Due to the high rate of increase in cases of disorders in food injection, especially in women who have reported severe behavioral problems with respect to food, the attention of scientists has been significantly captured. There have been two main disorders related to food that has been witnessed in adolescents and adults; anorexia nervosa, and bulimia nervosa. However, anorexia nervosa has been more pronounced with an 80% to 85% appearance in the young population, more so women between the age of 12 years and 25 years (Wozniak, Rekleiti, and Roupa 15). However, the disorder does also affect the masculine gender as well.
Anorexia nervosa, also known as anorexia, is an eating disorder characterized by inappropriate eating rituals or patterns, irrational fear of gaining weight, immoderate food restriction, distorted body self-perception, and obsession with having a thin/slim figure (Garner and Garfinkel 273). The disorder entails the excessive loss of body weight through either restricting the amount of food taken into the body in women or over-exercising in men and is often diagnosed in females than males by approximately nine times more (Garfinkel and Garner 115). In the medical field, the term anorexia refers to lack of appetite however, the majority of those affected with anorexia nervosa do not lack appetite in the real sense.
Those affected by the disorder generally look at themselves as being overweight even when they are malnourished or starved. Such people with anorexia have been observed to check on their weight more often, check on their portions of consumption, and whenever they eat, they do so selectively consuming only given types of foods (Garner and Garfinkel 273; Mayo Clinic Staff 2). It is also common for those with anorexia nervosa to go an extra mile in order to conceal their character from friends and family members by deceiving them about what they have eaten and their eating program and they may even go as far as pretending to have eaten earlier (NHS 1).
Just like other eating disorders, there is uncertainty on the main cause of anorexia nervosa. According to Stark, the majority of the people still look at them as “slimmer’s diseases” (2). As much as anorexia nervosa could develop from a strict diet, the reason for a diet transforming into an eating disorder is way beyond the intention of just losing weight. There may be confusion arising from the use of the term “anorexia” as it stands for lack of appetite which is not the case for anorexia victims as they do feel hungry but restrict themselves from food due to their fear of gaining weight to the extent that they lose their ability to eat a normal diet (Stark 3). However, there are some identified causes that are more pronounced, divided into biological and social causes.
Biological causes of anorexia nervosa
Anorexia nervosa could be caused by obstetric complications such as perinatal and prenatal complications, which include placental infarction, diabetes mellitus, neonatal cardiac abnormalities, anemia, and preeclampsia. One of the personality traits associated with the development of anorexia nervosa, harm avoidance, may be influenced by neonatal complications (Favaro, Tenconi, and Santonastaso 83). Genetically, it is believed that anorexia nervosa is highly heritable with the rate of inheritance being approximately between 56 percent and 84 percent (Kortegaard et al. 362).
In order to further examine genetic causes of anorexia nervosa, associative studies were performed on 128 different polymorphisms which were related to 43 genes including those involved in the regulation of emotions, eating habits, reward mechanics and motivation, and personal traits. Results obtained revealed existing variations in norepinephrine transporter gene promoter which was linked to restrictive anorexia nervosa (Urwinet al. 27). Anorexia nervosa has also been reported to be caused by addiction to chemicals that are released during physical activity and starving within the brain, as a result, those affected by the disorder have often reported achieving some high from starving.
Serotonin dysregulation could also result in anorexia nervosa. Alterations of 5-HT transporter, as well as 5-HT2A and 5-HT1A receptors, have been implicated in brain imaging studies. As a result, the alterations may result in changes in the control of impulse and mood as well as the hedonic and motivating aspects of feeding habits (Kaye et al. 73). Starvation has thus been hypothesized to result from the effects of serotonin dysregulation due to its effect of lowering the levels of steroid hormone and tryptophan metabolism which would thus result in a reduction in the levels of serotonin (Kaye et al. 73). Infections may also result in the development of anorexia nervosa. There are cases of abrupt development of the disorder witnessed in some people as a result of the reaction to mycoplasma or streptococcus infections.
Nutrition deficiency may also result in the development of anorexia nervosa. For instance, a shortage of zinc in the body may contribute to the development of the disorder. However, zinc is not responsible for causing the initial illness even though evidence points out at it as being the accelerating factor responsible for the deepening of anorexia’s pathology. The autoimmune system in the body has also been found to influence anorexia. For instance, the autoantibodies that are against neuropeptides such as melanocortin were found to influence personality traits that are associated with eating disorders, especially those that affect response to stress and appetite (Fetissov et al. 14865).
