What is an Eating Disorder?

There are different types of eating disorders and while they are all different, in many ways they also have a lot in common. An eating disorder may develop out of a simple diet. Some people, to relieve tension or depression will go on a binge. A binge is eating a lot of food in a very short time until uncomfortably full. Although the binges relieve some tension, they also cause disgust, guilt, and concern about weight gain which will lead a person to purge after their binges. A purge is a way to compensate for all the extra calories by vomiting, excessive exercise, fasting, or using laxatives. It causes rapid gain and loss of weight, feelings of inadequacy, and an obsession with food. Binge Eating Disorder, Bulimia Nervosa and Anorexia Nervosa are the most common forms of eating disorders. Binge-Eating Disorder and Bulimia Nervosa are considered mental disorders because people with these disorders do not feel like they are in control of their eating behaviour. If a person binges more than twice a week, it is considered Binge-Eating Disorder. The combination of bingeing and purging is called Bulimia Nervosa.

Anorexia, although still considered a mental disorder is more controlled, with the person either taking very small amounts of food or starving themselves to remain thin.

It is estimated that 0.5 to 1% of women in late adolescence develop anorexia. It is most common between the ages of 10 and 30 and 90% of the cases are women. However, cases are increasing for men, minorities, older women and pre-teens. There are children as young as 8 showing concerns and behaviours around food, and up to 50% of these youngsters are boys.

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Anorexia is associated with feelings and behaviours related to the fear of "fatness". These feelings include poor body image, a phobia about food and its ability to create fatness, and an intense fear of being a normal body weight. People with anorexia have not lost their appetite. They are very hungry indeed. They think about food all the time, want to be close to it - give it to others. What they don't do is allow themselves to succumb to their desire for food. Like all compulsive disorders, the roots of anorexia lie in deep anxiety, the sense that not only is life out of control, running away too fast, but that their ability to cope with life and all its demands is poor. Given these fears, it is all too easy for an individual to turn to the control of food and weight to gain some kind of control over their existence.

Typically anorexia starts when a young person feels overweight. This may be because they have gained a little more weight than average at puberty, or have slim friends with whom they compare themselves. A decision to go on a diet may be triggered by a specific event such as a comment or remark from a peer. The diet is most usually the first ever tried and it is initially quite successful, giving the young person a real sense of achievement at an otherwise insecure time of life. There may initially be approval from friends or members of the family which is a positive form of attention. The anorexic never starts off intending to starve themself into emaciation. They just feels that life will be better if they lost a few pounds - which it is for a while. At some point in the diet there is a subtle psychological change - which is not experienced by normal dieters - and dieting actually becomes more intense as the diet progresses and the target weight is near.

The dieting behaviour goes underground so that it can become a private secret rather than a public activity and strategies are developed to convince "others" that eating is taking place when in fact it is not. This requires a great deal of craftiness such as throwing food away, finding ways to get rid of it off a plate at mealtimes, or pretending to already have eaten. Hence by the time that weight loss is noticeable to the family, the anorexia is already well under way.

In their own private eating world, the person developing anorexia will become very "ritualised" around food. This may take the form of eating fractions of portions of food at specific times of the day, - like one third of an apple - or eating the crusts around a sandwich but not the middle. They will toy with their food, cut it up into tiny pieces and eat them very slowly. Even non-fattening foods will be feared. Many anorexics weigh themselves several times each day. An anorexic can panic if they show a small change in weight after eating one lettuce. The physical effects of anorexia are mostly connected with the effects of starvation on the body:

* menstruation stops(in women)

* breathing, pulse and blood pressure rates plummet

* mild anaemia occurs

* osteoporosis

* impaired kidney function

* infertility

* immune system fails to fight infection

* physical weakness

* sensitivity to heat and cold.

* erosion of the teeth from acid in the stomach due to vomiting

* as body weight falls to low levels the anorexic may be covered with a fine downy hair

* ulcers and rough skin on legs and feet due to poor circulation

* digestive problems as a result of starvation

* constipation which makes the abdomen feel dense and large.

* Bone loss as a result of under nourishment

* shrinkage of the reproductive organs in both men and women

* destruction of areas of the brain which are responsible for endocrine production.

The most significant feature of anorexia is denial of the disease and anorexics are typically very intelligent people with a great deal of academic ability.

