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With the increasing presence of the ideal body image floating around in our everyday lives, many are beginning to worry about their weight. Focusing on a healthy lifestyle is not a problem and is good for one’s health. But sometimes, weight loss can take a violent turn that can lead people down the path of an eating disorder if not handled carefully.
Eating disorders can have disastrous effects on a person’s body and mind. According to the most recent statistics, anorexia nervosa has the highest mortality rate compared to the other psychiatric disorders and affects around 1 in 250 women and 1 in 2000 men. Let's explore some anorexia nervosa facts to learn more about it.
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Anorexia nervosa is a severe eating disorder that causes a person to maintain a very low weight.
A person with anorexia nervosa may reach a stage of being very underweight by over-exercising or suppressing their diet. People with anorexia often think they are overweight, even when this is not the case, and suffer from body dissatisfaction.
Weightloss, Flaticon
Psychologists have tried to characterise the symptoms of anorexia nervosa to help trained professionals such as therapists. Therapists can then use these as guidelines when diagnosing patients with eating-related disorders.
The DSM is a manual by psychologists that lists the different mental illnesses, and the characteristics that trained professionals should use to diagnose mental illnesses. According to the DSM-5, to be diagnosed with anorexia nervosa, patients must meet all of the following criteria:
Fear of becoming fat or gaining weight
Have a distorted view of themself
Restricting how much they eat to stop them from gaining weight or help them lose weight
An illustrative example of the DSM-V Manual, Sharon Thind - StudySmarter
There are different types of anorexia nervosa. However, the only difference with atypical anorexia nervosa is that the individual is not underweight, but they may still have lost a lot of weight; every other symptom is the same.
Bulimia vs anorexia nervosa
A similar eating disorder to anorexia nervosa is bulimia. The difference is that in bulimia, sufferers eat a lot over a period of time and then force themselves to get rid of the ‘excess’ calories they have eaten. They sometimes take laxatives or enemas or force themselves to vomit.
Some examples of symptoms are:
Overwhelming fears of gaining weight
Body dissatisfaction
Use of laxatives or other methods to get rid of calories after eating
Weight and height under healthy levels for their age
Lower BMI
Poor circulation
Sleep issues
Dizziness and vertigo
Frequent headaches
Digestive issues
The problem with the similarities between eating disorders is that misdiagnosis can easily occur. As a result, the individual can receive the wrong treatment, which may exacerbate their disorder and/or symptoms.
Amongst psychologists, there are disagreements of what factors cause the onset of eating disorders. For example, biological psychologists argue that our genetic makeup causes such illnesses. In contrast, psychologists who take the social approach say that our environment and experiences may cause such illnesses.
Consider the following biological explanations.
Family studies and twin studies show that genes influence the onset of eating disorders:
Research has found individuals have a higher risk of developing anorexia if an immediate family member has the same eating disorder (Strober, Freeman, Lampert, Diamond & Kaye, 2001).
Twin studies found a 56% concordance rate in Monozygotic twins (identical, have the same genes) and 5% in dizygotic twins (share 50% of the same DNA) for anorexia nervosa (Holland, Sicotte & Treasure, 1988).
Specific genes have been linked to anorexia:
We inherit our genes from our parents; a variant of the EPHX2 gene has been linked to anorexia.
Anorexia nervosa affects more women than men:
Women are more likely to report weight dissatisfaction than men.
The dual centre theory-hypothalamic dysfunction:
The hypothalamus sends signals to the brain when we are hungry. However, research has shown disruptions in neural connections in the hypothalamus. Therefore, the brain may not be able to receive hunger signals well and, over time, cause the onset of anorexia. This is related to the glucostatic hypothesis (hunger and satiety are related to short-term shifts in glucose metabolism) and the lipostatic hypothesis (the fatty-acid concentration levels in the blood control the long-term food regulation).¹
Serotonin:
Serotonin is a neurotransmitter (chemical messenger). High levels of serotonin have been associated with increased feelings of anxiety, and serotonin usually is produced with food consumption. Reducing food intake lowers serotonin levels and makes people with anorexia feel better. Furthermore, people with anorexia have increased levels of serotonin before being diagnosed with an eating disorder.
