Anorexia Nervosa (An) a Serious

Anorexia nervosa (AN) a serious illness which negatively affects the body and the mind of its victims (Bulik et. Al,2005). The illness is a very common eating disorder which is universally linked to emaciation as well as a marked increase in the level of physical activity. Persons with Anorexia nervosa are not capable of maintaining a normal and healthy body weight. This is because most of them drop to about 85% of their normal body weight (Bulik et al., 2005). Despite the rise in cachesis, individuals having Anorexia nervosa (AN) are largely possessed about their body weight and largely remain dissatisfied with the largeness of their own bodies. They therefore tend to be engaged in activities and behaviors that are designed to increase weight loss. Anorexia nervosa (AN) victims usually place their focus of interest on their weight and shape. They also have their body esteem intertwined with their self-esteem. In females, amenorrhea is considered a diagnostic criterion. This criterion is however considered to be unreliable as a result of the frequency with which persons with Anorexia nervosa (AN) are made to take birth control pills so as to help in regulating their menses. The difference between individuals with Anorexia nervosa (AN) and those who do not menstruate is minimal. The personalities of persons suffering from Anorexia nervosa (AN) are; perfectionism, low self-esteem obsessionality as well as anxiety.

The high morbidity as well as mortality associated with Anorexia nervosa (AN) calls for a fast response in the development of its effective treatment (Bulik et al., 2005). Agras et al. (2004) highlighted the various obstacles that are associated with the research as well as the treatment of Anorexia Nervosa. Some of these include the relatively low prevalence and incidence, the general lack of consensus on the best interventions, the variable presentations which exists within the population of patients on the basis of age as well as illness factors, the high treatment costs as well as the complex interaction of the psychiatric as well as medical problems that are associated with the illness.

The Permanente Medical Group (2004) defined Anorexia nervosa as a psychological condition which causes sufferers to restrict food in an effort of losing weight. The behavior can get out of control and cause severe weight loss. Most sufferers have a rather distorted view of their own bodies as fat regardless of how thin they may be. The sufferers are usually very sensitive on their perceived fatness are very terrified of weight gain.

The common symptoms of the illness include;

Excessive weight loss within a very short time period

Continued dieting

An usually interest on food as well as food rituals

Very little consumption of food

Obsession with exercise

Individuals with Anorexia nervosa have rather usually rituals such as the weighing of their food, cutting it into very small pieces as well as refusing to eat in the presence of other people.

It is rather uncommon for individuals with Anorexia nervosa to collect various recipes as well as prepare very elaborate meals for both family and friends without eating the food themselves.

II. Importance of Problem to Society

a. Extent of problem

In the U.S. alone, closes to ten million females as well as a million males are suffering from eating disorders such as anorexia nervosa and anorexia bulimia. Close to twenty five million more have a problem with binge eating (Fairburn et al., 1993; Hoek, 1995; Fairburn et al., 1993; Shisslak et al., 1995).

Due to the secretiveness as well as shame that are associated with the eating disorders most of the cases are never reported. This is coupled with the sub-clinical eating disorders and attitudes. For instance, Smolak (1996) indicated that close to 80% of the average American female is dissatisfied with their own appearance.

1. Females between 20 to 50 years old suffer from the illness, anorexia nervosa and the mortality rate that is associated with this illness is about twelve times more than the death rate of all other death causes (Sullivan, 1995).

2. Anorexia nervosa is noted to have the highest rate of premature fatality for all forms of mental illnesses (Sillivan, 1995).

A study conducted by Hoek and van Hoeken (2003) revealed that;

Close to 40% of the newly identified anorexia cases appear in girls aged between fifteen and nineteen years old.

There is a significant increase in the cases of anorexia from the period 1935-1989 among women aged between fifteen and twenty four.

There is a general rise in the incidents of the illness in women aged between fifteen and nineteen years old in every decade since 1930.

b. Effects on individuals, families, communities

Anorexia nervosa has been noted to affect the sufferer, families as well as the general community.

The effects of anorexia nervosa of individual

Casper (1986) in his study on the pathophysiology of anorexia nervosa noted that the illness affects women mostly. The illness is however indicated by Dryden-Edwards (n.d ) to cause psychological and behavioral effects on the sufferers. The psychological and behavioral effects have been noted to affect family and the communities as well.

