Anorexia And Bulima Essay, Research Paper
Anorexia and Bulima Nervosa
Anorexia nervosa is a disorder of self-starvation which manifests itself in an
extreme aversion to food and can cause psychological, endocrine and gynecological
problems. It almost exclusively affects adolescent white girls, with symptoms involving a
refusal to eat, large weight loss, a bizarre preoccupation with food, hyperactivity, a
distorted body image and cessation of menstruation. Although the symptoms can be
corrected if the patient is diagnosed and treated in time, about 10-25 percent of anorexia
nervosa patients die, usually after losing a least half their normal body weight.
Anorexia nervosa patients typically come from white, middle to upper-middle class
families that place heavy emphasis on high achievement, perfection, eating patterns and
physical appearance. (There has never been a documented case of anorexia nervosa in a
black male or female.) A newly diagnosed patient often is described by her parents as a
“model child,” usually because she is obedient, compliant, and a good student. Although
most teenagers experience some feelings of youthful rebellion, persons with anorexia
usually do not outwardly exhibit these feelings, tending instead to be childish in their
thinking, in their need for parental approval, and in their lack of independence.
Psychologists theorize that the patient’s desire to control her own life manifests itself in
the realm of eating–the only area, in the patient’s mind, where she has the ability to
direct her own life.
In striving for perfection and approval, a person with anorexia may begin to diet in
order to lose just a few pounds. Dieting does not stop there, however, and an abnormal
concern with dieting is established. Nobody knows what triggers the disease process, but
suddenly, losing five to ten pounds is not enough. The anorectic patient becomes intent on
losing weight. It is not uncommon for someone who develops the disorder to starve herself
until she weighs just 60 or 70 pounds. Throughout the starvation process she either denies
being hungry or claims to feel full after eating just a few bites.
Another related form of anorexia nervosa is an eating disorder known as “bulimia.”
Patients with this illness indulge in “food binges,” and then purge themselves through
vomiting immediately after eating or through the use of laxatives or diuretics. People with
bulimia nervosa consume large amounts of food and then rid their bodies of the excess
calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising
obsessively. Some use a combination of all these forms of purging. Because many individuals
with bulimia “binge and purge” in secret and maintain normal or above normal body weight,
they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone
they know. Many individuals with the disorder remain at normal body weight or above
because of their frequent binges and purges, which can range from once or twice a week to
several times a day. Dieting heavily between episodes of binging and purging is also
common. Eventually, half of those with anorexia will develop bulimia. While on the surface
these patients may appear to be well adjusted socially, this serious disease is particularly
hard to overcome because it usually has been a pattern of behavior for a long time.
There are two major sub-types of disorders found within bulimia nervosa:
Purging Type: — The person regularly engages in self-induced vomiting or the misuse of
laxatives, diuretics, or enemas
Non-purging Type: — The person has used other inappropriate compensatory behaviors,
such as fasting or excessive exercise, but has not regularly engaged in self-induced
vomiting or the misuse of laxatives, diuretics, or enemas.
Whom Does It Affect?
Most researchers agree that the number of patients with anorexia nervosa is
increasing. Recent estimates suggest that out of every 200 American girls between the
ages of 12 and 18, one will develop anorexia to some degree. Therapists find that persons
with anorexia usually lack self-esteem and feel they can gain admiration by losing weight
and becoming thin. While most anorexia nervosa patients are female, about 6 percent are
adolescent boys. Occasionally the disorder is found in older women and in children as young
as eight years old. Some researchers believe that certain characteristics are common to
the families of persons who develop the disorder.
Although this “typical” family model may not apply to all patients, it is common to
many. Researchers describe these families as warm and loving on the surface. Evidently,
this loving atmosphere masks a series of underlying problems in which family members are
excessively involved in each other’s lives, and overly dependent on one another. Apparently,
they often are unable to deal with conflicts within the family. Either they deny that
conflicts exist, or they become so overwhelmed by numerous petty conflicts that they are
unable to recognize real problems.
What are the Symptoms?
