Anorexia Nervosa (An) Is Blamed

Anorexia nervosa (an) is blamed on many factors, including media images of ultra-thin models and actresses, family conflicts, and genetics. The first case was recorded in 1689, suggesting that genetics and family issues are involved (DeAngelis, 2002). Symptoms can include distorted body image, very low body weight, obsession with losing weight, fear of food and gaining weight, excessive exercise, purging, and amenorrhea (Hatch & al, 2010). Of course anorexia is just one form of eating disorder; experts from the National Association of Eating Disorders claim that as many as 10 million Americans are suffering from some form of eating disorder "at any given time" (Novotney, 2009), and today it is estimated that up to 13% of patients are male. Anorexia often gets worse with time or develops into bulimia, and consequences can include osteoporosis, infertility, dental erosion, and death (Novotney, 2009). This life-threatening illness is often difficult to treat so much research has been devoted to determining the root causes and possible treatments. However, as Lock and Fitzpatrick (2009) have noted, until recently most of the research among psychologists has focused on adult patients rather than children or adolescents, and this is a problem because eating disorders most often develop during childhood and adolescence. Therefore, finding the best treatment for anorexia will likely require more intensive research on children and adolescents (Lock & Fitzpatrick, 2009). Moreover, this type of approach will likely yield a much higher success rate for treatment since the disorder can become highly resistant to improvement by the time a patient reaches adulthood (Lock & Fitzpatrick, 2009). "Nipping it in the bud" will likely require early intervention.

Etiology

Very recent research suggests that an may be more genetically determined than previously thought (Hatch & al, 2010). One 2010 study found a link between an and dysfunctions in emotional processing that are likely genetic (Hatch & al, 2010). Other researchers believe the disorder has a genetic basis because the incidence rate is actually low considering societal pressures to be thin, it often runs in families, it is resistant to treatment, and it has a "typical age of onset" (Hatch & al, 2010). In addition, there are biological reasons why the habits involved in the day-to-day life of someone with an are difficult to break. As Kanarek et al. found in a 2009 study on rats, food restriction leads to the need for increased exercise in order for the brain to produce sufficient endogenous opioids for feelings of well-being; in turn, the increased exercise becomes an addiction leading to severe withdrawal upon discontinuation (Kanarek & al, 2009). In addition, self-starvation can lead to addictive feelings of euphoria as the body "gives up" on receiving adequate nutrition and hunger decreases as a result of the release of internal opiates (Lucas, 2004).

In another study on over 2,100 female twins that hypothesized a link between an, heredity, and a predisposition for depression, researchers did find a 58% heritability estimate for comorbid depression with an (Wade & al, 2000). However, regardless of the degree of genetic basis, the fact that an so often begins in childhood or adolescence lends credence to therapeutic approaches focusing on issues involved within families and during the difficult stages of "growing up." Researchers already know that family dynamics associated with an include "enmeshment, rigidity, and lack of conflict resolution" (Rhodes & al, 2009).

Therapy

In truth, family therapy does have a consistently higher success rate among patients who have had symptoms of an for less than three years, when compared to individual therapy (Rhodes & al, 2009). Researchers first began studying family dysfunction as a cause for an in the 1970s, and in the 80s Maudsley developed an integrative family therapy approach based on evidence from "randomized control trials" (Rhodes & al, 2009). This particularly helpful approach was developed in the United Kingdom and promotes long-term success despite being a short-term, outpatient family therapy program (DeAngelis, 2002). In general, the Maudsley treatment approach calls for parents and siblings to take an active role in the patient's day-to-day eating habits and emotional support (Rhodes & al, 2009). Food intake must be increased gradually until menstruation returns; this step is followed by a reintroduction to normal adolescent activities such as socializing and dating (Rhodes & al, 2009). Other forms of family therapy used to treat an include structural, systemic, narrative, and multi-family (Lock & Fitzpatrick, 2009). Individual psychotherapies utilized in the treatment of an include psychodynamic, interpersonal, cognitive behavioral, developmentally oriented, cognitive remedial, and dialectical (Lock & Fitzpatrick, 2009). In addition, nutritional therapy is often necessary to balance body and brain chemistry before improvement can take place (Lock & Fitzpatrick, 2009).

Prevention

Since an can be so difficult to treat after onset, some researchers are focused on possible measures to prevent the development of eating disorders in the first place, and some of their findings are highly promising (Novotney, 2009). For example, a 2008 study of nearly 500 adolescent girls with poor body image found a 60% reduction in the development of eating disorder symptomology among those who participated in intervention activities (Novotney, 2009). Preventive interventions were based on the theory of cognitive dissonance and required young women to express criticisms of society's ultra-thin female ideal through various individual and group exercises (Novotney, 2009). This suggests that at the middle school and high school levels, parents, teachers, and counselors may be able to counteract some harmful media messages about thinness and self-esteem by guiding girls to think critically about the "unattainable ideal" presented for female beauty (Novotney, 2009). Even at the elementary school level, researchers have found a reduction in the development of eating disorders among children who participated in web-based activities designed to promote healthy eating and positive body image (Novotney, 2009).

Current Research on Treatments

As a result of research finding a link between an and unconscious, disturbed emotional responses, scientists and psychologists are studying possible pharmacological or psychotherapeutic treatments that counter negative automatic emotional responses (Hatch & al, 2010). As far as therapy, this will involve patient practice in repeating positive responses to replace negative-response habits (Hatch & al, 2010).

Other research is underway for the treatment of older, more resistant an patients, or those in areas without a lot of treatment options or facilities (Novotney, 2009). For patients in rural areas, partially web-based therapies are being studied; for adult women, couples therapy is being tested as a replacement for the family therapy useful with younger patients (Novotney, 2009). The couples therapy is based on cognitive-behavioral methods proven effective for other issues such as addictions and anxiety disorders (Novotney, 2009).