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Eating Disorders: Anorexia Nervosa

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Eating Disorders: Anorexia Nervosa

Sandra Quick

Dr. Kathleen Dunley, Ph.D

University of Phoenix

I remember the day as if it were yesterday. My Mom and I were in a room designated for the bride and her wedding party to dress for the wedding. My Mom had tears streaming down her face, tears of joy I assumed. I was wrong; she was crying because I was 28 years old, weighed only 92 pounds and was suffering from a serious disease called Anorexia Nervosa (AN). Every day since that day in June, I struggle to prevent relapse. AN is a serious disease that effects primarily American woman usually around age14. By focusing on why an individual is affected by AN, what treatment is available, and the large number of those that relapse, this essay will show why so many people do not seek treatment, additional research is needed and so many individuals relapse.

Eating disorders are not followed by the Federal Government; therefore, no statistics show if there is an increase or if simply more patients are diagnosed. “It’s a national disgrace that we still don’t have published data on how many people have an eating disorder.” (Monroe-Striegel, 2006, p. 123), who heads the psychology department at Wesleyan University in Middletown, CT, Ninety percent of American adults are aware of at least one eating disorder. According to the Association of Anorexia Nervosa and Associated Disorders, teachers from elementary and middle schools report that over 60 percent of their students have at least one type of eating disorder. An even sadder statistic shows 42 percent of nine and ten year olds wish they were thinner (Prah, 2006).

Who is to blame for eating disorders? According to a poll conducted for National Eating Disorders Association (NEDA) by GMI, Inc. (2005), women are more likely to blame the media while men are more likely to blame a lack of willpower. NEDA states that AN is a disease affecting up to 35 million Americans. Contrary to the old stereotype, white girls from affluent families are not the only victims; men, woman, and children (as young as seven)

of any race, social environment, and income bracket also fall victim to AN (Prah, 2006). Many Americans are quick to blame the nation’s obsession with appearance on this high percentage, but professionals with experience in eating disorders, say that eating disorders are the cause of a compound blend of biological, psychological and social factors. Modern research implies that genetics may play a larger role than once thought, and research by NEDA shows that individuals may be born with a tendency to acquire an eating disorder. In 2009, a study concluded that eating disorders are linked to a history of child abuse, both sexually and emotionally (“Eating Disorders,” 2006). Experts are not completely sure what causes eating disorders, although many supporters for the victims of AN, indicate that society instills a thought of being thin in order to be beautiful.

Many individuals who suffer from AN do not seek treatment because they feel shame, others may rely on web sites who view AN as a lifestyle rather than a disease, with tips on avoiding detection. Several experts who deal with eating disorders have launched a campaign to shut these sites down. Eating disorders are real and can carry devastating health conditions. They are not a fad or a lifestyle choice. Treatment is costly and many individuals relapse within the first 17 months.

Legislative measures on AN and other eating disorders is meager in the history of Congress, with only one eating disorder bill ever passed in 1989 by a congressional declaration in the Senate, wherein “National Eating Disorders Awareness Week” was designated (Cogan, Franko, & Herzog, 2005). In April 2000, a non-profit organization, Eating Disorders Coalition for Research, Policy and Action was founded. Their mission is to develop federal recognition of eating disorders as a priority to the public. EDC has set goals to educate members of Congress and their staff, influence existing Legislation, draft new legislation, and work with key stakeholders in Federal agencies (Cogan, et al., 2005)

Between 2007 and 2013, insurance changes were made to help individuals who suffer from eating disorders, Table 1 shows the chronology:

Table 1
Chronology
| | |
|Date |Event |
| |Harvard University study finds that 25-40 percent of Americans with eating disorders are male, this exceeding |
|2/2007 |earlier estimate |
| |Wellstone-Domenici Mental Health Equity Act requires insurance companies to cover mental disorders but does not|
|10/3/2008 |specifically mandate coverage of treatment for eating disorders |
|2/25/2009 |Lawmakers introduce Federal Response to Eliminate Eating Disorders legislation, which would require insurance |
| |companies to cover treatment for eating disorders. The bill does not advance; similar legislation is introduced|
| |in 2011 |
|8/26/2011 |Court orders Blue Shield of California to cover medical expenses of anorexia patient, a victory for those |
| |seeking coverage for eating disorders |
|2/10/2010 |American Psychiatric Association recommends listing binge eating as a mental disorder. |
|8/1/2011 |British hospitals say some 5-year-olds have eating disorders |
|8/26/2011 |Court orders Blue Shield of California to cover medical expenses of anorexic patient, a victory for those |
| |seeking coverage for eating disorders. |
| |2013 |
|5/2012 |New edition of Diagnostic and Statistical Manual of Mental Disorders may include binge eating |

(Hosansky, 2011) As evidenced in Table 1, the lack of increased awareness, insurance measures, and changes with mental health diagnosis. Even though eating disorders were first discovered in the 17th Century, until recently, little has occurred to assist individuals in getting the professional help needed. Lack of insurance coverage plays a major role, treating an eating disorder can exceed $30,000 over the course of treatment; this does not include any relapse prevention treatment (Hosansky, 2011). Patient advocates are encouraging congress to require insurance companies to cover some of the costs for treatment – just like obesity (Prah, 2006). In 1996, Congress passed a mental health parity law; however, it did not restrict insurers who offer mental health coverage from billing higher costs to the insured victims of AN. Often hospitals are forced to discharge patients admitted for AN treatment much sooner, due to the guidelines set forth by insurance companies. As a result, the risk of readmission at a later date costs the insured a higher amount over a long term. Prior to the use of managed-care insurance, AN patients were allowed a hospital for a minimum of 50 days for adequate treatment, resulting in only 10 percent having to return for additional treatment. Since managed-care, patient’s average stay is only 15 days, 33 percent need to return for further treatment.

The Eating Disorders Coalition is a lobbying and advocacy group located in Washington, DC. This group says that as of 2006, over 14 million individuals are affected with some sort of eating disorder. For many of these people, getting full range coverage for these disorders is difficult, due mainly to the fact that treating eating disorders involves several specialists such as primary care physician, a therapist, a psychiatrist, and a dietician. Most privately insured patients claim that the insurance companies do not adequately provide coverage for most of the professional services needed. Insures argue that there is no clear set of rules for treatment and little research regarding the treatment of eating disorders is conducted. With the cost of health care, professionals are demanding better evidence of the effectiveness of treatment (Kulkarni, 2012).

Even with increased awareness of the severity and chronicity of AN, there are considerable voids in the knowledge to treat this disease effectively. Treatment for eating disorders is difficult because it is so individualized. There is one method that has become increasingly efficacious, the so-called Maudsley Method, which consists of deep outpatient care. The therapist works with the family and observes the patient’s individual physical symptoms, to assist in setting up a regular eating routine to follow at home until the patient gradually begins to restore their weight with the guidance of parents and family (Hosansky, 2011). This course of treatment, usually over a period of one year, is closely focused therapy, or until which time the patient begins to eat without the guidance of others and ultimately acquires a healthy self-image. Studies indicate this type of treatment can successfully treat two-thirds of anorexic patients (Hosansky, 2011). The recovery process is uncomfortable not only physically but also emotionally painful, and many patients feel overwhelmed at the thought of eating the recommended food intake each day plus snacks.

