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.

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