The psychological and behavioral effects of anorexia nervosa include;

The sufferer may become seriously underweight which can then lead to social with withdrawal and depression

The individual may become extremely irritable and may be easily upset and may have difficulty in interacting with other people

The patient may suffer from sleep interruptions which may lead to fatigue at day time

The attention as well as concentration can reduce

Most sufferers who have anorexia usually become obsessed with thoughts of food as well as food itself. They constantly think about food and are compulsive about their eating rituals.

The other psychiatric problems that are exhibited by sufferers of anorexia nervosa are affective mood disorders and well as personality disorders

Individuals with the illness are very complaint in almost all aspects of life except with their relationship with food. The lack adequate amount of self-perception. They tend to be very eager and exhibit a heightened sense of perfection.

The symptoms of anorexia nervosa in males tend to be like the psychological problems that are observed in overweight women.

As compared with the symptoms in men, the symptoms of anorexia nervosa in women are generally associated with displeasure with their body as well as general strong feeling of becoming thin.

As a result of the growth as well as development that takes place during childhood and adolescence, the signs and symptoms of anorexia include a natural increase in their height as well as a slowed increase in the development of the general body functions.

These features have been noted to lead to general negative effects on an individual's daily activities.

The physical signs and symptoms of anorexia include;

Circulatory problems. Even though, they can be regarded as not life-threatening, the abnormally slow rate of heart beat (bradycardia) and low level of blood pressure (hypotension) are some of the most frequent manifestations of the starvation that is associated with anorexia nervosa. The general reduction in the heart capacity is however associated with severe starvation and weight loss.

III. The Causes of the Problem

Latzer, Ben-Ari, Galimidi (2002) conducted a study on anorexia nervosa on the family. Their study was however on the effects that anorexia nervosa has on younger sisters. The aim of the study was to effectively describe as well as analyze the kind of experience that sisters of patients having anorexia nervosa have. Their experience was examined critically in terms of the illness, the step sister as well as the relationship that exists within the family in coping with anorexia nervosa.

The findings indicated that the sister's emotional experience was very much affected by the illness. The findings were classified into six main categories which included; emotional process basic changes in life functions, structural processes, body image as narrative of the illness..In regards to the structural processes, the concept relates to the fact that a certain family member is ill as a crucial element of the family system. The family dynamic process relates to the emotional experience of the sister as one of duality. All of these concepts are important since they underscore the various implications of the illness in regard to the terms of putting the sister at risk of being affected by additional pathological symptoms. This study presents a detailed description, analysis and explanation of the experience of a younger sister. This helps in elucidating the risks associated with her mental and emotional functioning.

Extant literature has been dedicated to the possible causes of anorexia nervosa. Over the years, the possible causes have changed as a result of new evidence as well as discoveries. The genetic predisposition has been extensively discussed by scientists, the role of perfectionism in anorexia has also been extensively discussed using psychiatry while sociology has been used in explaining the relationship that exists between mothers and cases of anorexia. The role of media in the predisposition to anorexia is also discussed.

One of the most used debates in the study of anorexia nervosa is that of nature vs. nurture. This issue has been employed in questioning the role of genetics as well as environment in the analysis of behavior. Several researchers especially geneticists have attempted to interpret the behavior of a person on the basis of natural phenomena. The work of Strober et al. (1985,p.239) indicated that since the 19th century to date, researchers who are studying anorexia nervosa have explore several multiple causes of the illness. Through this work, Strober et al. (1985) that their scientific experiment would be crucial in suggesting that the main cause of anorexia nervosa is genetic disposition. Their study involved the directly interviewing of first degree as well as second degree relatives of several probands on various diagnoses of eating disorders as well as other forms of questions that relates to specific behaviors (p.239). The researchers chose to ask all of the relatives on issues pertaining eating habits, excessive rituals, ideal shape of body as well as patterns of weight gain and loss (p.240). The prognosis also involved noting the history of the probands as well as their relatives'.

