Running Head: ANOREXIA NERVOSA



Running Head: ANOREXIA NERVOSA

Practical Paper: Anorexia Nervosa

Sarah Brick

Child and Adolescent Therapy

Professor Katy Araujo

10.28.05

Anorexia Nervosa

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV TR) specifies anorexia nervosa as an eating disorder. The DSM IV TRdistinguishes between two types of this disorder. These include the restricting type and the binge-eating/purging type. During an episode of anorexia nervosa the restricting type will not engage in binge-eating/ purging behavior. Rather, the restricting type achieve weight loss through dieting and exercise. The binge-eating/purging type is very different from the restricting type. The binge-eating/purging type regularly engages in binge-eating or purging behaviors through the misuse of laxatives, diuretics, enemas and /or self induced vomiting. In addition, the DSM IV TR has specified four criteria for the diagnosis of anorexia nervosa. The criteria includes the following (a) the individual refuses to maintain body weight at or above a minimally normal weight for age and height, (b) morbid preoccupation and fear of gaining weight or becoming fat even though underweight, (c) distorted perception in the way which one’s body weight or shape is experienced, self-evaluation is based on body weight or shape, and/or denial of the seriousness of low body weight, and (d) the absence of at lease three consecutive menstrual cycles. In addition, the DSM IV TR classifies being underweight as being less than 85% of the expected weight for age and height.

Major medical complications such as bradycardia, edema, osteoporosis, stunted physical development, and atrophy of the brain may occur as a result of prolonged starvation. High rates of comorbid substance abuse, mood disorders, anxiety disorders, and personality disorders are also associated with anorexia nervosa.

Research indicates a substantial number of adolescent women with eating disturbances that do not however meet the full criteria for anorexia nervosa, but would be categorized in DSM IV TR as having an Eating Disorder Not Otherwise Specified. In addition, research suggests that the younger age at onset may be indicative of better prognosis.

A compressive evaluation of a suspected eating disorder of a child or adolescent should include a plethora of assessment tools. Some of these assessment tools may include interviews between child and parents, standard eating disorder rating scales, questionnaires, nutritional and medical evaluations. Treatment begins with a confirmed diagnosis.

Treatment for anorexia nervosa is an ongoing process. More than 60% of sufferers who receive anorexia treatments will fully recover, and 20% will recover but will continue to struggle with eating disturbances.

The treatment of anorexia nervosa is multidimensional. Treatment may involve psychological, nutritional, pharmacological, and cognitive-behavioral elements. The setting in which treatment is provided varies as well. Outpatient, day patient, and inpatient treatment are the main settings in which treatment takes place. The treatment provider must evaluate if hospitalization is necessary or if the treatment will progress as an outpatient/daypatient. The first step of treatment is to restore health to the anorexic through weight gain and improved eating habits. Once the starvation process is reversed, and improved eating habits are learned, psychotherapy can begin.

In several articles, cognitive behavioral therapy and family based therapy were identified as the treatment of choice for treating anorexia nervosa. Cognitive behavior therapy and family-based therapy have not undergone systematic investigation testing their combined effectiveness. However, the lack of evidence is apparent in most all areas of adolescent and child anorexia nervosa. Aside from cognitive behavioral therapy and family-based therapy, there are other therapies that have been useful as well. Group therapy and interpersonal therapy have been effective components of the treatment of anorexia nervosa.

Cognitive behavioral therapy and family-based therapy are equally important in the treatment of anorexia nervosa. Cognitive behavioral therapy helps to reshape negative, faulty thought processes and change maladaptive behavior. Family-based therapy assists with cognitive behavior therapy in that family members can assist with accountability and learning process. Family involvement or family therapy is crucial when working with an adolescent or child anorexic. Treatments that encourage parent participation appears very effective (especially when the anorexic illness is short lived, and hospitalization was not required). Parents can take an active role by understanding their child’s disorder, holding them accountable to their healthy goals, and supporting child’s health. At this point however, research has not been able to describe the best interventions of the family.

Anorexia nervosa appears to be predominately attached to Western values and conflicts. Anorexia nervosa has been described as a culture bound syndrome. The rate of anorexia nervosa differs among cultures and changes with time as cultures evolve. Anorexia nervosa is seen predominately in industrialized, contemporary cultural groups. Traditionally anorexia nervosa is associated with Caucasian upper-socioeconomic groups. This perception is changing, however. For example Jewish, Catholic and Italian cultures place a high importance on food. This heightened awareness and importance of food may predispose these cultural groups to higher incidents of eating disorders.

Traditionally, African-Americans had lower incidents of eating disorders. It appears however that this too is changing. Research indicates that the prevalence of anorexia nervosa between African Americans and Caucasians is about the same or rising. This is attributed to the fact that thinness is gaining more value with the African-American culture, similar to that of the Caucasian culture.

Higher levels of eating disorders can be seen in other American ethnic groups as well. For example, a recent study revealed that Hispanic and Asian-American early adolescent girls had greater body dissatisfaction than Caucasian girls.

Within the United states, American culture appears to be mainstreaming into all ethnic groups, and it is this acculturations that may be responsible for the higher prevalence of anorexia nervosa and other eating disorders.

Outside of the United States, eating disorders are much rarer. Beauty and attractiveness is often attributed to plumpness which equates prosperity, fertility, and economic success. In these ethnic groups it would be absurd to purposefully starve oneself, or binge and purge. These ideologies are often developed in nonindustrialized and premodern countries.

Cultures where women have restricted social roles appear to have lower rates of anorexia nervosa. For example, in Muslim cultures the man dictates the women accordingly and eating disorders are virtually unknown.

In Hong Kong and India anorexia nervosa is observed, however it is missing one main fundamental characteristic. Fear of fatness or a desire to be thing is not their concern, rather these anorexic individuals fast for religious purposes, or by unconventional nutritional ideas.

The causes of anorexia nervosa have only been recently investigated. It appears that there is no one cause, rather the disorder can be triggered by a combination of genetic, psychological and social factors. This recent development may affect the way in which treatment is handled.

The amount of research with substantial finding pertaining to adolescent and child anorexia nervosa is limited and almost non-existent. The majority of the treatment studies have been conducted with adult participants, and their results may not be generalizable to children and adolescents with eating disorders. In addition, anorexia nervosa is rare and finding a representable sample size for studies is difficult. Therefore the research that has been conducted involves a small sample size which often results with no statistical significance. More effort should be placed on this population and ensuring empirical research.

Eating disorders affect between five to ten million females and one million males in the United States, and this rate is increasing. It seems that with a deadly disorder on the rise, more attention would be directed towards it. Based on the literature, anorexia nervosa is a disorder that needs to be given more attention but has yet to receive it. More research is needed on child and adolescent anorexics. In addition, if a more proactive approach to anorexia were present, perhaps a lower prevalence would result.

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