Anorexia Nervosa Anorexia nervosa (AN) is an eating disorder that is characterized by the refusal to sustain a healthy weight (Kumar, Tung, & Iqbai, 2010). Many believe that anorexia is more common amongst Caucasian women, but anorexia occurs throughout all cultures and races. AN has the highest mortality rate of an psychiatric disorder (Kumar, Tung, & Iqbai, 2010). Every major organ system is affected because of the malnutrition that anorexia causes. People with anorexia look in the mirror and see a distorted image rather than what is reality. Victims of anorexia see someone that is huge when in actuality they may be average size and weight. Once a person is diagnosed with anorexia it is hard for them to recover. Not only is it hard for a person with AN to recover, it is also extremely easy to relapse. It takes intense therapy and treatment to cure someone with anorexia. AN exists in every culture and race; it varies amongst African Americans differently as opposed to other cultures.
Symptoms of anorexia include an intense fear of gaining weight, refusal to keep body weight up, and amenorrhea for 3 consecutive months (Kumar, Tung, & Iqbai, 2010). Amenorrhea is the abnormal absence of menstruation. Some other symptoms of AN are lanugo, joint swelling, dental cavities, tooth loss, and abdominal distension (Kumar, Tung, & Iqbai, 2010). Lanugo is the growth of fine white hair that grows when anorexics have no body fat left to keep themselves warm (Morrisey, 2010). There also tends to be changes in the endocrine and metabolic systems that encourage AN patients to further constrain their diet. People with anorexia have major impairments in psychological functioning, severe medical complications, and is associated with psychiatric morbidity (Carter et al., 2009). Anorexia can even cause bone loss in individuals of severe cases. It is obvious why people with anorexia could possibly suffer from bone loss because in order for a person to have strong bones they must ingest calcium, but anorexic patients barely eat anything at all. Symptoms of anorexia are terrifying and make one think, why would someone ever want to do this to their body? The treatment of AN is clinically challenging because of a lack of clear understanding of the underlying neuropsychiatric changes. Unlike other mental illnesses, effective pharmacological interventions for AN have not been identified (Kumar, Tung, & Iqbai, 2010). It is not a surprise that people with AN tend to resist treatment and still have that distorted image of themselves in their heads. Nutritional rehabilitation and weight restoration, frequently involving a period of day hospital or inpatient treatment, often constitutes the first step in the recovery process (Carter et al., 2009). There was preliminary evidence found by researchers, Pike and colleagues, that individual cognitive behavior therapy was superior to nutritional counseling in preventing relapse following inpatient weight restoration. Although there was sufficient evidence to support this study, there was another study conducted by Kaye and colleagues, that determined the antidepressant medication, fluoxetine, was superior in preventing relapse (Carter et al., 2009). The Cognitive behavioral therapy method involved three phases: strategies to address behavioral dysfunction pertaining to eating and weight that increase the risk of relapse, cognitive restructuring techniques pertaining to eating and weight, and application of a schema-based approach to address a broad range of relevant issues that extend beyond eating and weight. The results of this study concluded that the cognitive behavioral therapy method versus usual treatment may be helpful in improving the outcome and preventing relapse in comparison with treatment as usual (Carter et al., 2009). Some work has shown that there are differences in African American and Caucasian individuals seeking treatment for eating disorders. Many hypothesize that fewer African Americans will seek treatment for eating disorders than Caucasians. Treatment success rates are still insufficient. A growing literature on ethnic disparities in health care access and health outcomes highlights the importance of clinicians’ understanding the impact of sociocultural background on illness presentation and help-seeking behaviors for improving the quality of care delivered (Franko et al., 2007). This is a major factor as to why some people of different ethnic backgrounds may receive better treatment or any treatment at all. Latino Americans, Asian-Americans, and African Americans make fewer doctor visits than Caucasians and are less likely to have health insurance (Franko et al, 2007).
