, overprotectiveness, and a tendency to avoid conflict. In addition, these families may develop harmful alliances with one parent or another. Parents of those with anorexia are more likely to display both affection and neglect when compared to parents of non-anorexic children. Fathers in these families often demonstrate controlling behaviors, and instances of physical or sexual abuse may occur. However, it is important to note that not all families affected by anorexia conform to this particular profile.

Blackman (1996) states that the development of anorexia is heavily influenced by society’s values and their impact on individuals. Anorexics are significantly affected by societal approval regarding weight and body size, as they associate their self-worth with attaining a slim appearance. This obsession with physical attractiveness, often linked to beauty, success, and happiness, is widespread in Western culture. Our society places great emphasis on these superficial standards and continuously exposes us to idealized images of women through mediums like magazines, films, and television (Blackman, 1996).

The underrepresentation of overweight or average-looking individuals in the media and advertising industry in developed countries contributes to the high prevalence of anorexia nervosa. In contrast, this disorder is uncommon in less industrialized and non-western nations (Blackman, 1996). Furthermore, research indicates that immigrants who relocate to westernized countries are more prone to developing eating disorders (Blackman, 1996).

Anorexia is often triggered by comments from important individuals in the sufferer’s life, such as coaches or friends. These comments can suggest that they are gaining weight, becoming big or clumsy, or that their athletic performance is suffering (Blackman, 1996). Although unintentional or innocent, these remarks further reinforce society’s belief that weight gain is unacceptable. Alternatively, some people may attribute their initial desire to lose weight to the media’s influence. Certain patients claim that they want to resemble a favorite film star or model (Blackman, 1996).

The prevalence of dieting and eating disorders, such as anorexia nervosa, is commonly associated with females during or around adolescence. However, males are often overlooked in this area of research. It is important to acknowledge that eating disorders are not rare among males. About 10-15% of individuals diagnosed with bulimia are male, and approximately 0.2% of adolescent and young males meet the strict criteria for bulimia. The rates of anorexia nervosa in males are also comparable (Carlat, 1997).

The research on the study of males and females in relation to eating disorders is growing, with the main objective being to identify any notable differences between genders. Discovering significant differences would lend support to the notion that the disease has a biological foundation, while other factors such as schizophrenia or depression could be seen as influential. On the other hand, if both genders possess shared cultural and psychological risk factors, it would offer additional evidence for the sociocultural perspective on causes of eating disorders (Carlet, 1997).

Males and females with anorexia do share some similar central features, but they also have their own unique issues related to social pressures and vulnerabilities (Carlet, 1997). In contrast to females who perceive themselves as fat, males often start as obese. Males are more prone to dieting for specific goals in sports like wrestling or swimming. Additionally, males may restrict their diets to reduce the risk of medical problems experienced by other family members, such as cardiovascular diseases and diabetes (Blackman, 1996).

According to Carlat (1997), male profession was strongly associated with the development of eating disorders. In their study, Carlat et al. investigated a patient who admitted to using appetite suppressants for maintaining a slim physique required for acting jobs. This practice eventually led to binge eating and purging behaviors. The research further showed that among 135 males with eating disorders, 22% had anorexia nervosa, 73% were not married, and all but four were Caucasian.

Carlat (1997) noted that individuals in this group had an average age of onset at 19.3 years and an average education level of 1.6 years of college during their initial treatment. It is crucial to acknowledge that these statistics should not be misinterpreted as suggesting a higher vulnerability to developing eating disorders, as they might have been affected by the sample selection process.

Carlat (1997) states that males with anorexia exhibit similar concerns about body image and weight as females with anorexia, rather than males with bulimia. Similar to females, male individuals suffering from anorexia also possess a fear of gaining weight and strive to attain a body weight that is only 75% of their ideal weight (Carlat, 1997). Furthermore, research indicates a higher prevalence of homosexuality/bisexuality among males with eating disorders in comparison to the general population. Recent data reveals that while only 1%-6% of healthy males identify themselves as homosexual, approximately 2% of females with eating disorders identify as homosexual (Carlat, 1997).

Research has shown that 27% of male patients with eating disorders identified as homosexual. Additionally, among males with anorexia, there was a higher prevalence of asexuality, which is defined by a lack of sexual interest for at least one year before evaluation. This finding aligns with previous observations in females (Carlat, 1997; Murnen, 1997). It is believed that in the case of anorexia, protein-calorie malnutrition causes decreased testosterone levels and actively suppresses sexual desire (Carlat, 1997).

The high occurrence of homosexuality and bisexuality in males with eating disorders provides support for both psychosocial and biological theories regarding the causes of these disorders. Psychosocially, homosexuality can be seen as a contributing factor that places males in a subculture where physical appearance is heavily emphasized, similar to the societal pressures faced by women (Carlat, 1997). As a result, the pursuit of thinness driven by these social pressures leads to the development of eating disorders (Carlat, 1997).

According to Carlat (1997), the brain structure of homosexual men and heterosexual women can be considered biologically similar. Specifically, both groups show similarities in the third interstitial nucleus of the anterior hypothalamus (INAH3), a small group of cells. It has been observed that gay men have this cell cluster approximately half the size of straight men, placing them in a size range similar to heterosexual women. The INAH3 region is strongly associated with regulating male-typical sexual behavior (Nimmons, 1994). Therefore, it can be argued that homosexual men respond to environmental stressors in a biologically feminine manner, which increases their vulnerability to eating disorders (Carlat, 1997).

