The Psychology of Eating Disorders 1

 

Numeration added

1.         Imagine a day in which your life was dictated by the food that you ate. Imagine standing on a scale while you ate or purging after eating large amounts of food. Those with eating disorders may engage in some of these activities. Eating disorders are serious conditions that affect millions of people in the U.S. More than ninety percent of those with eating disorders are adolescent and young adult women (Eguia & Bello, 2001). Unfortunately, the consequences of eating disorders can be served and sometimes fatal. This paper will address the major characteristics and distinguishing factors of anorexia nervosa and bulimia nervosa as well as discuss assessment and treatment strategies and issues that family members may be dealing with in regards to these two disorders.
2.  
3.              There are several similar characteristics of anorexia nervosa and bulimia nervosa. Both disorders typically begin for a person in their adolescence and the majority of cases are reported with females (Eddy, Keel, Dorer, Delinsky, Franko& Herzog, 2002). Often times the consequences of these disorders can be very severe. Many of those with eating disorders suffer from major medical conditions. One in ten cases of anorexia nervosa is fatal. In addition to the fact that both eating disorders can cause medical conditions, both bulimics and anorexics share some personality characteristics. Those with either eating disorder tend to feel isolated and alone (Eddy et al., 2002). They do not want to admit that they have a problem and therefore keep the disorder to themselves. They share characteristics of impulsivity and obsessiveness traits, however, the different disorders have different levels of these two traits (Claes, Vandereycken, Vertommen, 2002).
4.  
5.              Although there are some distinct similarities between the two eating disorders, there are some criteria that distinguish the disorders. Anorexia Nervosa is a condition in which people starve or deprive themselves of food in order to control their weight (National Institute of Mental Health, 1994). One diagnostic criterion listed in the DSM-IV for anorexia states that the individual refuses to maintain a normal body weight for their respective height and age. Those suffering from anorexia have an extremely low body weight that is at least 15% of their normal body weight (National Institute of Mental Health, 1994). Another criterion in the DSM-IV is that the individual is convinced that he/she is overweight and is terrified at the idea of gaining weight. People suffering from the disorder are obsessed with food and their weight. Additional, another criterion listed in the DSM-IV for those with anorexia is that persons suffering from the disorder have a distorted idea of their body images or will not admit to having a problem with their own body weight. Some develop unusual eating habits like not wanting to eat in front of others and adhering to strict exercise routines (National Institute of Mental Health, 1994). Individuals may measure food before eating and prepare food for other but refuse to eat any themselves. In a paper titled "Anorexia and Bulimia: Early Prevention and Detection", the authors list several typical characteristics of someone with anorexia nervosa including distorted self-image, hair loss, dry skin, hypertension, cutting food into small bites, habitual calorie counting, rituals around food, social isolation, obsessive behavior, high demands placed on self and irritability (2001). The authors also cite that 40-45% of those suffering from anorexia also suffer from depression (Eguia & Bello, 2001). In addition, the DSM-IV lists that an individual must miss at least three menstrual cycles to meet the classification of anorexia. 
6.  
7.              There are two types of anorexia nervosa, restricting type and binge-eating/purging type. The restricting does not engage in binge eating or purge eating behaviors. However, the binge-eating/purging type engages in activities including self-induced vomiting and/or misuse of laxatives, diuretics, or enemas (Eddy et al, 2002). Bulimia Nervosa is also a serious eating disorder. Unlike those with anorexia, those suffering with bulimia tend to have a normal body weight (Eguia and Bello, 2001). Those suffering from bulimia eat large amounts of food and then rid themselves of the food through harmful means like self-induced vomiting, laxatives, diuretics, enemas, and excessive exercise. Bulimics engage in these activities in order to be in control of one's weight.
8.  
9.              The first criterion listed in the DSM-IV for bulimia is "recurrent episodes of binge eating" (2000). An episode is characterized by eating large amounts of food in a given period of time and also a lack of self-control in the amount of food being ingested. Once the individual eats the large amounts of food, the individual then rids themselves of the food in one of the various methods. Some people use a combination of these methods (Eddy et al., 2002). As noted in the DSM-IV, in order for one to be classified as bulimic, the binging and ridding of the food must occur at least twice a week for three months. In order to distinguish between anorexia nervosa-binge eating/purging type and bulimia nervosa, the purging/binging activities must occur outside of anorexia episodes. Another important characteristic of bulimics is they often binge in secret because they know that they eating habits are not normal. They feel guilty for their behaviors and may keep their behaviors secret until their mid-life (Eddy et al., 2002). Other characteristics of bulimics include significant fluctuations in weight, fasting, hyperactivity, preference for large portions, swallowing food in whole instead of chewing, hiding when they eat and stealing food. Like anorexics, bulimics may suffer from depression (Eddy et al., 2002). 
10.  
11.              There are two types of bulimia nervosa, purging type and non-purging type. Those suffering from purging type use some means to expel the food from their bodies either with self-induced vomiting or misuse of a diuretic drug. Those with non-purging type bulimia use some other method to maintain their weight like excessive exercising or fasting after an episode. 
12.  
13. Factors that distinguish the eating disorder from other disorders:
14.  
15.              Those suffering from anorexia and bulimia may suffer from other disorders. Both those suffering from anorexia or bulimia may additionally suffer from depression (Eddy et al., 2002). Also, those with eating disorders have been found to have links to obsessive-compulsive spectrum disorders. This is due in part to the repetitive behaviors and obsessiveness that is common among those with eating disorders (Claes, Vandereycken, Vertommen, 2002). In a study by Claes et al., the researchers found that those with anorexia nervosa restrictive type have more compulsive traits linked to cleaning activities while bulimics and anorexics binge-eating/purging types exhibit more impulsivity traits (2002). Additionally, bulimics showed more obsessive traits than anorexics. It is somewhat difficult to distinguish between anorexia binge-eating/purging type and bulimia purging type. One distinguishing component that the DSM-IV notes is that those with anorexia are at least 15% below the normal body weight for height and age, whereas those with bulimia maintain their normal weight. Those suffering with eating disorders may start with one eating disorder and then eventually have the other disorder. However, one does not have both disorders at the same time. However over half of those with anorexia will develop bulimia (Eguia & Bello, 2001).
