Anorexia

Anorexia Literature Review HSC 4134 Donniesha Desue

Abstract

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Anorexia is a popular eating disorder that many young women have been suffering from in the United States for the longest. Eating disorders represent a significant public health concern, because they are associated with serious medical and psychiatric morbidity, role impairment and often go undertreated (Grange, Swanson, Crow and Merikanges (2012). Many young women feel that they do not fit Americas portrayal of perfect bodies and this eventually leads to anorexia. This paper will include articles that explain the history of Anorexia and how it became so popular among young adults. Also, the many characteristics that make up Anorexia will be discussed. In this literature review, you will find out where Anorexia is most popular and what age groups it mostly occurs in. This literature review will help readers understand the importance on why it is healthy for individuals to love themselves for who they are. This paper will also cover the treatments and the medical aspects of anorexia.

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Most young adolescents feel that they need to be thin based on what they see in the media or in society. In the early 1970s, social scientists and feminists argued that women had desires for slender bodies were the cause of their bodies (Cheney 2010). The most relevant eating disorder that has been considered a culture-bound syndrome is Anorexia nervosa (Cheney 2010). Eating disorders now affect women across the world from different ethnic backgrounds and cultures. In the article Most girls want to be skinny: body dissatisfaction among ethnically diverse women, it states that African American women, Latinas and minority women commonly do not suffer from body dissatisfaction. Also, the articles states that they rarely suffer from eating disorders, this is due to their sociocultural statuses. Anorexia Nervosa is a lifethreatening illness that may has negative impacts on a persons physical, emotional and social development according to (Jones, Volker, Lock, Taylor, and Jacobi 2012). Anorexia usually begins in the early to mid-adolescence and it has a prevalence of 0.5-0.7 % in the general population according to (Jones, Volker, Lock, Taylor, and Jacobi 2012). Many women feel that being thin is a way that they can gain acceptance in society. Some women believe that they have to be thin in order to be a part of a higher social class (Cheney 2010). Women that felt separated from peer groups, communities and American society believed that being skinny offered them some sense of belonging. In society you have women who desire Hollywood movie stars and other celebrities just for their physical appearance. It has been stated that appearance standards play major roles in body dissatisfaction in the United States and Western European according to (Forbes, Jung, Vaamonde, Omar, Paris and Formiga 2012). The main factors that contribute to a womans body dissatisfaction as well as eating behaviors are social, cultural and historical factors (Cheney 2010). Also in the article, it states that women use

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their body to express meanings and to show their identities. Being that women use their body for a sense of belonging, it is easy to see how food refusal is forced by profound anxieties (Cheney 2010). Anorexia Nervosa can be very severe and sometimes often long-term. This eating disorder can also be considered as a chronic mental illness that is linked with morbidity and mortality (Gentile 2010). The medical consequences from individuals with anorexia nervosa involve metabolic and physiological changes. These changes are carried out in the starvation states or from purging behaviors. Anorexia Nervosa occurs more in women than in men; approximately 5-8% of the patients are males (Gentile 2010). The fundamental characteristics for anorexia nervosa are accurate weight and height measurements. It is not easy to diagnose anorexia nervosa, because of the many factors (Gentile 2010). One major factor is that anorexia differs in severity from patient to patient. Also, denial is the second major factor that makes diagnosis difficult. This major factor shows how some individuals do not believe they are ill and a loved one usually has to be the one to bring them in for treatment services. Being anorexia is when individuals have fear of gaining weight or becoming fat. People with this illness make sure they avoid fattening foods or they engage in self-induced vomiting or purging. Other things you might see an anorexic individual doing is excessive exercising, appetite suppressants or diuretics (Gentile 2010). Some of the consequences that anorexic Individuals may experience is an reduced level of estrogen in women and men lose their sexual interest. Anorexic Nervosa is normally caused in women and it usually begins during adolescence. For young women living in western countries, 0.5-1% is the risk of them possibly developing anorexia (Gentile 2010). There are early physical, psychological and behavioral signs that are easy ways to detect anorexic nervosa. The early physical signs are loss of periods,

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failure to begin menstruating, weight loss and also if BMI falls below 17.5kg/m. Some early signs of behavioral signs are excessive physical exercise, avoidance of sharing their meal times with others, eliminate foods they once enjoyed, vomiting and using laxatives. Psychological signs of anorexia nervosa include obsessive weight, unrealistic perception of being fat and if they have an extreme fear of getting fat or gaining weight. The four major risk factors of anorexia nervosa are family factors, personal factors, psychological characteristics and socio-cultural factors. Family factors play a major role in the development of the illness. For instance, low-parent contact and criticism are risk factors that may lead to young women becoming anorexic. Other examples of family factors are overinvolvement, disruptive events in life and parental psychiatric disorders. Some personal factors anorexia nervosa is infant feeding problems, restrictive dieting, childhood overweight or obesity and prematurity. Women who feel negative about themselves are showing psychological characteristics. Some examples of physiological characteristics are negative self-evaluations, perfectionism, depression and anxiety disorders. A Socio-cultural factor is when women feel like they should be thin because of what they see in the media. Women believe that society promotes thinness, because it represents popularity and success. In the article Anorexia Nervosa: identification, main characteristics and treatment, they explain the major aims in treatment for anorexia nervosa. Some of the main treatments include restoring body weight and correcting malnutrition. The article also states that correcting dysfunctional behaviors and thinking is a required. Other mandatory treatment for anorexia nervosa includes treating depression and obsessive thinking. Restoring autonomy and preventing relapse is another aim of treatment. Also, it is very important to have a supporting family member or friend. With social-physiological factors, it is stated that anorexia nervosa is the

