Anorexia Nervosa Is a Psychological

Anorexia Nervosa is a psychological eating disorder that is characterized by a distorted body image and obsessive fear of gaining weight -- resulting in starving oneself or eating and then regurgitating food. The term was actually coined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The condition typically effects younger women, between 15 and 19 years old (40% of the cases), and has an incidence rate of about 12 cases per 100,000 persons per year. Approximately 90% of anorexia sufferers are female, and the majority of cases go either undiagnosed or untreated until other medical issues intervene (Coslin, 1999, 6-10).

Anorexia sufferers typically experience weight loss about 15% below the level of normal body weight for their age group. People suffering from the disorder are typically quite thin, but convinced they are overweight. They will often refuse to eat, take massive doses of laxatives, or indulge in excessive exercise -- all from the fear of being perceived as fat. The disorder itself is thought to be more common among members of higher socioeconomic sectors, and even more so within groups that are involved in activities in which being thin is considered a positive attribute (dancing, theater, long-distance running, modeling, etc.). Health professionals have attributed some of the psychological pressures of becoming thin to the way in which the media portrays beauty, and certainly noticed an increase in anorexic cases within the last 2-3 decades ("Anorexia: Media & Body Image," 2009).

History of Anorexia Nervosa - the history of anorexia nervosa begins with early descriptions dating from the 16th century and 17th century and the first recognition and description of anorexia nervosa as a disease in the late 19th century. In the late 19th century, the public attention drawn to "fasting girls" provoked conflict between religion and science. Such cases as Sarah Jacob (the "Welsh Fasting Girl") and Mollie Fancher (the "Brooklyn Enigma") stimulated controversy as experts weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria, superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to physicians, transforming anorexia nervosa from revered to reviled (Brumbert, 2000).

In 1873, Queen Victoria's Personal Physician, William Gull published a work entitled, "Anorexia Nervosa -- Apepsia Hysteria" in which he described four cases of the disorder to the medical community. Sir William Gull writes that Miss a was referred to him on 17th January 1866. She was aged 17 and was greatly emaciated, having lost 33 pounds. Her weight at this time was 5 stones 12 pounds (82 pounds); her height was 5 ft 5 inches. Gull records that most of her physical condition was normal, with healthy respiration, heart sounds and pulse; no vomiting nor diarrhea; clean tongue and normal urine. The condition was that of simple starvation, with total refusal of animal food and almost total refusal of everything else. Gull prescribed various remedies and variations in diet without noticeable success. He noted occasional voracious appetite for very brief periods, but states that these were very rare and exceptional. He also records that she was frequently restless and active and notes that this was a "striking expression of the nervous state, for it seemed hardly possible that a body so wasted could undergo the exercise which seemed agreeable." Miss a remained under Gull's observation from January 1866 to March 1868, by which time she seemed to have made a full recovery, having gained in weight from 82 to 128 pounds. In fact, Gull's original description still forms the basis of modern day definitions of anorexia (Madden, 2004).

(Note, will expand this historical section -- awaiting some other materials).

Definition -- a standard global definition of anorexia applies to several criteria, now adopted by the World Health Organization. They include:

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

Intense fear of gaining weight or becoming fat, even though underweight.

Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, or excessive exercise.

Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas) (WHO -- ICD, 2008).

Causes of Anorexia Overview -- Because anorexia is a complex physical and psychological disorder, it is often difficult to isolate one single cause. There are those who believe it is a genetic predisposition, those who think it is environmentally motivated, and those who even find that there are certain vitamin and mineral deficiencies present in those with predisposition to anorexia. Likely, though, it has no single cause, but is a compilation of numerous factors that, depending on the personality involved, result in the disorder.

Genetic Factors - Family and twin studies have suggested that genetic and environmental factors account for 74% and 26% of the variance in anorexia nervosa, respectively. This suggests that genes influencing both eating regulation, and personality and emotion, may be important contributing factors. In one study, variations in the norepinephrine transporter gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia (Klump, et.al., 2001).

Neurobiological factors - Anorexia may be linked to a disturbed serotonin system, particularly to high levels at areas in the brain with the 5HT1A receptor - a system particularly linked to anxiety, mood and impulse control. Starvation has been hypothesized to be a response to these effects, as it is known to lower tryptophan and steroid hormone metabolism, which might reduce serotonin levels at these critical sites and ward off anxiety. Other studies of the serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. There is evidence that both personality characteristics and disturbances to the serotonin system are still apparent after patients have recovered from anorexia. Changes in brain structure and function are early signs often to be associated with starvation, and is partially reversed when normal weight is regained. Anorexia is also linked to reduced blood flow in the temporal lobes. It is possible that it is a risk trait rather than an effect of starvation. Anorexia may be linked to an autoimmune response to melanocortin peptides which influence appetite and stress responses (Kaye, et.al., 2005).

Nutritional factors - Zinc deficiency may play a role in Anorexia. It is not thought responsible for causation of the initial illness but there is evidence that it may be an accelerating factor that deepens the pathology of the anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase compared to patients receiving the placebo (Shay and Mangian, 2000).

Psychological factors -Anorexic eating behavior is thought to originate from an obsessive fear of gaining weight due to a distorted self-image and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating. This is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person. People with anorexia nervosa seem to more accurately judge their own body image while lacking a self-esteem boosting bias. People with anorexia nervosa also have other psychological difficulties and mental illness. Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders may be the most likely conditions to be compatible with anorexia. High-levels of anxiety and depression are likely to be present regardless of whether they fulfill diagnostic criteria for a specific syndrome. Research into the neuropsychology of anorexia has indicated that many of the findings are inconsistent across studies and that it is hard to differentiate the effects of starvation on the brain from any long-standing characteristics. One finding is that those with anorexia have poor cognitive flexibility ((Jansen, et.al., 2006).