Social factors and media
Social factors include the effects of the media and fashion. It has been a general feeling among those who do not conform to ideals presented by media and fashion industries to diet. However, dieting may not automatically present a problem to some people, though it may result in anorexia nervosa in others. Cultural factors have also contributed to a great extent by promoting thinness, through the media, as the preferred female form and size in the Western culture and industrialized nations. The link between culture and anorexia nervosa has been significant as culture has been found to either accelerate, cause, or be an envelope determining the culture or society that anorexia is bound to appear. Dinicola argues that changes in culture may result in the emergence of anorexia in adolescent girls from immigrant families that are found in Western societies with high levels of industrialization (245).
There are also some professions that exert a lot of pressure on weight loss and thinness such as dancers and models who were found to be more likely to develop anorexia in the course of their careers. It has also been proven from research that those affected by anorexia have more contact with cultural sources that champion for loss of weight (Kaye et al. 74).In most cases, the disorder would start in the teenage years and could be a way of dealing with complicated emotions connected to transitioning from a teenager to an adult (Stark 4). Teenagers affected by the disorder would have minimal growth on their breasts and heaps which comforts them as normally they wouldn’t be prepared for such physical changes and developments (Stark 4).
According to observations made from research, female students were ten times more likely to develop anorexia nervosa as compared to the males, with a study conducted on female high school students in Japan depicting 45 percent of the students who were underweight by approximately 10% to 20% wanting to be thinner, with 85 percent of those with normal weight also wanting to be thinner (Mukai, Crago, and Shisslak 678). Due to the belief created in teenage girls that slimness is more attractive, and the concern of teenagers on their weight, weight-control behaviors have been more prominent (Mukai et al. 678).
Social influence has also contributed significantly to causing anorexia nervosa among teenage girls as they would learn from one another about the consumption of foods that are low in calories, fat content, and diet pills. As a result, cases of lack of nutrition may result pushing for higher chances of developing anorexia nervosa (Mukai et al. 679). Anorexia is also more bound to occur in populations with a prevalence of obesity. According to Lozano, anorexia nervosa could result from an evolution drive that is sexually selected in a society that size is associated with age, which implies that the thinner one is the younger they are (934). Stark argues that anorexia nervosa could also be a means of coping with difficult emotions and situations as the amount of energy that is spent by the affected on thinking about losing their weight and dieting would leave very little room for concentrating on other pressing emotions (6).
The media also plays a great role in accelerating the spread and prevalence of anorexia nervosa. The constant presentation of images depicting desirable thin models by the media also pushes for more slimming in order to conform to the standards and trends presented by the media (Stark 3). Due to the distorted vision of the world depicted by mass media, both adolescents and children have been limited in determining whether or not what they see is true or false which makes them more vulnerable to what they witness in the media. According to results obtained from a study conducted on 548 adolescent and preadolescent girls, 47 percent of the surveyed acknowledged their intention to lose weight after seeing the images published in magazines while 69 percent confessed to the influence of magazines on their perception of the ideal body size, shape, and weight (Lopez-Guimera et al. 389).
Utter et al.’s study that was conducted on a population of 4,746 adolescent girls and boys aimed at demonstrating the influence of advertisements and magazine articles on stimulation of weight management behavior, and concerns on weight. The results showed a very high probability, of approximately 70 percent, of practicing a number of harmful behaviors of controlling weight in girls who were more exposed to glamor and fashion magazines including those who perused articles on weight loss and issues related to diet. They were also found to be six times more likely to be involved in extreme unhealthy behaviors of weight control(Lopez-Guimera et al. 389). There has also been an increasing influence from websites and the internet emphasizing thinness as the ideal trend in modern society. It was observed that women who viewed such websites had at least a record of decrease in their self-esteem with reports further depicting a higher likelihood of developing negative behaviors associated with weight control, restrictive food behavior, and over-exercising.
Anorexia nervosa has far-reaching effects ranging from health effects to death. Stark argues that the number of those who have passed on as a result of anorexia nervosa has been significant, with their deaths being as a result of the direct consequence of losing weight beyond the required level or suicide (6). According to Stark, anorexia nervosa could result in underweight which may thus result in serious medical catastrophes including low blood pressure, dizziness, brittle bones, infertility/loss of periods in women, fainting, poor circulation, damage of the kidney, increase in facial hair, dehydration, low body temperature, and loss of hair (Stark 6). In case of recovery from the disorder, some effects such as damage caused to bones would remain permanent due to irreversibility.
Despite limited cases of subjective distress in the acute stages of anorexia nervosa, such effects as emotional disturbance are more pronounced and frequent majorly comprising mood symptoms and anxiety (Hugo 15). The emotional challenges are also bound to increase over time accompanied by several social and physical difficulties which include loss of personal autonomy, disintegration from leisure activities, inability to care for oneself, and interruption of a person’s educational goals (Hugo 15). These effects would impact negatively on the quality of an individual’s personal life increasing the importance and reliance on the disorder in their lives. Those affected with anorexia nervosa have also been diagnosed with common cases of depression with some studies recording prevalence of up to 63% (Hugo 15) as cited in (Herzog et al. 1992).
