Abnormal Psychology Term

Abnormal Psychology Term Paper: Anorexia Nervosa (AN)

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Brief Introduction on Case Study

Sophia is a 19-year-old female who is currently living with her parents while she attends a local community college. Sophia is experiencing a persistent behavior in eating behavior. Sophia fears gaining weight, and therefore, she does not eat. Sophia’s eating disorder has caused her to have low body weight, dizziness, fatigue and sometimes nausea. She has frequent urination due to her dehydration. Her lowest weight was 70 pounds, which is 10 kgs. (At least 25% of her ideal body weight). Sophia’s parents noticed that she started losing appetite since she was a little girl while in elementary school. Every year during the holidays she would lose her appetite and her food intake would be very low compared to the other members of the family. The parents were very concerned about Sophia because they knew that the daughter may be developing an eating disorder that could cause harmful effects on her health.

Sophia did not change her behavior and as time passed, she started complaining about feeling cold, fatigue, low blood pressure, osteoporosis, fainting, nausea, dizziness, and low body weight. Her parents were not aware that their daughter has an eating disorder that is likely to cause complications on the future of the family. Sophia had been complaining about her low body weight and fatigue, but she did not go to get medical help or treatment because she was too embarrassed and afraid that her family would find out what she was going through.

Nowadays, many people are developing eating disorders like Anorexia Nervosa (AN) due to many factors such as peer pressure, changing social environment, a lack of communication with others, stress and self-starvation practices. To address Sophia’s eating disorder, her parents brought her to the doctor. In the clinic, Sophia was examined, and the doctor concluded that she is suffering from an eating disorder. The doctor diagnosed her with Anorexia Nervosa due to the physical symptoms of low body weight and other physiological problems such as dizziness, fatigue, and nausea. The doctor told Sophia’s parents that she will be hospitalized in order to treat her eating disorder. Sophia was at first reluctant to be hospitalized because of her embarrassment when others would know about her condition.

DSM-5 Diagnostic Criterion

According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5), Anorexia nervosa is the most severe eating disorder that is characterized by a distorted body image and the refusal to maintain minimum weight. Patients with AN are preoccupied with their low body weight, they think they are fat, they try to control their eating and discourage themselves from eating. However, if the patient fails to maintain a reasonably low body weight for an extended period of time, then he or she may be diagnosed with AN. DSM-5 defines maladaptive behaviors as an overall pattern of behavior that includes clinical features of “self-starvation” and “self-induced vomiting”, self-mutilation or engaging in harmful activities (antropophagia). The DSM-5 includes a subtype Diet Induced Anorexia, which is characterized by paraclinical features of self-starvation. In order to diagnose anorexia nervosa, the causes must be known and these causes must play a role in the development of the illness. In this paper, we will explore the possible causes that may lead to developing AN.

Anorexia Nervosa is an eating disorder that can cause a person’s weight to be less than 80% of what it should be for his/her age, height, and gender. People with Anorexia often have obsessions about food and calories, portions sizes etc., are afraid of becoming fat even though they are underweight and have a distorted body image that prevents them from seeing themselves properly (Kästner et al.,2021).

One can easily know that a person is experiencing Anorexia nervosa when he or she is not maintaining a normal weight and has a distorted body image. People who are suffering from this disorder keep their physical appearance as well as their weight as the center of their life. They tend to look at themselves excessively as well as others when they are in public places. They constantly weigh themselves in order to know their correct body weights and they regularly check their body size comparing it with others.

Anorexics may become compulsive exercisers in an effort to control their weight because they have a distorted body image that makes them view themselves as being fat, despite the fact that they are not (Kästner et al.,2021).

Etiology of Anorexia nervosa

The causes of AN are not only moderate but also psychological or biological. The psychological causes of anorexia include the following:

1) A desire to be thin, which is widespread in our culture. This desire may be due to various reasons such as peer pressure, but it also results from a lack of acceptance of one’s physical appearance by oneself.

2) Obsession with body image. Concerns about body image can cause people to develop an eating disorder. Having a high regard for appearance can create unhealthy competition and even lead to mood disorders such as depression or anxiety.

3) Depression is often associated with the onset of anorexia nervosa and other eating disorders. A person may feel depressed and in turn, he or she might try to control their eating. However, when a person does not eat enough to feel full he or she may become more depressed.

4) Substance abuse is also associated with anorexia nervosa and it is likely that the two conditions share a common neural circuitry. Thus, many people recover from substance abuse after overcoming anorexia nervosa.

5) People who are genetically predisposed to being thin may be more at risk for developing anorexia nervosa. This is due to their body perception of what it means to be thin which will lead them deeper into the disorder.