16.  
17.              It can be somewhat difficult to detect that someone is suffering from bulimia because typically the person maintains a normal body weight (Eguia & Bello, 2001). However, some common signs for detecting bulimia include eating in secret, obsession about one's body weight and shape, fasting, significant fluctuations in weight, preference for large portions, tendency to eat quickly, lack of will power or energy, and swelling of the parotid glands, as a result of the induced vomiting. With anorexia, signs to watch out for including distorted body image, intense fear of gaining weight, rituals revolving around eating, preference for small portions, throwing out food or spitting food out, tendency to eat slowly, refusal to maintain normal body weight, irritability, and social isolation. Eguia & Bello state that if one observes some of the signs as the behavior of another, a diagnostic consultation may be necessary (2001). 
18.  
19.              Eguia & Bello also feel that it is up to teachers and schools to watch for signs in eating disorders (2001). The authors provide areas to watch out for including perfectionism, changes in personality, lack of concentration, physical activity, and sports and bathroom use. (Eguia & Bello, 2001). Teachers should note if a student is particularly concerned with have a perfect body or weight. Many students are involved in sports, however when the sole purpose of engaging in sports is to lose weight then there may be a reason for concern. One with an eating disorder may engage in physical activity in a compulsive and intense way. Those with eating disorders may have a change in personality. They may have mood swings, become depressed, withdrawn, or even display aggressive behavior (Eguia & Bello, 2001). In addition, it is important for teachers and parents to watch for signs of inability to concentrate. Those with eating disorders may become so concerned with their weight that they lack the interest to concentrate on anything else (Eguia & Bello, 2001). Finally, teachers should watch for excessive bathroom use as that may point out that one is purging.
20.  
21.              In addition to watching for warning signs, other assessment tools can be used to detect eating disorders. Clinical interviews and self-report questionnaires have also found to be helpful in assessing eating disorders (Abrams, Garner & Garfinkel, 1998). It is also to get a medical assessment when determining if one has an eating disorder (LoBuono, 2001). One particular assessment tool has been effective in detecting eating disorders with athletes. In studies done on young female athletes research has found that cognitive mapping may be useful in detecting eating disorders. This assessment tool is done by gathering information on the young athletes' understanding of disordered eating at a given time and compared to a later time (Wiginton & Rhea, 1999). The athlete is asked to write words or statements about weight concerns and unhealthy eating habits, then asked to link the words or statements using arrows to represent the relationships of the concepts. Then the trainer reads the concepts back to the athlete and seeks clarification on any concept that is unclear. When analyzing the cognitive map, it is noted how many positive statements are identified with being thin versus negative comments. A complete picture of the student's mental representation of being thin can be used with the cognitive map to assess the student (Wiginton et al., 
22.  
23.              Families may be dealing with a myriad of issues when their child has an eating disorder. Often times there is a family history of eating disorders so it is possible that others in the family are dealing with similar issues (LoBuono, 2001). It has been found that eating disorders are a learned response to stress. Therefore, there may be a high degree of stress taking place in the home (LoBuono, 2001). It has been found that families of patients with eating disorders share similar social characteristics. They tend to not handle stress and conflict well and often times do not get along with one another. Also, parents are children with eating disorders may be unaware of the control that they imposed over their children (LoBuono, 2001). Now they may feel helpless because they cannot control their child's disorder. 
24.  
25.              Parents may also be experiencing guilt and shame over the situation. They may feel that they caused the eating disorder. Parents and siblings may have made comments towards the child about her/his weight and helped to contribute to the child's self-image (Sarason & Sarason, 2002). The parents may feel embarrassed that their child has a problem. The eating disorder may cause disruption in the family due to one child's unhealthy eating habits. Other children may feel jealous that the child with the eating disorder is getting more attention from their parents. 
26.  
27.              When treating patients with eating disorders it is important to combine individual, group and family therapy and also seek the help of a nutritionist and doctor (Kirchner, 1999). The nutritionist and doctor are used to coordinate healthy eating plans and monitor medical complications (LoBuono, 2001). The primary goal of the treatment is to stabilize the patient's medical complications and nutritional status. In addition, it is important to resolve the psychosocial precipitants of the problem and redefine healthy eating habits (Kirchner, 1999). For anorexics, the goal of treatment is to get to the normal body weight and establish good eating habits. Also, it is important to address any dysfunctional behavioral regulations and other mental disorders (American Psychiatric Association, 1993). Family therapy should be used when the patient is a child in order to address any family issues that may have precipitated the disorder (Kirchner, 1999). 
28.  
29.              For both anorexia and bulimia cognitive behavioral therapy is the main form of therapy that is used to help change eating behavior. Some CBT methods include planning meals, nutritional counseling, and keeping a journal (American Psychiatric Association, 1993). Other methods used in cognitive behavior therapy for eating disorders include supervised exercise and body image therapy (Abrams, Garner & Garfinkel, 1998). For both bulimia and anorexia patients, hospitalization is often only used when outpatient treatment does not work. Charlotte LoBuono believes that hospitalization should only be used as a last resort and is necessary when patients are medically unstable (2001). Hospitalization should be used when there are serious medical problems. Medications are sometimes part of the treatment plan when there are other mental disorders like depression or anxiety is present (American Psychiatric Association, 1993). 
30.  
31.              Eating disorders are serious mental disorders that, if not taken seriously can be deadly. It is often difficult to detect that someone has an eating disorder because the main components of eating disorders are keeping the disorder private and denying that there is any problem.