Although there are several theories as to the causes of anorexia, it is increasing partly due to cultural changes and social pressure and development in food and nutrition, leading to an early maturation of young girls compared to that of the early 20th Century. (Phillip W. Long, M.D.1999 NIMH (National Institute of Mental Health))

Social &Cultural Theory

It is understandable that anorexia hardly exists in third world countries where there is barely enough food for survival and where fatness is regarded as a sign of affluence. It is also rare in countries which have sufficient food but which do not see slimness as a sign of sexual attractiveness. However, in the developed countries where there is a tendency to associate fatness with negative attributes such as lower social or economic status and personal inadequacy, anorexia is on the increase. In countries where it's perfectly normal to be big, everyone is the same so it doesn't matter. As different cultures start to integrate and live in Western societies, the pressures to look like their counterparts leads them to have a low self-esteem of themselves. Young white women and girls faced with thin and beautiful white celebrities long to be like them -- it would make sense to think that young Black and Hipic women and girls, when faced with beautiful and thin celebrities, such as popstars and models sharing the same culture might also wish to achieve the same physical goals.( Furnham & Alibhai 1983)

In addition, race discrimination in the professional job market may contribute to their low self-worth and desire to be loved and accepted. Those pursuing professions or activities that emphasise thinness, like modelling, gymnastics, dancing, singing, athletes, filmstars and wrestling are more susceptible to anorexia. Even today's men in the entertainment business are of a more muscular, slender build compared to the extremely skinny or bulkier type of years ago. While girls wish to attain a specific size, men who become anorexic are likely to have had a specific role model in mind - usually a sportsman or a rock star, when they begin to diet.

Too much emphasis is being made on fashion being thin and the numerous diet pages in magazines and teenage literature. (About Face Organisation's Website)

Environmental Theory

Another social theory to the cause of anorexia could be family surroundings. The typical anorexic comes from a "perfect on the outside" family. The parents are often older and are reported by the child as demanding, placing emphasis on their educational or athletic achievements instead of them as a person. This is the parent's attempt of showing love. They feel that if they were to gain 99% in a test, they would be held accountable for not having got it all right. Their own body becomes their greatest achievement. Getting anorexia could be an unconscious choice, but by showing rigid control of their body and not eating with their family, the anorexic demonstrates independence in the only way they can.

As a result, looking back on their early life, many anorexics remember growing up trying to please others and meet their expectations. They usually succeed, since many are high achievers and good students, anxious to please their parents or teachers and earn their approval. These are the children who are described by teachers as well behaved and conscientious, never causing trouble or disruption at school, and never giving their parents any of the usual forms of adolescent rebellion, such as rudeness or defiance.

Evaluation

These ideas show that it is perfectly reasonable to assume that the social pressures of

being a young person in today's society can be associated with the onset of anorexia so if

today's culture is a risk factor for anorexia, and wanting to be thinner precipitates

the illness, why is it that out of all the women and girls who diet at some time in their

lives, only some go on to become anorexic? A youngster growing up in a strict family with high expectations feels that she has no control over herself as her parents are taking away her independence and are basically mapping her life out for her. The only thing left is her body, so she uses this to control what she eats as an achievement of her independence. This can backfire on the anorexic, making the parents more overbearing than before.

Biomedical theory

Genetic factors

Eating disorders appear to run in families--with female relatives most often affected. This finding suggests that genetic factors may make some people prone to eating disorders. Female family members of women suffering from anorexia nervosa or bulimia nervosa develop eating disorders at rates up to 12.3 times higher than those of women who have never suffered from an eating disorder. Also, women who have sons or brothers that have had anorexia are also more likely to get this eating disorder themselves. Recent research looks at newborns of mothers with a history of eating disorders, and presents evidence that these babies also have characteristics that appear to put them at risk of having similar problems.( Dr. Michael Strober, lead author of the study and director of the Eating Disorders Program at the UCLA Neuropsychiatric Institute). Twins too showed a genetic tendency to develop the same disorder, with identical twins being 55% more prone to the disease than non - identical twins at 7%.

Biochemistry

In an attempt to understand eating disorders, scientists have studied the biochemical

functions of people with the illnesses. The hypothalamus is a part of the brain which controls the body's neuroendocrine system -- the part which regulates the multiple functions of the mind and body, such as sexual behaviour and emotional arousal, physical growth and development, appetite and digestion, kidney function, heart, sleep, thinking and memory. An experiment on rats in the 1940's identified the hypothalamus as playing a crucial part in eating behaviour. It was discovered that abnormalities in the lower- central region of the hypothalamus, the VMH (Ventro-Medial Hypothalamus) caused the stop-eating signals to cease working so that the rats became extremely obese (Teitelbaum 1967). In the same way that the VMH inhibits eating, there is a part that stimulates eating, the LH (Lateral Hypothalamus). If this is damaged, it would cause the rat to starve.

Opioid Addiction

Opioids are substances that are produced naturally in the brain when under stress. Their job is to relieve pain and give pleasure. As self-starvation leads to stress for the body and the release of opioids, this gives the person a feeling of being high. Anorexics tend to exercise excessively as both starving and vigorous exercise produce high levels of endorphins in the brain. It could therefore be argued that anorexics become addicted to that "high" thus becoming addicted to their own opioids.