Theorists suggests that there are certain biological and environmental factors that predispose a person to anorexia nervosa (AN). These factors or causes of AN may vary within the population in a variety of ways. Studies have shown that there is a link between AN and genetics. Not all people that have relatives with AN will develop an eating disorder, but these individuals are at a higher risk of developing anorexia nervosa. There is usually no family history of eating disorders evident in the first-degree relatives (parents, siblings) of someone with AN (Reed et al., 2021). However, it has been found in twins studies that there is a strong genetic influence on those who do develop AN. Various research showed that monozygotic twins were more similar than dizygotic twins, suggesting a genetic influence on vulnerability to AN. Twin studies have also shown that there is a strong genetic influence on the development of anorexia nervosa and AN (Dinkler et al., 2021).

AN is a chronic illness and causes people to withdraw from social situations, but there are many other symptoms that develop as well. Withdrawal may be the physical aspect, where individuals refuse to eat or even maintain adequate blood glucose levels and body temperature. Another aspect is the psychological aspect, where individuals find it difficult to be in social situations and communicate effectively with others. These traits put people at risk for developing a psychiatric disorder like anorexia nervosa and lead to further problems.

The article is a compilation of research on the causes and symptoms of anorexia nervosa, as well as a brief overview explaining what it is. This article will help readers understand this condition better. I also hope that it might give those who are struggling with the disorder some idea about how to beat it, should they choose to do so. It is my intention to create awareness and understanding about anorexia nervosa so that people can make informed decisions before making any important decisions or changing their lifestyle in order to avoid its consequences.

Impairment

The physiological symptoms of anorexia nervosa described in this article are extremely common, affecting over 50% of patients. It has a profound impact on their lives and is the principal cause of death from eating disorders. For these reasons it’s important to understand how anorexia nervosa affects each individual patient, as well as to recognize warning signs for those that wish to seek treatment. This can help reduce the number of deaths and prevent future cases of anorexia nervosa.

The main symptoms of anorexia nervosa are inappropriate food control and body image distortion, which can affect many other facets of everyday life. Other common symptoms include amenorrhea; hypersomnia; and orthostatic hypotension. A physician’s discovery of these physical symptoms is often their first indication that a patient has an eating disorder. Anorexia nervosa can occur in individuals of any body type, any sex, and at any age (although the onset is typically earlier in females). Anorexia nervosa has been found to have the highest mortality rate of all psychiatric illnesses (Kästner et al.,2021).

Two major factors are responsible for the increased mortality rate of anorexia nervosa. The first is the patient’s body weight and body mass index. These patients are typically at least 15% below normal body weight, with a BMI of 17 or less. Patients who suffer from anorexia nervosa often weigh 40-50% below normal weight (Kästner et al.,2021). The second factor is the patient’s refusal to seek medical treatment for their eating disorder. In a recent study, 75% of patients did not seek treatment for their illness. In addition, friends and family members of anorexics were not supportive in encouraging them to seek treatment (Herzog, 1994).

Physical complaints that are commonly found in patients who develop anorexia nervosa are excessively dry skin, hair and nails, excessive sweating which causes weight loss, nausea and vomiting that can lead to dehydration. Both men and women are affected by premature osteoporosis and heart muscle weakening. Chronic low blood pressure can cause acute cardiovascular collapse if not treated with medication. The lower the person’s body weight is the greater the potential risk of mortality.

Prevalence Rates

Anorexia nervosa is the primary form of eating disorder and the most severe. It mostly common among the females, typically during the adolescence and early adulthood. Anorexia nervosa starts with self-starvation. The person has an intense fear of gaining weight, they become consumed with body image, and they think that they are fat even though they are actually very thin. This disorder is caused by a combination of social factors, genetic issue, and life events – which could be anything from a traumatic childhood experience to being forced to diet as a child.

The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Anorexia nervosa is usually diagnosed in females. The diagnosis usually happens during adolescence or early adulthood. Research has found that the mean age of onset is between 16 and 18 years old. There are risks to those with anorexia nervosa, including poor health, injury, and death. More so, those with this disorder can have the possibility of taking their own lives because of the severity of their illness. Those with anorexia often lose a lot of weight very fast and even if they gain some weight after a period of time it never seems to be enough for them because everything looks so small to them.

The highest prevalence of anorexia nervosa is between the ages of 13 and 18 years old. The highest point of incidence is between the ages of 12 and 13 years old for girls. Anorexia nervosa is about 90% more common in females than males. The rate of mortality for anorexia nervosa is six times greater than the general population’s mortality rate. Most people with anorexia have a low body weight, but not everyone who has a low body weight has anorexia (van Eeden et al., 2021). Body mass index (BMI) is not a factor that determines whether or not someone has anorexia nervosa – it only tells how much body fat a person has.