According to Carlat et al., both males and females had high rates of co-morbid major depression, substance abuse, anxiety disorders, and personality disorders. After one year of treatment, a concerning 59% of males continued to have their eating disorder, specifically anorexia nervosa (Carlat, 1997).

According to Carlat (1997), patients with anorexia commonly experience osteoporosis, anemia, and hypotension. Blackman (1996) adds that chronic starvation caused by anorexia can result in seizures and fainting spells. Anorexic individuals typically show signs such as paleness, fatigue, muscle wasting, and a slow heart rate known as bradycardia; their skin may also feel cold to the touch. Additionally, a notable indication is the presence of fine downy hair on the arms and torso. Laboratory tests often reveal abnormal values due to severe electrolyte imbalances and life-threatening dehydration. Amenorrhea, defined as the absence of menstrual periods, occurs in post-menarchal girls who have lost over 20% of their expected body weight (Blackman, 1996; Rock, 1996).

According to Blackman (1996), amenorrhea is a diagnostic characteristic of anorexia nervosa in women, as noted in the DSM IV. It is associated with the body’s reaction to substantial loss of fat and its incapacity to sustain a pregnancy under such circumstances. Starvation results in the absence of menarche, resulting in hormonal alterations, anxiety, depression, and potentially psychosis (Kershenbaum, 1997).

Several consequences have been associated with anorexia nervosa, spanning from bilateral foot drop in a 15-year-old girl (Kershenbaum, 1997) to more serious outcomes like sudden death and suicide (Neumärken, 1997). Sudden death refers to an unforeseen and inexplicable event of mortality. In specific instances, individuals who experienced sudden death displayed irregularities in ECG recordings days prior to their demise. Autopsies further unveiled alterations in brain structure and cardiac muscles, including atrophy (Neumärken, 1997).

Despite the numerous negative effects, one may question why individuals with anorexia continue to engage in dieting. Anorexia can induce a feeling similar to a “runner’s high,” which can also be achieved through exercise. This is a result of the brain releasing opiates, which in turn diminishes appetite and stimulates increased levels of physical activity. Once an individual begins and continues anorexic behavior, it strengthens the release of these endorphins and becomes pleasurable and self-rewarding. Consequently, the sufferer becomes trapped in a cycle of self-starvation that is no longer intentional or simple to halt (Blackman, 1996).

The treatment for anorexia involves psychotherapy, nutritional education, and refeeding. However, it should be noted that nutritional education takes time. When a person is significantly below their healthy weight, their cognitive ability is impaired. According to Merriman (1996), the capacity for abstract thinking is the first higher mental function to be lost. As the condition worsens, anorexic individuals may have difficulty assimilating information. Therefore, the nutritionist needs to carefully plan nutrition education sessions to make them as meaningful as possible to the person.

Refeeding can be challenging for anorexic individuals as they often struggle to gain weight. This is because their metabolism becomes less efficient, resulting in increased diet-induced thermogenesis. At the beginning of refeeding, anorexic patients may waste about 50% of the energy from their food due to this inefficient metabolism, making it difficult to maintain any weight gain (Moukadden, 1997). Another study found that even with weight gain over a period of 3 months to a year, it was still inadequate for maintaining a healthy nutritional status. This is because patients did not reach a sufficient body mass index and their immune system indicators remained lower compared to control subjects during a one-year follow-up (Marcos, 1997).

Given the information provided, it is difficult to fully comprehend the complexity of the issues that anorexic individuals face when it comes to dieting. Anorexic people may be struggling with a range of problems, such as substance abuse, depression, sexual abuse, uncertainty regarding their sexual orientation, or dissatisfaction with their own bodies. It is possible that each individual anorexic experiences a unique combination of these issues to different degrees. Determining the extent to which psychological, societal, and biological factors contribute to the development of this disorder is currently too intricate. It seems to vary from person to person, although certain characteristics are more commonly observed.

The range of variation in individuals with the disorder makes it impossible to categorize the anorexic sufferer into a specific stereotypical group. It is not limited to white adolescent girls only; it affects different groups and is increasingly being observed in groups that were previously unaffected. There is evidence that the disorder is becoming more common among immigrants who relocate to westernized cultures, but it is rarely observed in less developed countries.

Males are increasingly being seen as sufferers of anorexia, a disorder traditionally associated with females. Rather than indicating a specific group being more susceptible to developing this condition, this information suggests that society’s unrealistic and unattainable ideals contribute to encouraging weight loss in individuals who may be more sensitive, insecure, or emotionally disturbed. Losing weight often temporarily boosts their confidence, making them feel in control of a certain aspect of their life. Consequently, they develop a desire to experience this feeling again and embark on further weight loss efforts. This pattern continues until intervention occurs, when someone steps in and convinces the sufferer to seek help. However, this can be challenging since anorexic individuals are typically deeply in denial and are often the last to recognize the severity of their situation.

It is challenging to recover from anorexia, as the body resists weight gain during the initial refeeding period. Even after a full year of treatment, evidence suggests that many anorexics still struggle with their disorder, indicating that recovery has not been achieved. Anorexia is associated with numerous complications, emphasizing the importance of promptly complying with treatment for better chances of recovery. The complex nature of anorexia involves self-perception and societal expectations regarding physical appearance.

Research indicates that there are multiple factors contributing to the development of the disorder, suggesting that society alone is not the sole cause. Society, however, does play a role in its prevalence, emphasizing the need for a more realistic perspective on endorsed ideals.

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