Through the work of Hamovit Gershon et al. (1983) on anorexia and genetics, Strober et al. were able to compare their findings with the past findings. Strober at al (2000) concluded that a total of thirty five cases of eating disorders were effectively identified through relatives, and twenty one of which were among relatives of the rather anorexic probands. This indicated that anorexia nervosa is somehow familial (Strober et al.,2000).

All in all, the early symptoms of the AN were very consistent with genetic predisposition which was indicated by the study of the disorder through relatives. The female relatives of the individuals suffering from anorexia had a rather higher risk of developing various forms of eating disorder as compared to the males.

The findings of Gershon at al were almost similar with the ones of Strober et al. except in the case of statistical evidence.

On the basis of the experiments as well as results of the work of Gershon et al. (1983), the work of Strober et al. (2000) is noted as not the only commentary in the field of genetics. Because either the work of Strober et al., nor Gershon et al. (1983) provided any form of mechanisms that are responsible for the appropriate concordance that exists between the relatives of those suffering from eating disorders. The results are noted to be rather vague.

The work of Strober et al. (2000) indicated that the various familial variables are important in the development of anorexia. His colleagues however faulted this proposition.

Some of the most probable explanations for the familial anorexia are noted to include the role of the genetically transmitted defects that exists in the neurobiologic processes that control the feeding behavior. These processes are noted to be the ones that are active in the weight and eating regulation processes.

The exposure to the psychologically detrimental conditions and experiences as well as the co-transmission or the presence of certain personality traits is noted to be integral (Strober, 2000,p.245).

The work of Strober et al. (2000) on the illness shaving a genetic cause is considered one of the most recent studies in the scientific field.

The other possible cause that is closely associated with the cases of familial anorexia nervosa is perfectionism, a personality trait. IN the work of Strober et al. (2000), it was revealed that the subjects who were anorexic probands displayed ritual-like and controlling personality traits.

The traits that were exhibited had a very close resemblance with the ones identified by Halmi et al. (2000) in their psychiatry study on "the role of perfectionism as a phenotypic trait in anorexia nervosa" (Halmi et al.,2000,p.1179).

Halmi et al. (2000) discovered that the persons with anorexia nervosa exhibited levels of perfectionist personality traits that have caused the subjects to set rather high standards of individual performance.

The work of Halmi et al. And Strober et al. indicated a comparable level of personality trait for the anorexic probands. Additionally, both Halmi et al. And Strober et al. are involved in the study of anorexia nervosa in regards to genetics. They both used the family-based associations as well as linkage studies in the identification of possible genes of susceptibility that are active in the development of the condition, anorexia nervosa.

In Halmi et al. (2000) there is a proposition of that the trait of perfectionism is one of the many related phenotypic temperamental or the personality trait makers that express an element of genotypic form of vulnerability to the illness (anorexia nervosa).

The tests were given 322 women who had a long history of the illness. According to Halmi et al. (2000), the Multidimensional Perfectionism Scale is a form of questionnaire that pertains to 6 perfectionism aspects which includes personal standards, concern over mistakes, parental criticism, organizations as well as doubts over actions. The Perfectionism subscale of Eating Disorder Inventory-2 uses two questionnaires as well.

Halmi et al. (2000) et al. concluded that individuals with the illness, anorexia nervosa, got higher scores for the two assessments.

The obtained results indicated that people who suffer from anorexia nervosa are more likely to control their lives as well as adhere to strict rituals.

Hewitt at. al (1995) in their study on the perfectionism trait as well as perfectionist self-presentation in the eating disorder characteristics, attitude as well as symptoms mentioned that they believe that the anorexic persons display an element of perfectionism in all aspects of things that they do including their eating behavior.

Perfectionist is noted to never fail in everything that involves them in. They are noted to be in a constant quest to perfect their notion of ideal weight. On the basis of other studies, the work of Halmi et al. (2000) employed the results of other physicians in the comparison as well as analysis of the overall statistics.

Via comparable data as well as a comprehendible analyses as well as the approachable hypothesis the article contained one of the most fathomable explanations of how the concept of perfectionism can be an important causative factor of anorexia.