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reaction to the demands of adolescence for more independence and increase in social/sexual activity (Wozniak, Rekleiti, Roupa 2012). Anorexia is reported higher in individuals that are biologically related to anorectic patients (Wozniak, Rekleiti, Roupa 2012). The onset of anorexia nervosa cases usually happens in the ages 13-20 years of age. Women with anorexia nervosa have higher than normal levels of personality disorders and disordered personality traits (Watters, Malouff 2012). Young women who have the illness have less desirable personality characteristics. A person with anorexia nervosa has lower emotional stability, agreeableness, outgoingness and openness. Women and males are affected by the pressures of wanting to be thin. In the United States, there are many adolescents that feel like they should be thin based off movies, television shows and magazines. Also, in the United States attractive women are considered tall and slender. For guys, the United States portray them as masculine and strong. Eating disorders and obesity are very important conditions that have short and long term consequences for comorbid disease risk, medical and psychiatric costs, quality of life and longevity (Austin, Nelson, Birkett, Calzo and Everett 2013). In the article about eating diosrders and obesity, the authors state that African American female adolescents may have some protection from participating in vomiting or diet pill to reduce weight (Austin, Nelson, Birkett, Calzo and Everett 2013). Individuals with severe anorexia have the highest mortality rate with reduced life expectancy (Hay, Touyz and Sud 2012). Severe anorexia puts a heavy burden on an individuals health. At 20 years the mortality rate is 20% and these young adults die in their 30s (Hay, Touyz and Sud 2012). The mortality rates are higher in anorexia nervosa than any other disorders. Early identification and intervention is very crucial for people suffering from the illness.

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Eating disorders are serious health issues affects your cognitive, emotional, and physical well-being. Anorexia nervosa and bulimia nervosa have self-punishing patterns and selfdestruction thoughts relating to the body and their image (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo and Worthington 2012). One of the most common treatments for eating disorders is Cognitive-behavioral therapy. With Cognitive therapy, some people are prone to relapse or respond very well to the therapy. One good technique that individuals with eating disorders should practice is self-forgiveness. Self-forgiveness helps with anxiety and depression, guilt and blame. It reduces self-punishing patterns such as criticizing, self-destruction and negative feelings about self (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo and Worthington 2012). Self-forgiveness is considered as an intrapersonal experience that helps release resentments. Mood disorders are associated with eating disoreders according to the authors (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo and Worthington 2012). Guilt, shame and worthlessness come from not being able to meet high expectations. Negative emotions are associated eating disorders, because it relates to self-forgiveness. Eating disorders relate to selfforgiveness, because having self-forgiveness increases the treatment efficacy for anorexia (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo and Worthington 2012). Individuals must be able to forgive themselves in order to have a successful recovery. Individuals who suffer from eating disorders have low-self forgiveness; this is apart of the eating disorder cycle. Eating disorders affect approximately 7.5 million women and 2.5 million men in the United States (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo and Worthington 2012). It is also stated that anorexia nervosa affects middle and upper socioeconomic classes more than it does with ethnic minorities. The two main eating disorders are anorexia nervosa and

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bulimia nervosa. Anorexia nervosa can be best characterized by volitional self-starvation (Garcia, Delavenne and Dechelotte 2011). Bulimia nervosa main characteristics are binge eating and purging behaviors. The major factors that play a major role in both of these eating disorders are shape, weight, eating and obsessional control. Atypical anorexia nervosa is a disorder that fulfill some of the features of anorexia nervosa but the diagnosis is not justified (Garcia, Delavenne and Dechelotte 2011. In the article current treatment for anorexia nervosa: efficacy, safety and adherence, SSRIs are well tolerated for anorexia nervosa. SSRIs has low rates of adverse events; however it is not stated if SSRIs prevent relapse. There is no best treatment for anorexia patients. In a study where 35,000 high school students in the United States received a self-report screening questionnaire that was based of the Eating attitudes test and 25% of the girls reported disorders in eating according to (Austin, Ziyadeh, Forman, Prokop, Keliher and Jacobs 2008). Highschool boys were also questioned in the study and 11% reported disorders in their eating habits. Many of these high school students had severe weight control symptoms and they never received any treatment. In this article, the authors (Austin, Ziyadeh, Forman, Prokop, Keliher and Jacobs 2008) state that anorexia and bulimia nervosa are associated with complications such as osteoporosis, gastrointestinal, cardiovascular and endocrine systems. In the United States, the prevalence rates of anorexia nervosa, bulimia nervosa and binge eating disorder is approximately at 0.9%, 1.5% and 3.5% for women (Austin, Ziyadeh, Forman, Prokop, Keliher and Jacobs 2008). The authors also state that men only make up 10%-25% of the entire population of anorexia or bulimia nervosa. The importance of this study was to show how all high schools are at risk for developing these eating disorders. If individuals identify these unhealthy symptoms