Treatment

Different therapeutic interventions have been studied as potential treatments for anorexia nervosa .Cognitive behavioral therapy for people with anorexia nervosa (CBT-AN) is one of the most promising treatments currently available. However, the outcomes of CBT-AN may well be affected by the expectations of patients and their families. This study investigated whether parents of adult patients with AN expect that their children will improve after treatment for AN (Agras, 2019).

Data were collected from parents of children aged 10–16 years attending outpatient clinics for treatment for AN in three hospitals: Emergency Ward 3 in Princeton, NJ; University Hospital at Northwick Park, London, UK; and National Hospital, Singapore. Doctors and nurses treating patients with AN completed a semi-structured interview about their expectations for therapy outcomes following CBT-AN treatment (Agras, 2019). A self-report questionnaire was also used to measure parental expectations. The questionnaire contained items that were scored on a five-point Likert scale; scores on higher scores were indicative of higher expectations. Parents were found to have more positive expectations of children’s improvement after therapy than their doctors and nurses did. This study suggests that parents do expect the improvements they believe will result from CBT-AN, although they may expect these improvements to be slower than other clinicians hold them to (Dalle et al., 2020).

There was another study done by the University of Pittsburgh School of Medicine, which has had many studies published that support CBT. This study focused on the importance of parent involvement in the treatment process. It was found that when positive parental involvement with therapy occurred, children showed less episodes of AN and weight gain than those who did not receive support from their parents (Agras, 2019). Many variables were studied to determine what factors were related to these differences (e.g., number and length of hospitalization, family dynamics).

Adolescents represent a prominent subgroup of individuals with AN. Their treatment approach typically involves psychotherapy in addition to family therapy. The most commonly studied psychotherapeutic method used in the treatment of adolescents with AN is cognitive behavioral therapy (CBT) for anorexic adolescent girls.

However, results from clinical trials of CBT-AN have been only partially positive; thus, there is a need to examine other treatment approaches.

Motivational interviewing is a non-confrontational counseling style used in motivational enhancement therapy (MET) that guides individuals through solving ambivalence and bolstering their motivation to change their maladaptive behaviors (American Psychiatric Association, 2013). Motivational interviewing has been used with adolescents with AN, and the results have been positive. Theoretically, motivational interviewing is based on the assumption that regardless of their motivation to change their maladaptive behaviors, individuals will only change if they engage in an active, objective process of problem solving.

Although there are positive studies regarding the use of motivational interviewing (MI) with adolescents with AN, there is also resistance to this research. Amongst this resistance is the concern that it may be too confrontational in nature, and as a result not be effective. The purpose of this study was to explore the doubts held by adolescents with AN, their parents and clinicians regarding the use of motivational interviewing. Participants in the study were interviewed alone, invited to participate in a diagnosis workshop, and subsequently interviewed about their opinions about motivational interviewing for adolescent girls with AN. The interviews were conducted between February through May 2012.

The selective serotonin reuptake inhibitors (SSRIs) is also another option to treating anorexia nervosa. This medication is also referred to as antidepressants. In many cases, this medication works well for the anorexic patient (Resmark et al., 2019). And then, the medications such as antipsychotics and mood stabilizers are used in conjunction with these types of medications to produce a combination of treatment that often helps improve anorexia nervosa symptoms. Other treatments include cognitive behavioral therapy (CBT) and family-focused treatments or social-skills training that focuses on communication and problem-solving between parents and children about weight issues. This therapy is also referred to as parent-child psychoeducation programs or family psychoeducation programs (Agras, 2019).

References

Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of anorexia nervosa—new evidence-based guidelines. Journal of clinical medicine, 8(2), 153.

Kästner, D., Weigel, A., Buchholz, I., Voderholzer, U., Löwe, B., & Gumz, A. (2021). Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals. Journal of eating disorders, 9(1), 1-11.

Dalle Grave, R., Conti, M., & Calugi, S. (2020). Effectiveness of intensive cognitive behavioral therapy in adolescents and adults with anorexia nervosa. International Journal of Eating Disorders, 53(9), 1428-1438.

Agras, W. S. (2019). Cognitive behavior therapy for the eating disorders. Psychiatric Clinics, 42(2), 169-179.

van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), 515.

Reed, K. K., Abbaspour, A., Bulik, C. M., & Carroll, I. M. (2021). The intestinal microbiota and anorexia nervosa: Cause or consequence of nutrient deprivation. Current Opinion in Endocrine and Metabolic Research, 19, 46-51.

Dinkler, L., Taylor, M. J., Råstam, M., Hadjikhani, N., Bulik, C. M., Lichtenstein, P., … & Lundström, S. (2021). Anorexia nervosa and autism: a prospective twin cohort study. Journal of Child Psychology and Psychiatry, 62(3), 316-326.