Hugo argues that the physical problems arising from anorexia nervosa are mainly due to two major reasons, consequences of purging behavior, or starvation (15). Cases of starvation result in severe effects in the body system with most of the effect being spread to the musculoskeletal system which would be witnessed in the loss of muscle strength which includes the heart muscles, impairment of linear growth, weakness, and reduction in the density of the bones (Hugo 15). Hugo further argues that the effect of anorexia nervosa would be even more likely to be worse in the case of young women as they would be at high risk of having bone fractures at a later stage in their lifetime (15) as cited in (Lucas et al. 1999). Target organs would also be affected as a result of the effect on the endocrine system resulting from anorexia nervosa which would thus result in loss of bone mineralization, infertility, and/or risk of polycystic ovaries (Hugo 15).
In case of incomplete development in pubertal development, chances of incomplete development of secondary sexual characteristics occurring would be on the higher side with common cases of retardation in the rate of growth being witnessed (Hugo 15) as cited in (Goldbloom and Kennedy 1995). Anorexia nervosa has also been found to cause complications in the reproductive hormones resulting in low levels of FSH and LH, raised cortical levels, resistance in the growth hormones, and suppressed TSH. Several effects of purging were also noted including long-term disabilities such as erosion of tooth enamel which could amount to the destruction of the whole dental system (Hugo 15). The appearance, comfort, and self-esteem of the affected are also interfered with due to worn painful teeth.
Hugo, as cited in (Kohn et al. 1997; Krieg, Pirke, Lauer, and Backmund 1988; Dolan, Mitchell, and Wakeling 1988) argues that brain volume is reduced in anorexia nervosa. Studies conducted on the structural changes in an adolescent’s brain after gaining full weight found traces of persistent deficits in the grey matter though the white matter was recovered (Hugo 15). As much as some of the cognitive deficits in anorexia nervosa may be restored after the recovery of weight, other abnormalities in the executive function would continue even after the process of weight recovery (Hugo 15). For instance, those with anorexia nervosa have been found to have scores above one standard deviation from the rules on tests of perpetual perseveration, rigidity, and shifting of sets (15) as cited in (Tchanturia et al. 2002).
It is argued that as much as there may be little knowledge on the effects of long term and short term loss of weight on the function of the brain and its development in children, there is a higher probability that such loss of weight may result in both long and short term damage on cognitive development and functions (Favaro et al. 86). There are also a number of difficulties bound to occur such as social difficulties resulting from the continued dependence on one’s family even after maturity into adulthood which may include such difficulties ass getting involved in intimate relationships (Favaro et al. 86; Hugo 16). Anorexia nervosa may also impact one’s employment life as a result of disruption resulting from hospitalization or limitation resulting from the disorder (Hugo 16).
Diagnosis of the disorder depends on multiple medical conditions including the presence of neurodegenerative disease, bacterial infections, brain tumors, and imbalances in the body hormones. According to Hugo, diagnosis of the disorder is greatly dependent on a history supported to be appropriate by the collaborative account of the patient’s relative or parent (18). To obtain such a history, one would have to use an empathic, non-judgmental, and supportive style of the interview which would allow the patient to open up thereby revealing the extent of their behaviors and symptoms. One of the most prominent complaints reported by the patients at first sight has been physical, including complaints of lethargy, suffering from constipation, fatigue, abdominal pains, feeling bloated, irregular menstruation, and occasional swelling of feet and hands (Hugo 19).
Cases of erosion on the dental enamel could also be observed especially on the lingual surface of the upper teeth which would be affected in most cases (Hugo 19) as cited in (Mitchell 1995). There may also be calluses observed on the back of the hand resulting from the use of hands to provoke the gagging reflex in order to cause vomiting. Metabolic alkalosis may also result from dehydration and loss of fluids due to edema, which is common in patients reporting to have used diuretics or laxatives (Hugo 19). There may also be variations in the endocrine abnormalities including blunting of the thyroid-stimulating hormone, abnormalities in the menstrual cycle, and the response of the growth hormone to the hormone-releasing thyroid (19).
Treatment of anorexia nervosa
There is no specific treatment for anorexia nervosa that works better than the rest even though there has been sufficient evidence that has proved the effectiveness of early intervention and treatment (Hugo 30). However, the treatment for this disorder has three primary objectives, to restore the patient’s required weight, to eliminate or reduce the thoughts or behaviors that may lead to the recurrence of the disorder, and to treat the psychological complications related to and/or resulting from the illness. The treatment is more concentrated on a diet, medication, therapy which is inclusive of family-based therapy/treatment, therapy on cognitive behavior, cognitive remediation therapy, and acceptance and commitment therapy (Wozniak et al. 75; Skuse 15; Kortegaard et al. 364).
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