Dopamine:
Dopamine is also a neurotransmitter that is involved in reward-motivated behaviour. This theory suggests people with anorexia nervosa may have high amounts of dopamine, which causes anxiety. They may not seek pleasure, e.g. eating tasty food, so they can carry out avoidant behaviour, not eating food.
Neurodevelopmental, e.g. birth complications:
Several birth complications have been associated with anorexia, including maternal anaemia (iron deficiency), premature heart issues, and diabetes.
The chemical structure of dopamine, Flaticon
Research evidence shows that our genetic makeup is involved in the onset of anorexia. However, it is not the only factor contributing to it (Strober, Freeman, Lampert, Diamond & Kaye, 2001; Holland, Sicotte & Treasure, 1988).
If this was the case, then a 100% concordance rate in twins and family-related individuals (the likelihood of two people who share the same genes of developing the same illness/disease) should be found.
Supporting evidence has found that people with anorexia tend to have dysfunctional neurotransmitters:
Serotonin: SSRIs are a drug that works by preventing serotonin from being reabsorbed. They have not been found to work as an effective treatment for anorexia.
Although, Kaye et al. (2001) found that these effectively prevented relapse in recovered anorexic patients. This finding suggests that serotonin may be involved in the onset rather than the maintenance of the eating disorder. Still, we cannot conclusively say serotonin is the cause of anorexia. We can only say it is associated.
Dopamine: Leppanen et al. (2020) found that anomalies in the basal ganglia associated with the reward pathway and habit formation/learning exist in those with anorexia nervosa. As a result, people with anorexia may find it hard to ‘feel’ rewards, so they do not feel pleasure from eating.
There are multiple cognitive theories exploring anorexia nervosa.
Certain traits and characteristics have been associated with anorexia:
Individuals with faulty thought processes concerning their weight.
People with a perfectionist personality and high levels of self-doubt: Fairburn et al. (1999) found perfectionism to be a common trait amongst those with anorexia nervosa when compared to other psychiatric disorders. Grave importance, especially in western society, is placed on controlled eating, and self-worth is judged based on shape and weight.
Individuals exposed to cultural and media norms of the ‘idealistic, successful thin’ person.
People with these traits also tend to have faulty schemas that lead them to develop a distorted image of themself and their bodies.
The traits mentioned above can then lead to the following behaviours/cognitive approaches:
Taking an ‘all or nothing approach’ – a cognitive distortion where they see everything as black-and-white, e.g., only eat ‘good’ food and avoid ‘bad’ food. Sufferers think they are fat if they can see some fat on their body, or think they over-ate because they feel full.
Overgeneralisation – a cognitive distortion in which a person experiences or thinks of a negative experience and thinks it will be recurring in the future.
An example would be thinking: ‘I’m fat because I always eat too much’.
Catastrophic thought – a cognitive distortion where an individual overthinks a negative experience that may occur even though it is unlikely. They may also overestimate how bad an event or behaviour is or underestimate their ability to cope with a particular event.
An example would be thinking that if they eat sugar, they will gain lots of weight or that they may not be able to stop themselves.
Under this psychological pressure, the person is easily influenced and sensitive. If someone gives them positive feedback about their weight, it encourages them to continue this maladaptive behaviour. Or, if the person starts on a restrictive diet and does not lose weight, this leads to negative feedback and may cause them to believe they need to be even more restrictive.
This thinking leads to a vicious cycle and causes the individual to fear food and weight gain, called Beck’s vicious cycle (1967).
The strengths of the cognitive approach are:
Supporting evidence – Fairburn, Cooper, Doll and Welch (1999) found that before the onset of anorexia nervosa, individuals had higher levels of perfectionism and a tendency to self-evaluate compared to the control group negatively.
The definition of anorexia is that people think they are overweight when they are not. This is an example of a faulty cognitive process and shows that cognitive processes should be studied to understand anorexia.
