Eating Disorders: Anorexia

Abstract It has been stated that nearly half of all Americans personally know someone with an eating disorder. This paper will show the danger and effects of Anorexia Nervosa. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that ten percent of anorexics die within ten years after contracting the disease. Anorexia has four primary symptoms Resistance to maintaining body weight at or above a minimally normal weight for age and height. Intense fear of weight gain or being “fat,” even though underweight.

Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight, loss of menstrual periods in girls and women post-puberty.

Eighteen to twenty percent of anorexics will be dead after twenty years and only forty percent ever full recover. Treatment of an eating disorder in the US ranges from %500 per day to about $2,00 per day. The average cost for a month of inpatient treatment s about $30,00. It is estimated that individuals with eating disorders need anywhere from three o six months of inpatient care. Health insurance companies for several reasons do not typically cover the cost of treating eating disorders.

Do you ever think that right now, one percent of all women are starving themselves, some literally starving and exercising themselves to death? Eating disorders are becoming an epidemic; they are confusing, complex diseases that many people know little about. Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat.

To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. Anorexia Nervosa is described as “one of the least understood and most intractable of all mental illnesses” (Schindehette, Sandler, Nelson and Seaman, 2003, p. 136).

Many of the victims of this disease will battle it for the rest of their lives. However, if Anorexia Nervosa is diagnosed early, during the teen years, it is possible to cure it with appropriate treatment (Cooper, 2001). Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body.

Therefore, women struggling with Anorexia Nervosa need effective treatment, and after four decades of research, there is an increasing number of treatment options ranging from counseling, to nutritional therapy, to medication. Yet, some researchers and victims still advocate that there is a need for further research in this area (Kaplan, 2002; Hendricks, 2003). In order to formally diagnose an individual with Anorexia nervosa, clinicians turn to the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994). The DMS-IV lists four criteria that an individual must meet in order to be diagnosed as anorexic, generally:

A. The individual maintains a body weight that is about 15% below normal for age, height and body type. B. The individual has an intense fear of gaining weight or becoming fat, even though they are underweight. Paradoxically losing weight can make the fear of gaining even worse. C. The individual has a distorted body image. Some may feel fat all over, others recognize that they are generally thin but see specific body parts as being too fat. Their self worth is based on their body size and shape. They deny that their low body weight is serious cause for concern.

D. In women, there is an absence of at least three consecutive menstrual cycles. A woman also meets these criteria if her period occurs only while she is taking a hormone pill (Orstoff, M & Hall, L. 1999). Recognizing symptoms, such as strict dieting, weight loss, binge eating or fasting, feeling dizzy, weak, and/or depressed, in addition to insomnia; family members should seek out the advice of a health care provider.

The health care provider will take a complete medical history as well as do a physical examination (Cooper, 2001). After this process is complete, then the doctor can begin treating the patient with Anorexia Nervosa, which may include referrals to specialists in counseling, nutrition and other medical fields. One traditional forms of treatment is counseling, the goal of psychotherapy is to work with the patient so that through therapy she or he will be able to control eating and maintain body weight.

There are two primary types of psychotherapy, and they are individual therapy and family therapy. Individual therapy counsels one on one with the patient. Sometimes there is a team of medical specialists, yet the therapy sessions are between the patient and her doctor(s). This type of therapy has mixed results. According to an article in the Journal of the American Academy of Child and Adolescent Psychiatry (1999), individual therapy is superior when used in treating older adolescents and those who have late-onset Anorexia Nervosa (Robin et al.), and a 2003 publication in The American Journal of Psychiatry concurs with this finding (Pike, Walsh, Vitousek, Wilson and Bauer).

However, both articles’ findings state that individual therapy is not the best treatment for young adolescents or those with early-onset Anorexia Nervosa. While individual therapy does not work well with young adolescents or patients with early-onset Anorexia, family therapy seems to have made significant strides in treating this group of patients. In fact the Canadian Journal of Psychiatry stated, “without the involvement of the parents and family as therapeutic allies, weight gain is extremely difficult to achieve” (Geist, Heinmaa, Stephens, Davis and Katzman, 2000).

