Eating Disorders, Depression, and Anorexia Nervosa: A Review

Introduction: Prevalence and Overview

We frequently hear about persons who suffer from diseases such as HIV/AIDS and cancer; however, what we rarely hear about are eating disorders, yet this is a disease that affects many people every year. In the past quarter century, eating disorders have become a serious matter, and a significant number of individuals have been diagnosed with them. Age-wise, more teenagers compared to other age brackets suffer from eating disorders. The pervasiveness of disordered eating has become a grave issue and is assessed to be far greater than commonly reported.

One of the primary reasons why eating disorders are a rising cause of concern is their direct link to increased depression in the disordered eater. Statistics indicate that eating disorders — which consist of illnesses such as anorexia nervosa, bulimia nervosa, binge-eating disorder, as well as atypical eating disorders — are projected to occur in approximately five to ten million young and adult females and roughly one million males in the United States (Patrick, 2002). These statistics lead one to believe that depression is not merely a symptom of eating disorders but could very easily also be a result of them. Eating disorders, as discussed further in this paper, are often a response to pressure to conform to social standards or perceptions, which, if unmet, can lead to mockery and decreased self-respect and self-esteem — in turn producing increasingly depressive behavior and attitudes.

Research done by Patrick (2002) shows that 5–10% of post-pubescent females are considered disordered eaters. It is estimated that atypical eating disorders occur in about three to six percent of middle-school-age females and in about two to thirteen percent of high-school females. For instance, studies indicate that about 10% of females aged 13 years old have admitted to using self-induced vomiting primarily in an effort to lose weight. However, eating disorders are not ailments that occur only among young and adolescent girls. Statistics indicate that women aged between 25 and 35 who attend college are assessed to engage in bingeing and purging as methods of managing weight (Patrick, 2002). All these statistics point to the need of the disordered eater to conform to what is socially acceptable, doing whatever is necessary to fit that mold — even if it means adopting a harmful diet or making oneself sick to maintain a social image.

Causal Factors of Eating Disorders

One of the causal factors of eating disorders is participation in sports. Individuals who take part in athletics such as dancing and gymnastics must maintain a small and lean body frame. Gymnasts, in particular, constantly try to lose weight in order to maintain their shape. As a result, many end up eating progressively smaller amounts of food and over-exercising their bodies to stay in shape.

Another causal factor is peer pressure and body image. In the present day, many women around the world absorb the notion from a very young age that to be beautiful and attractive, one must have a thin body. Stores, billboards, and magazines are constantly filled with images of emaciated and very slim models, which has caused numerous teenage and adolescent girls to starve themselves in order to achieve what has come to be considered the ideal figure. This has become a significant issue because many young girls fail to realize that the images in magazines are not always authentic — they have often been altered through airbrushing to make models appear ideal.

Eating Disorders and Depression

A further causal factor for eating disorders is low self-confidence or self-esteem. Many teenagers today develop disordered eating by starving themselves after being mocked for being overweight or for failing to conform to societal body image standards (Mazzeo and Bulik, 2009).

According to statistics from the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 50% of all patients diagnosed with eating disorders have a history of depression. Furthermore, binge eating affects three percent of the adult population in the United States, making it the most prevalent eating disorder. Depression also afflicts the majority of people suffering from anorexia, which is another serious eating disorder common in the United States. Individuals with anorexia nervosa do not consume sufficient amounts of food to sustain a healthy weight, and the outcomes of the associated depression can be grave. Research studies indicate that individuals suffering from anorexia have a 50 times greater likelihood, compared to the general population, of dying by suicide as a result of depression (Jaret, 2015).

It is important to note that depression may bring about eating disorders such as anorexia nervosa; however, there is also evidence suggesting that eating disorders can bring about depression. For instance, being severely underweight and malnourished — an aspect very prevalent in anorexia — can produce psychosomatic changes that are known to adversely affect mood and cause depression. Depression observed in individuals suffering from eating disorders has its own distinctive features, as the majority of those who develop eating disorders typically harbor a sense of inadequacy in relation to others or to societal expectations. They become fixated on perfectionism, which then extends to what they eat. Underlying this perfectionism, however, is anxiety and depression. More often than not, such patients have experienced significant emotional trauma (Jaret, 2015).

Conclusion

With regard to Eating Disorders Not Otherwise Specified (EDNOS), which is considered the most prevalent classification of eating disorder encountered in everyday clinical practice, it is nonetheless largely overlooked by researchers (Russell et al., 2008). It is important to note that the literature on the efficacy of treatments for bulimia nervosa and anorexia nervosa varies considerably in quality.

Anorexia nervosa can be defined as a psychosomatic illness characterized by an obsessive desire to lose weight by refusing to eat (Soanes and Stevenson, 2008). Causal factors include participation in sports such as gymnastics, low self-esteem, the pursuit of perfectionism, and social pressure to conform to a particular physical appearance. Depression also afflicts the majority of people suffering from anorexia, and being severely underweight and malnourished can produce psychosomatic changes that adversely affect mood and contribute to depression.

This literature review sought to examine anorexia nervosa while also considering the difficulties faced by nursing staff when caring for such patients, as well as the prevention and treatment of eating disorders and depression. The main theme identified across the reviewed literature is weight restoration. This theme indicates that patients suffering from anorexia nervosa and depression can have a profound fear and anxiety about gaining weight, causing them to be resistant to treatment and to the process of weight recovery. The literature recommends that nursing staff focus on low self-esteem alongside weight restoration in order to reduce the patient's fear of gaining weight. It was also acknowledged that, as adolescents are often still developing, setting a specific weight target can be challenging; accordingly, the literature suggests that a weight range, rather than a precise target, may be more appropriate in practice (Karpowicz et al., 2009).

Overall, it is clear that patients suffering from anorexia nervosa can present considerable challenges for nursing staff. Although difficulties such as those associated with weight restoration do exist, providing effective treatment to these patients remains achievable. By consistently building a trusting therapeutic relationship, addressing low self-confidence in conjunction with beginning weight restoration to decrease the fear of gaining weight (Karpowicz et al., 2009), patient compliance with care can be improved. It is therefore evident that nurse education is essential in overcoming the challenges presented by patients with anorexia nervosa and in delivering appropriate and effective treatment and care.