Cognitive-behavioural therapy is the most common treatment type used for eating disorders, which shows that cognitive processes are involved in anorexia (Murphy et al., 2010).
The weaknesses of the cognitive approach are:
It focuses heavily on how people process and interpret information but disregards other factors like genetic influences or environmental factors. Therefore, the theory is reductionist.
A problem with research investigating the cognitive approach for anorexia is that it relies heavily on self-report techniques. As the approach argues that the individuals have a distorted view of themselves, the results may lack validity. This data collection method can cause ethical issues such as psychological distress.
Consider the following psychological explanations.
Family systems theory, Flaticon
Minuchin et al. (1978) applied the family systems theory to create the psychosomatic family model to explain anorexia nervosa. The model suggests poor family dynamics cause the onset of anorexia, which may cause psychological pressures/illnesses to manifest into physical illnesses.
This type of family is called the enmeshed family. The family members have an overly tight-knit relationship and are usually forced to act and think in a certain way. The model describes characteristics of the family that may lead to the onset of the eating disorder:
Autonomy – family members are too involved in each other and boundaries are normally disregarded, this can lead to anorexia nervosa as the child may try to get some level of control over their diet habits.
The child may struggle to make decisions and habits on their own and so they may have difficulties deciding what they want to eat, when they want to eat and how frequent they should eat. This could occur as they are not used to making their own decisions and these can evoke the symptoms of anorexia.
Control – family members may be overprotective and controlling.
The child may try to rebel and go against their parent by stopping to eat.
Social learning theory is concerned with how the environment acts as a good or desirable behaviour model. Observation, imitation and reinforcement are critical factors in social learning theory.
Another social influence that can contribute to the onset of anorexia nervosa is the media. The media plays a significant role in the way people internalise beliefs and attitudes about their self-image. They typically portray successful people as ‘pretty, skinny or muscular’.
People may then internalise the view that they also need to fit into these standards to succeed. Research has found that this can contribute to the onset of anorexia (Williams, Thomsen & McCoy, 2003).
Consider the study by Becker et al. (2002), where adolescent Fijian girls were exposed to television on disordered eating attitudes and behaviours. Using a multi-wave, cross-sectional design, the study compared Fijian schoolgirls before and after exposure with a 26-item eating attitudes test.
They then underwent a semi-structured interview.
They found that disordered eating behaviours and indicators were significantly more prevalent following exposure to the media source, suggesting television negatively impacts eating disorders and behaviours. Interest in weight loss was often focused on modelling themselves around the television characters. The introduction of mass media in this culture influenced eating behaviours.
Regarding the family role, Kramer (1983) found that people with eating disorders had issues with family dysfunction. This supports the theory put forward by Minuchin et al. (1978).
The treatment types used for anorexia highlight that the family plays a major role at the beginning of anorexia.
Liebman, Minuchin and Baker (1974) created a treatment programme heavily based on family therapy that did not require drug therapy.
Social learning theory is reductionist as it assumes that external factors such as the environment and the media cause anorexia. Therefore, the model ignores internal factors such as our genes and dysfunction in the brain that may cause this illness.
Social learning theory also does not explain why all women in western societies aren’t anorexic; only some women are.
It may be better to take a multifactorial approach, i.e., combine multiple approaches to explain phenomena.
An example of this is the diathesis-stress model, which suggests individuals may be genetically predisposed (vulnerable to develop) to anorexia, which psychological pressures from external forces may then trigger.
¹G. R. VandenBos, APA dictionary of psychology. American Psychological Association, 2007
Characteristics of anorexia nervosa are:
The social causes of anorexia are:
The effects of anorexia are:
The biological causes of anorexia are:
Anorexia and anorexia nervosa are often used together, implying that they mean the same thing. However, anorexia nervosa is the clinical term for the eating disorder, referring to the use of nervosa, as this is a medical term (Latin, referring to the nervous system).
This means that there is a diagnostic criterion that one must meet to suffer from anorexia nervosa.
Anorexia alone can be used to describe an aversion to food and does not have the same medical connotations.
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