Psychological symptoms such as social withdrawal, obsessive-compulsiveness and
depression often precede or accompany anorexia nervosa. The patient’s distorted view of
herself and the world around her are the cause of these psychological disturbances.
Distortion of body image i another prevalent symptom. While most normal females can give
an accurate estimate of their body weight, anorectic patients tend to perceive themselves
as markedly larger than they really are. When questioned, most feel that their emaciated
state (70-80 lbs.) is either “just right ” or “too fat.”
Certain reproductive functions also become impaired. In females this results in a
cessation of menstruation (amenorrhea) and the absence of ovulation. Menstruation usually
will not resume until endocrine balance is restored. Ovulation is suppressed because
production of certain necessary hormones decreases.
Profound physical symptoms also occur in cases of extreme starvation. These
include loss of head hair, growth of fine body hair, constipation, intolerance of cold
temperatures and low pulse rate.
Many differences in symptoms are apparent between anorectics and bulimics.
Anorexia nervosa patients usually are not obese before onset of their illness. Typically,
they are good students who become socially withdrawn before becoming ill and often came
from families who fit the anorexia prototype described earlier. Bulimics, on the other
hand, usually are extroverted before their illness, some are inclined to be overweight, have
voracious appetites and have episodes of binge eating. Anorexia patients often have a
better chance of returning to normal weight because their eating patterns, unlike those of
bulimics, have been altered for a relatively shorter time.
Causes and treatment of Anorexia
While the cause of anorexia is still unknown, a combination of psychological,
environmental and physiological factors are associated with development of the
disorder.In anorexia patients, improper functioning of part of the brain called the
hypothalamus which controls such activities as maintenance of water balance, regulation of
body temperature, secretion of the endocrine glands and sugar and fat metabolism, begins
to work improperly after the onset of anorexiamay result in lower blood pressure and body
temperature, a lack of sexual interest and hormonal changes resulting in amenorrhea and
reduced production of thyroid hormone. Further studies are needed, however, to
determine if anorexia patients have a biological predisposition to develop the illness.
Treatment for anorexia nervosa is usually threefold, consisting of nutritional
therapy, individual psychotherapy and family counseling. A team made up of pediatricians,
psychiatrists, social workers and nurses often administers treatment. Some physicians
hospitalize anorexia patients until they are nutritionally stable. Others prefer to work
with patients in the family setting.
But no matter where therapy is started, the most urgent concern of the physician
is getting the patient to eat and gain weight. This is accomplished by gradually adding
calories to the patient’s daily intake. If she is hospitalized, privileges are sometimes
granted in return for weight gain. This is known as a behavioral contract, and privileges
may include such desirable activities as leaving the hospital for an afternoon’s outing.
Physicians and hospital staff make every effort to ensure that the patient does not
feel overwhelmed and powerless. Instead, weight gain is encouraged in an atmosphere in
which the patient feels in control of her situation, and in which she wants to gain weight.
Individual psychotherapy is also necessary in the treatment of anorexia to help the
patient understand the disease process and its effects. Therapy focuses on the patient’s
relationship with her family, friends, and the reasons she may have fallen into a pattern of
self-starvation. As a patient begins to learn more about her condition, she is often more
willing to try to help herself recover. In cases of severe depression, drugs such as
antidepressants are part of therapy. Behavior improvement generally occurs rapidly in
these cases and the patient is able to respond more quickly to treatment.
The third aspect of treatment, family therapy, is supportive in nature. It examines
how the patient and her parents relate to each other. Persons with anorexia often become
a source of family tension because refusals to eat cause frustration in the parents. The
goal of family therapy is to help family members relate more effectively to one another, to
encourage more mature thinking in the anorectic patient and to help all family members
work together for the well-being of the patient and the family unit.
In treating anorexia, it is extremely important to remember that immediate
success does not guarantee a permanent cure. Sometimes, even after successful hospital
treatment and return to a normal weight, patients suffer relapses. Follow-up therapy
lasting three to five years is recommended if the patient is to be completely cured.