There are many different prevention methods taken to try and prevent anorexia. School based programs, focusing on risk factors for females with interactive elements, dissonance induction, and booster sessions are all ways to prevent anorexia (Berger et al., 2008). Many facilities have primary prevention programs aiming to reduce the risk factors of anorexia. Many prevention programs which are also referred to as interventions focus mainly on girls because they are 10 times more likely to have an eating disorder than boys (Berger et al., 2008). The most common and the most favorable setting for these prevention programs are at schools. This is one to the most favorable places for obvious reasons that include not only convenience, but a place most common for eating disorders to take place. Some earlier programs have implemented the fear appeal amongst people at risk for this disorder. These tactics are progressively becoming extinct because this approach did not show improvements in helping prevent anorexia (Berger et al., 2008). The programs that show to be most effective are: interactive, selective, multiple sessions, solely offered to females, offered to participants over 15 years of age, and delivered by professional interventionists (Berger et al., 2008). The success of prevention programs vary from patient to patient because not everyone is going to feel the same way about the prevention techniques. Adolescents who perceive family communication, parental caring, and parental expectations as being low are at increased risk for developing eating disorders (Loth, Neumark-
Sztainer, & Croll, 2009). Family aspect during adolescence can be another major factor towards preventing anorexia or other eating disorders. Many studies have shown that everyday family practices, such as their eating habits, play a major role in shaping a child’s dietary practices and may serve an important role in the development of eating disorders (Loth, Neumark-Sztainer, &
Croll, 2009). If parents constantly comment on their child’s weight, or even make weight in their household a key element of beauty; it is more than likely that that child will have an eating disorder or dietary issues. For example, a mother may make a big deal about her weight and she may even go as far as to getting cosmetic surgery, this impression is subliminally critical on the child. If the child sees their mother critical on herself about gaining weight, the child is going to do everything in their power not to even gain a pound. Things like this can have a huge impact on a child’s self esteem which may lead to anorexia or other eating disorders. According to a study, there are eight recommendations on how families can protect their children from eating disorders: 1) enhance parental support, 2) decrease weight and body talk, 3) provide a supportive home food environment, 4) model healthy eating habits and physical activity patterns, 5) help children to build self-esteem beyond looks and physical appearance, 6) Encourage appropriate expression of feelings and use of coping mechanisms, 7) increase your understanding of eating disorder signs and symptoms, 8) gain support in dealing appropriately with your own struggles (Loth, Neumark-Sztainer, & Croll, 2009). Many say everything starts within the home, if the home environment is supportive and has a good dietary routine, this could play a major role in preventing anorexia or other eating disorders.
Anorexia nervosa amongst African Americans is said not to be as common as within the Caucasian population. Although this disorder is not as common within the African
American population, epidemiologic data now indicate that eating disorders occur across ethnically and socio-economically diverse populations (Franko et al, 2007). There is so much unknown information across the ethnically diverse population in relation to eating disorders and how the distress affects each culture. There have been many reports that focus on the fact that anorexia is not necessarily more common amongst African Americans, but studies show that they have higher body dissatisfaction than white participants, but a trend toward less fear of weight gain. An explanation for the higher body dissatisfaction could be the relatively high percentage of obesity among black participants (Fernandes et al., 2010). This study also reported that no black women in a large community sample meet the lifetime criteria for AN, compared to the white women (Fernandes et al., 2010). Although African American women may have a higher body dissatisfaction percentage, another study reported that women across age and race categories are vulnerable to body dissatisfaction and disordered eating behaviors (Reel, SooHoo, Summerhays, & Gill, 2008). Heble and colleagues found that the effects of inducing a self-objectification state on the psychological and behavioral outcomes of experimental participants from ethnic backgrounds and found that African Americans have higher levels of self-esteem, more positive attitudes toward their bodies, and lower levels of self-objectification compared to other ethnic backgrounds such as Caucasians, Asian-Americans, and Hispanics (Reel, SooHoo, Summerhays, & Gill, 2008). The way Caucasian men and women think is completely opposite from the way that African American men and women think, but what black and white women do have in common is that women base their judgment of their bodies on what men of their culture desire. Caucasian men reported thinness as being more important to them in women they date than their African American counterparts (Reel, SooHoo, Summerhays, & Gill, 2008). This study also reported that African American women think that African American men prefer larger women and that African American women