Family therapy may not only employ the assistance of parents and other family members, it can also call on schools and friends as part of the treatment strategy. One such strategy is a program called the Maudsley Method. This radically new treatment option was developed in the 1980’s at the Institute of Psychiatry and Maudsley Hospital in London.

This method “coaches parents to help their kids gain weight by whatever means necessary—by preparing their favorite foods, with 24-hour monitoring to prevent purging and hours of cajoling at the dinner table” (Schindehette, Sandler, Nelson and Seaman, 2003, p. 136). Many studies report significantly greater success with family based therapy. People magazine (2003) reports that while the mortality rates for AN still average around 5 to 20 percent, the Maudsley Method is reporting success rates as high as 90 percent five years after treatment was initially sought.

Other studies agree that family therapy is one of the best treatments for young adolescents and those with early-onset AN (Robin et al., 1999; Geist, Heinmaa, Stephens, Davis and Katzman, 2000). While individual and family therapy two of the more traditional methods of treating Anorexia Nervosa, nutritional therapy, which is called psychoeducational therapy, is also commonly used. The aim of psychoeducation is the process of giving information about the nature of the disease in hopes to cultivate behavioral and attitudinal changes in the patient.

Furthermore, a study has reported that family based psychoeducation produces the same results as family therapy while costing less (Geist, Heinmaa, Stephens, Davis and Katzman, 2000). However, these results may not be replicated with a group of older adolescents (Pike, Walsh, Vitousek, Wilson and Bauer, 2003). Medication Medication is another method used to treat AN. Using medication, pharmacological therapy, to treat AN also has some promising results.

According to European Child and Adolescent Psychiatry, “recent evidence suggests a role for medication in the relapse prevention stage of the illness” (Kotler and Walsh, 2000). Medication is commonly used along with another form of treatment, as are many of the treatments, too. This is referred to as a multidisciplinary approach. Pharmacological therapy uses medicines that help the patient reduce the fear of becoming fat, depression and anxiety as well as weight gain (Cooper, 2001).

While each of these treatments reports success in various groups or when combined with other treatments, there are still individuals who do not feel that the treatments are effective. One such person is Jennifer Hendricks who authored Slim to None, which is a book that chronicles her daily struggle with AN. Many times throughout the text Hendricks stated that she did not feel that the treatments she was receiving were of any benefit.

Christopher Athas, President of the American Institute of Anorexia Nervosa, stated in the foreword of Slim to None, “There is a glaring inadequacy of the mental health system to treat and fully understand this disease” (2003, p. ix). Eventually Jennifer lost her battle and died. The Canadian Journal of Psychiatry also states that there is a significant need to find “effective management that truly impacts on long-term outcome” (Kaplan, 2002, p. 236). Anorexia is not about feeling thin, proud or beautiful; take the time to listen to an anorexic and hear that they are feeling fat, unattractive and inadequate.

References Hall, L., & Ostroff, M. (1999). Anorexia nervosa: a guide to recovery. Carlsbad, Calif.: Gürze Books. Cooper, P. G. (2001). Anorexia Nervosa. In Clinical reference systems (Vol. 2001, pp. 107). McKesson Health Solutions. Geist, R., Heinmaa, M., Stephens, D., Davis, R., & Katzman, D. (2000). Comparison of family therapy and family group psychoeducation. Canadian Journal of Psychiatry, 45, 173-178. Hendricks, J. (2003). Slim to none. McGraw-Hill. Hester, J. (2003). Never say die. British Medical Journal, 326, 719. Kaplan, A. (2002). Psychological treatments for anorexia nervosa a review of published studies and promising new directions. Canadian Journal of Psychiatry, 47, 235-242. Kotler, L. A., & Walsh, B. T. (2000). Eating disorders in children and adolescents: Pharmacological therapies. European Child & Adolescent Psychiatry, 9, 108-116. Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., & Bauer, J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia. The American Journal of Psychiatry, 160, 2046-2049.

Robin, A. L., Siegel, P. T., Moye, A. W., Gilroy, M., Dennis, A. B., & Sikand, A. (1999). A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1482-1491.

Schindehette, S., Sandler, B., Nelson, M., & Seaman, D. (2003, December 15). Recipe for life. People, 60, 135-138.