Anorexia Nervosa is defined in the Gale Encyclopedia of Alternative Medicine as "an eating disorder characterized by unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV (1994), defines two subtypes of anorexia nervosa -- a restricting type, characterized by strict dieting and exercise without binge eating -- and a binge-eating/purging type, marked by episodes of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. DSM-IV defines a binge as a time-limited (usually under two hours) episode of compulsive eating in which the individual consumes a significantly larger amount of food than most people would eat in similar circumstances."
The incidence of eating disorders, especially anorexia, is increasing at a worrisome rate. During the past three decades the prevalence has increased dramatically. (Tenore) reports an overall incidence of approximately five percent of the population of the United States.
Although eating disorders generally occur in adolescents, they are now seen much more often in children and adults, including the elderly. Also, it was originally thought that only 5% of anorexics are male, but that estimate is being revised upward. The peak age range for onset of the disorder is 14-18 years, although there are patients who develop anorexia as late as their 40s. In the 1970s and 1980s, anorexia was regarded as a disorder of upper- and middle-class women, but that generalization is also changing. More recent studies indicate that anorexia is increasingly common among women of all races and social classes in the United States.
Anorexia nervosa combines pathological thoughts and behaviors about food and weight with negative emotions concerning appearance, eating and food. These thoughts, feelings and behaviors lead to changes in body composition and functioning that are the direct result of starvation. As a result, among adolescents the illness severely effects physical, emotional and social development. In addition, there is a fair amount of evidence that suggests that anorexia nervosa often co-occurs with other psychiatric disorders including depression, anxiety disorders, and obsessive-compulsive disorder. (Lock). This makes not only diagnosing anorexia nervosa, but also treating it a serious difficulty.
It is important therefore to study and understand some of the causes of anorexia nervosa and the displayed behaviors in order to provide help and support for the many people, especially adolescent girls afflicted with this condition.
There is no one simple answer for the causes of anorexia. Some or all of the following could be woven together to produce starving, stuffing and purging in someone. There are biological factors which are intertwined with psychological factors. Some personality types, such as Obsessive-Compulsive and Sensitive-Avoidant, are more vulnerable to eating disorders. Anorexics generally were described as good children- eager to please, hard working and good students. Typically they are people pleasers who seek approval and avoid conflict. It is felt that it is this striving to perfection that leads to feeling inadequate and defective. This often leads to stress and anxiety which leads to eating disorders as a way of masking or avoiding the stressful demands. People with low tolerance for change have also seemed to turn to dieting and preoccupation with weight as a coping mechanism.
Lo Buono reports that psychological risk factors for eating disorders include generalized anxiety and phobias, depression, obsessive-compulsive tendencies, and social phobia. The impulsive personality type, often seen in those who abuse drugs and alcohol, is attributed to bulimic patients. A family history of disordered eating is important as well. Eating disorders are more common among those who are perfectionists, have low self-esteem, or are overly self-critical and believe themselves to be unsuccessful or ineffective in their everyday lives.
Tied up with the psychological factors is the issue of body image and how satisfied one is with his or her own image. This is affected greatly by the society and its views on what is the ideal body image. People who are convinced that they need to lose weight will often diet rigorously, even though they have been told in counseling that they do not need to do so. The diet becomes even more of a problem since it alters the body chemistry which then can prolong the disorder. So-called fad dieting can trigger a kind of physiologic binge/purge cycle. These diets restrict food intake, resulting in a decrease of the body's metabolic rate. People then go back to consuming normal amounts of food, although it is now stored as fat instead of being utilized as a source of nutrients. Weight gain follows, causing them to limit their food consumption more than they did before. Patients who strictly adhere to a low-fat eating plan may also place themselves at risk for an eating disorder, albeit unknowingly they may not be getting the necessary amount of fat, which may then cause them to binge on large amounts of high-fat food in order to meet their dietary fat requirement. Genetics have also been implicated in pre-disposing a person to anorexia nervosa.
The second group of factors that could result in eating disorders is the family. Some anorexia patients feel smothered by the family others feel abandoned, misunderstood or alone. Families of patients with eating disorders seem to share some particular social characteristics. Usually they do not handle conflict well and tend not to get along with one another. When the children are subjected to their parents' high expectations of achievement and success they may hide their doubts, fear, anxieties or imperfections by manipulating their weight and food. In addition, parents who overvalue physical appearance or make critical comments, even in jest, about their children's appearance may be unwittingly causing their children to seek solace in eating disorders. And it may not only be the family, but other members of the society who are creating pressures about physical appearance, for example, an appearance-obsessed friend or partner or a peer group.
A combination of family and psychological factors is the issue of childhood sexual abuse and its relationship to eating disorders. (Wonderlich et al. 1277-1283) reports studies which have found significant associations between a history of childhood sexual abuse and disturbances in eating. He also notes that "although the relationship of eating disturbances and other forms of child maltreatment has not received the amount of empirical attention seen in the childhood sexual abuse literature, there is evidence that eating disturbances may be linked to a history of childhood physical."
The third factor which contributes to the occurrence of eating disorders is the influence of the media. People are flooded by media words and images, hours of TV every day, dozens of magazines and many movies. In all these forms of media happy and successful people are almost always portrayed as actors and models who are young and thin. In contrast, stupid or evil people are usually portrayed by actors who are fat and unkempt. Many ads carry a subtle message that the only way to be acceptable in society is to buy their products and look like their models.
Hittner) reports that by age nine girls are becoming more preoccupied with shape and size. She blames this preoccupation on continual exposure to very thin women, such as the ones seen in magazines and on television-" just look at the actresses who star in TV shows popular with preteens, such as Friends, Party of Five, or Beverly Hills 90210. In between the story lines and ad copy is the message that if you want to be happy and successful than you need to be thin."
Fouts) described a study carried out to look at the effect of modeling and vicarious reinforcement in the television programs that pre- and young adolescents view. The study examined the body images and dieting behavior that central female characteristics in situation comedies model for young viewers and the positive and negative verbal comments that these characteristics received regarding their bodies. Fouts postulated that "repeated exposure to female characters' modeling the thin ideal may be particularly detrimental for individuals predisposed to developing an eating disorder such as anorexia nervosa. Not only do thin models present body images that young viewers may internalize and use to judge and motivate themselves, they may also model the means (e.g., dieting) for achieving unrealistic body shapes." The results were summarized thus-"the present study provides evidence that the thin female ideal is clearly presented in the types of television programs that older children and young adolescents predominantly view. Young viewers not only observe the modeling of thin female characters, but also observe their success in receiving positive comments from males. They also observe dieting and negative verbalizations indicating low self-esteem."
It is obvious that there is a strong emotional component to this eating disorder. (Heitger-Casbon) tells her story of how she overcame anorexia nervosa. But the beginnings of the tale indicated the emotional battle that perhaps started the problem. She says, "My story began 14 years ago, when I was 12 years old. I was an awkward middle-schooler who desperately…