tend to compare their bodies with other women of the same ethnic grouping rather than media images (Reel, SooHoo, Summerhays, & Gill, 2008). This is a possible explanation to why anorexia is less common in African Americans than in Caucasians. There are so many different studies that report different results such as Caucasians are more likely to become anorexic than African Americans and vice versa. According to Wildes and Emery, these differences are greatest when sub-clinical levels of disordered eating attitudes and behaviors are measured among college samples, but smallest when clinical symptoms among community participants are the focus of analysis (Franko et al., 2007). Although there are some differences between studies, the majority of them have the report of the same pattern in saying that anorexia and other eating disorders are less prevalent in African Americans than in Caucasians. There are many different attitudes, perceptions, and opinions towards anorexia nervosa. Some studies have found that AN is frequently perceived as under the personal control of those who suffer from it. As a result, the general public often blames individuals with AN for their illness (Crisafulli, Holle, & Bulik, 2008). What many fail to realize is that anorexia nervosa is a real mental illness that affects many people in our society today. Something may have triggered anorexia in that person, but none the less it is a serious condition and should not be taken lightly. Many people believe that this type of condition is something that can be easily fixed, but like most things that is easier said than done. People with AN need serious medical attention and intense therapy so that the patient no longer fears gaining weight. It is possible to recover from this condition; most AN patients are hard to get into treatment simply because they are so fearful of gaining weight. It is estimated that 40-50% of individuals who receive treatment for anorexia will recover completely (Loth, Neumark-Sztainer, & Croll, 2009). A sample of college women, approximately two thirds “somewhat,” “moderately,” or “very much” agreed that individuals with AN have only themselves to blame for their condition. Individuals with conditions thought to be more under their control are more likely to elicit anger (rather than pity) and less likely to elicit helping behavior than those whose conditions are perceived as less personally controllable (Crisafulli, Holle, & Bulik, 2008). What many do not know is that anorexia nervosa has many biological factors that contribute to this mental illness. According to Crisafulli, Holle, & Bulik, (2008), in the study they conducted people who were presented with even minimal information about the biological and genetic underpinnings of AN did tend to blame people with AN for their condition less than are those who were only informed of the sociocultural factors that may contribute to the disorder. If people knew more about anorexia nervosa, such as the biological factors, then they would not be so quick to assume that it is a self controllable mental illness. All in all, anorexia nervosa is a serious mental illness that characterizes the refusal and the fear to gain or maintain weight. AN exists across all cultures and ethnicities, but tend to be less prevalent in African Americans and more prevalent in Caucasians. The symptoms of anorexia include fear of weight gain, amenorrhea, lanugo, bone loss, and etc. The cause for this mental illness could be many factors such as the environment in which one was raised, low self-esteem, low support system, or distorted image of oneself. Some initial treatment options are nutritional rehabilitation, weight restoration, and impatient treatment. Some have to stay in the hospital for an extended time depending on the severity of the AN condition. Prevention for this illness involves having a healthy home/dietary environment as an adolescent, being predisposed to programs and interventions, and having a good support system. Many attitudes towards anorexia indicate that many people believe that this disorder can be self controlled, but studies show that if they knew about the biological factors, they would no longer think negatively about the mental illness. Unfortunately, anorexia nervosa is becoming more prevalent amongst us all.
References
Berger, U., Sowa, M., Bormann, B., Brix, C., & Strauss, B., (2008). Primary prevention of eating disorders: Characteristics of effective programmes and how to bring them to broader dissemination. European Eating Disorders Review, 16: pp. 173-183.
Carter, J. C. et al., (2009). Maintenance treatment for anorexia nervosa: A comparison of cognitive behavior therapy and treatment as usual. International Journal of Eating Disorders, 42 (3): pp. 202-207.
Crisafulli, M. A., Holle, A. V., & Bulik, C. M., (2008). Attitudes towards anorexia nervosa: The impact of framing on blame and stigma. International Journal of Eating Disorders, 41(4): pp. 333-339.
Fernandes, N. H., Crow, S. J., Thuras, P., & Peterson, C. B., (2010). Characteristics of black treatment seekers for eating disorder. International Journal of Eating Disorders, 43(3): pp. 282-285.
Franko, D. L., Becker, A. E., Thomas, J. J., & Herzog, D. B., (2007). Cross-Ethnic differences in eating disorder symptoms and related distress. International Journal of Eating Disorders, 40(2): pp. 156-164.
Kumar, K. K., Tung, S., & Iqbai, J., (2010). Bone loss in anorexia nervosa: Leptin, serotonin, and the sympathetic nervous system. Annals of the New York Academy of Sciences. pp. 51-65.
Reel, J. J., SooHoo, S., Summerhays, J. F., & Gill, D. L., (2008). Age before beauty: an exploration of body image in African- American and Caucasian adult women. Journal of Gender Studies. 17(4): pp. 321-330.