Via the analysis of the behavior of anorexia nervosa patients in scientific terms, the work of Strober et al. (2000) and Halmi et al. (2000) introduced the notion that genetics indicates a very strong correlation between several relatives as well as formation of anorexia nervosa. However, in the work of Vander Ven (2003) analyzed the illness (Anorexia Nervosa) using a sociological viewpoint. In their work, which was based on the social science discipline they concentrated on the fields of anthropology and sociology in the study of anorexia nervosa. Their objectives was to concentrate on how "mother blame' rhetoric related to anorexia, waxes and wanes and changes in form in synchrony with beliefs about the proper role of women in social life"

Their work examined the a time span that stretched from the 1940s to the present since this period indicated an increase in the number of women who entered academics as well as mental health sciences. The initial periods that were explored by the researchers were between 1940s-1950s. According to Vander Ven (2003), the eating disorder that affects children started during their infancy. Girl children who never received adequate breast-feeding from their respective mothers were noted to develop anorexia and malnutrition. This finding correlated with the work of Strober et al. which proposed that a possible cause of anorexia nervosa is mother blame' rhetoric related to anorexia, waxes and wanes and changes in form in synchrony with beliefs about the proper role of women in social life" (2000,p.245). Strober et al. And Vander Ven's work indicated that several scholars believe that the feeding preference of a mother is important in determining if their child or children would eventually develop anorexia.

On a similar note, the work of Strober et al. (2000) indicated that female relatives had a higher level of susceptibility in the development of anorexia nervosa. This has a high level of association with the work of Vander Ven on their focus just on female's mothers as the causes of anorexia nervosa.

Vander Ven's research shows that in the 1960s and 1970s, mother's displayed symptoms of depression as a result of their career. Consequently, these depressions lead to the mothers neglecting their daughters and thus fueling secondary effects. Vander Ven strongly notes anorexia nervosa as one of these external effects and therefore promotes the idea of neglectful depression as a cause of anorexia nervosa. According to Vander Ven, one of the scholars whose work dominated this time period, the families of the anorexic girls tended to be oriented towards achievement (p.105).

The work of Brusch (1977) relates closely to the work of Halmi et al. who had a strong belief that perfectionism has a form of family-based association as well as linkages. These cause a high level of gene vulnerability for the anorexia in the children (Halmi ate al,2000,p.1800).

The period that lies between 1980s as well as the present is indicative of a "double blind" in which the mothers of the rather anorexic children are strongly influenced by the dieting as well as the desire to develop a good career outside of their home.

It is obvious that if a girl child sees the dieting behavior of their mothers then they will tend to model a similar behavior which, have subsequently leads to anorexia nervosa.

According to Orbach (1988) popular culture like magazines such as magazines have an emphasis on the need for having an ideal body type. These represent a rather thin woman. Orbach (1988) postulated that mothers who are ardent followers of the media fad put a lot of pressure on themselves to be very thin a fact that creates insecurities in their children (daughters).The idea has a strong relation to the humanistic study of the forms of motivations gained from reading beauty as well as fashion magazine as well as the risk of anorexia (Thomsen et al.,2002,p.113).

A communications study in the field of humanistic discipline by Thomsen et al. (2001) explored the relationship that exists between the beauty of a woman and fashion magazines as well as their potential risks to anorexia (Thomsen et al.,2001). The study has been noted to be important since several other studies have concentrated on the potential link that exists between the frequency at which women read the fashion magazines and their level of potential anorexic risk.

The researchers of this connection have noted that the link is further complicated by the fact that women are increasingly exposed to various types of risks.

IV:Effective Strategies that Address the Problem

Extant literature has been dedicated to the study of the effective strategies in for treating Anorexia Nervosa. As a result of the high morbidity as well as mortality that are associated with Anorexia nervosa, the process of developing an effective strategy is best described as critical (Berkman et al., 2006). This is due to the fact that the frequent medical conditions, complications a well as compromises that are associated with the disease requires a practical solution that entails a comprehensive medical evaluation as well as nutritional counseling.

In a typical setting, the less medically compromised cases of Anorexia nervosa are treated on the basis of outpatients by various psychologist, psychiatrists as well as other therapists. The care is however managed by primary care providers.