Evaluation

Firstly, it is very rare for the sons to get an eating disorder before the mothers, as it is generally young women with no children who are at risk. Secondly, if there is just as high a risk of anorexia if a brother has had an eating disorder as there is with a son, the answer must lie in a defective chromosome of the male which should be easy enough to rectify, given modern medicine today. Could it be possible that there was a stress factor that ran through the family that increased the risk anyway and a combination of the two factors led to an increased risk? Surely, as well, a baby born to a woman with these sort of disorders is going to be at risk of a number of things when he is growing up. Apart from being nutritionally deprived whilst in the womb(which might cause a number of neurological problems) there must be some sort of emotional problems living in that kind of environment.

The bio-medical theory sounds the most understandable. As with all mental health problems the change in brain chemistry can cause the different parts of the brain to malfunction leading to all manner of psychoses. The only query is: does starving oneself cause physical changes in the brain, or are the chemical changes in the brain responsible for the eating disorder?

Alternative Theories to the Causes for Anorexia

Psychoanalytic Theory

Puberty for women is seen by psychologists to be a time of change and the hormones of puberty create body fat in women and the girl is reminded by her bodily changes that she is becoming a woman. There is also a big change in the age of puberty, which used to be at 18 years and is now occurring at 10, 11 and 12. Girls are experiencing their sexuality at an age where they appear to lack the emotional equipment to handle it so early puberty is linked with self- destructive behaviour in girls. Some researchers believe that anorexia is an attempt to stop the clock - to avoid growing up and becoming a woman and to avoid the problems that maturity brings.

Evaluation

This is arguable as - are all young girls aware that their periods will stop when they starve themselves, and how long is it before they realise that the bust is less affected by weight loss than other parts of the body. This theory does not take male anorexics into account.

Learning Theory

When a young person feels they need to lose a bit of weight, sometimes due to remarks from peers or the opposite sex, they go on a diet. As the weight starts to drop off, appraisal replaces the remarks. This leads to the desire to lose more weight which in turn leads to more attention. The diet soon escalates out of proportion and before long the positive attention turns to a more concerned attention. The anorexic enjoys this attention, whatever the kind and sees their behaviour as a way of being liked and being popular. This behaviour is carried on sometimes until the need for intervention by the medical authorities, which then sees the anorexic receiving attention and concerns from everyone around them, including their families.

Evaluation

This explanation is quite arguable as it is usually an unconscious decision to start starving yourself - the intention was to lose just a few pounds. Anyway, lack of attention, which is the issue, from people or family when young could quite easily lead to over-eating or other forms of self-abuse.

Treatments and Outcomes

Early treatments for anorexia were based on behavioural and psychotherapeutic techniques. These treatments were largely unsuccessful in the long term. Anyhow weight gain alone is not the only goal of treatment. The "best outcomes" are with therapies that treat the whole individual, and provide a variety of approaches, nutritional, psychological, personal growth and relaxation therapies. Part of this process would include building self-esteem. For those anorexics who are too far gone for these therapies to benefit them, a stay in hospital will apply where they can be force-fed under the powers of the Mental Health Act, since severe emaciation destroys the ability to think rationally, thus making any form of therapy very hard to do. Anyway, many therapists believe that it is impossible to carry out psychotherapy with an anorexic person unless weight has first been restored. ( The National Centre For Eating Disorders August 1999).

Medical Treatment

Scientists have found that the neurotransmitters serotonin and norepinephrine, (chemical messengers which control hormones in the brain) function abnormally in people affected by depression. Researchers funded by NIMH (National Institute of Mental Health) have recently learned that these neurotransmitters are also decreased in extremely ill anorexia and bulimia patients and long-term recovered anorexia patients. Because many people with eating disorders also appear to suffer from depression, some scientists believe that there may be a link between these two disorders. In fact, new research has suggested that some patients with anorexia may respond well to the antidepressant medication fluoxetine which affects serotonin function in the body.

Cognitive Treatment

Treatment of anorexia is often a long, drawn - out duration, requiring a combination of cognitive and analytic interpretative techniques to explore the past, identifying the underlying cause of the maladaptive behaviour. For older women personal therapy works best whereas family therapy is especially helpful for adolescent patients as every member of the family can understand what the patient is going through (Murray et al., 1997).

Anorexia can be fatal if left untreated. About one fifth of people with anorexia recover,  a further two fifths gain weight but develop other problems with eating such as bulimia nervosa or binge eating disorder. About one third of sufferers remain anorexic, with only one aim in life - to stay thin.  Death rates in long term anorexics are as high as ten percent, usually due to heart failure in the case of bulimic anorexia, suicide or lack of resistance to illness.

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