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and get treated immediately, they can prevent progression or reduce the risk of chronic health consequences. The two categories of anorexia nervosa are restricting and binge eating. The restricting category is the severe limitation of food intake is the main reason for weight loss. The binge eating known as purging, this is the period when self-induced vomiting, laxative abuse and excessive exercise is taking place (Cushing and Brenner 2013). The symptoms of patients with anorexia nervosa portray certain personality traits such as a desire for perfection, academic success, lack of age-appropriate sexual activity and a denial of hunger in the face of starvation (Cushing and Brenner 2013). The psychiatric characteristics consist of excessive dependency needs, developmental immaturity, social isolation, obsessive-compulsive behavior and constriction of affect (Cushing and Brenner 2013). The onset of anxiety disorders is commonly seen in patients with anorexia nervosa. People with an increased incidence of anorexia nervosa have lifelong problems of anxiety, depressive disorders and obsessive-compulsive disorder. It Is stated to be an 50-80% genetic contribution and when it is linked to high risk environments, anorexia nervosa is possibly developed (Cushing and Brenner 2013). Anorexia Nervosa is more popular in white population than any other race; however anorexia is present in all races. In the article Emergent Management of Anorexia Nervosa, anorexia nervosa has the highest mortality rates of all psychiatric disorders. Individuals who have the restricting type of anorexia are more closely associated with high risks of death. Also, in the article it stated that mortality is mostly due to suicide and not the complications of starvation. In conclusion, Anorexia mostly takes place in high schools and colleges. This eating disorder is based off of how individuals feel beauty is defined. Some women believe that being attractive means to be slim and tall. Many young girls are suffering from this disease, because they mainly

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have negative thoughts about how their bodies. Anorexia Nervosa is a disorder that negatively impacts an individuals mental health. In order to be considered mentally healthy as stated in the textbook, you have to be physically and emotionally healthy. A young girl suffering from anorexia is mentally unhealthy; she is not happy with her body and she has nothing but negative thoughts. In my opinion, I believe that United States should change the ways they portray women and young girls. If everytime women turn on the television and they only see thin beautiful girls, this leads to girls feeling like they have to be that same size. I feel like the media gives off mixed messages and it doesnt show how all sizes are beautiful. Being that women do not get to see that, all they think is that in order to be beautiful you have to be thin. If the media would portray women in different ways so it represents all race and weight sizes, eating disorders would decline. Based on the literature presented for Anorexia Nervosa, you can conclude that anorexia is mainly affecting young white women and that the rates are increasing year after year.

Austin S. Bryn., Ziyadeh J. Najat, Forman Sarah, Prookop A. Lisa & Keliher Anne. (2008) Screening High School Students for Eating Disorders: results of a National Initiative.

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Preventing chronic disease. 5:4 www.ncbi.nln.gov Bodell, P. Lindsay, Keel K. Pamela. (2010). Current Treatment for anorexia Nervosa: Effiacy, Safety and Adherence. 3: 91-108. www.ncbi.nlm.nih.gov Brenner E. Barry. Cushing A. Tracy. (2013). Emergent management of Anorexia Nervosa. Medscape. Emedicine.medscape.com Cheney, A. M. (2011). Most Girls Want to be Skinny: Body (Dis)Satisfaction Among Ethnically Diverse Women. Qualitative Health Research, 21(10), 1347. doi:10.1177/1049732310392592 Forbes, G., Jung, J., Vaamonde, J., Omar, A., Paris, L., & Formiga, N. (2012). Body Dissatisfaction and Disordered Eating in Three Cultures: Argentina, Brazil, and the U.S. Sex Roles, 66(9/10), 677-694. doi:10.1007/s11199-011-0105-3 Hay, P., Touyz, S., & Sud, R. (2012). Treatment for severe and enduring anorexia nervosa: a review. The Australian And New Zealand Journal Of Psychiatry, 46(12), 1136-1144. doi:10.1177/0004867412450469 Jones, M., Vlker, U., Lock, J., Taylor, C., & Jacobi, C. (2012). Family-based Early Intervention for Anorexia Nervosa. European Eating Disorders Review, 20(3), e137-e143. doi:10.1002/erv.2167 Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorder not otherwise specified presentation in the US population. International Journal Of Eating Disorders, 45(5), 711-718. doi:10.1002/eat.22006 Trujillo, A. E. (2012). Adolescents and Eating Disorders. Insights To A Changing World Journal, (3), 126-140.

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