            

Bibliography:

1. Abrams, K.A., Garner D.M. & Garfinkel, P.E. (1998). Handbook of Treatment for Eating Disorders. Newsletter of the American Bulimia Association, 6. American Psychiatric Association (2000). 
2.  
3. Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed., textual revisions). Washington, DC: American Psychiatric Association. American Psychiatric Association (1993). 
4.  
5. Practice guidelines for eating disorders. American Family Physician 47, 1290. Claes, L., Vandereycken, W. & Vertommen, H. (2000). 
6.  
7. Impulsive and compulsive traits in eating disordered patients compared with controls. Personality and Individual Differences 32, 707-714. Eddy, K.T., Keel, P.K., Dorer, D.J., Delinsky, S.S., Franko, D.L. & Herzog, D.B. (2001). 
8.  
9. Longitudinal comparison of anorexia nervosa subtypes. Wiley Periodicals 191-201. Eguia, R. & Bello, A. (2001). Anorexia and bulimia: early prevention and detection. Women\'s Health Collection 6, 163. Kirchner, J. (1999). Treatments for Patients with eating disorders. American Family Physician 60, 1819. LoBuono, C. (2001) 
10.  
11. Identifying and managing eating disorders. Patient Care 35, 25. National Institute of Mental Health (1994). 
12.  
13. Eating Disorders. Eating Disorders. Sarason, I.G. & Sarason, B.R. (2002). Abnormal psychology: The problem of maladaptive behavior (10th ed.). New Jersey: Prentice-Hall. 

source megaessays