Relapse is a conjoint factor for patients with AN, with a rate ranging from 9% to 65% ("Tackling relapse among anorexia nervosa patients," 2013). According to studies, there are four major predictors associated with relapse: having binge-purge AN; a history of childhood physical abuse; higher than normal scores off the EDE-Q Eating Concern Scale;[i] and higher than normal scores on the Padua Inventory (PI) Checking Behavior scale,[ii] (International Association of Eating Disorders Professionals Foundation, 2013). The greatest risk of relapse occurs during the first year of treatment (Herzog, W., Schellberg, D., & Deter, H. 1997) (Carter, J.C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D.B., 2004). A group of experts found that subject, regardless of the treatment course they choose, remain at risk of relapse up to 17 months post treatment (Federici & Kaplan, 2008). Qualitative studies have continued to call attention to four major factors in the recovery process of AN; social support, motivation to change, sculpting an image of one’s self autonomously from the disorder and influence with relation to therapeutic alliance (Beresin, Gordon & Herzog, 1989; Cockell, Zaitsoff, & Geller, 2004; Hsu, Crisp, & Callender, 1992; Pettersen & Rosenvinge, 2002; Tozzi, Sullivan, Fear, McKenzie, & Bulik, 2003).

It is evident from this essay; the need for more attention to this expanding health threat, through local, federal and global advocacy groups, the better the chances of succeeding in eating disorders research, treatment and prevention. The EDC is a good example of people who are concerned and can collaborate together to confidently influence AN policies (Cogan, et al., 2005). Hope is one day the treatment options, decreased statistics, and relapse prevention techniques improve from what is known today.

References

Association of Anorexia Nervosa and Eating Disorders. (2006). “Eating disorders.” CQ Researcher. Retrieved from CQ Researcher Database

Beresin, E.V., Gordon, C., & Herzog, D.G. (1989). The process of recovering from anorexia nervosa. Journal of the American Academy of Psychoanalysis, 17, 103-130. Retrieved from http://www.interscience.wiley.com

Carter, J.C., Blackmore, E., & Sutandar-Pinnock, K., Woodside, D.B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34, 1-9. Retrieved from http://www.interscience.wiley.com

Cockell, S.J., Zaitsoff, S.L., & Geller, J. (2004). Maintaining change following eating disorder treatment. Professional Psychology: Research and Practice, 35, 527-534. Retrieved from http://www.interscience.wiley.com

Cogan, J. (2010, February). Eating disorders. CQ Researcher, 16(6), 138. Retrieved from http://www.eatingdisordersreview.com

Cogan, J.C., Franko, D.L., & Herzog, D.B. (2005, Winter). Federal advocacy for anorexia nervosa: An american model. Int J Eating Disorder, 37, S101-S102. Retrieved from http://www.eatingdisorderscoalition.org/documents/ModelforFedAdvocacy

Eating Disorder Coalition. (2011). “Eating disorders. CQ Researcher, (16)6, 121-144. Retrieved from CQ Researcher Database

Federici, A., & Kaplan, A.S. (2008). The patient's account of relapse and recovery in anorexia nervosa: A qualitative study. European Eating Disorders Review, 16, 1-10. doi:10.1002/erv

Herzog, W., Schellberg, D., &Deter, H. (1997). First recovery in anorexia nervosa patients in the long-term course: A discrete-time survival analysis. Journal of Counseling and Clinical Psychology, 65, 169-177.

Hosansky, D. (2011, February). Eating disorders. CQ Researcher, 16(6), 121-144. Retrieved from http://www.thecqresearcher.com

Hsu, L.K., Crisp, A.H., & Callender, J.S. (1992). Recovery in anorexia nervosa: The patient's perspective. International Journal of Eating Disorders, 11, 341-350. Retrieved from http://www.interscience.wiley.com

Kulkarni, S.S. (2012). Patients Often Find Getting Coverage for Eating Disorders is Tough. Retrieved from http://www.kaiserhealthnews.org

Monroe-Striegel, R. (2006, February). Eating Disorders, The Issues. The CQ Researcher, 16(6), 121-144. Retrieved from http://www.thecqresearcher.com

National Eating Disorders Association. (2006). "Eating disorders: The issues ." CQ Researcher. Retrieved from CQ Researcher Database

Pettersen, G., & Rosenvinge, J.H. (2002). Improvement and recovery from eating disorders; A patient's perspective. Eating Disorders, 10, 61-71. Retrieved from http://www.interscience.wiley.com

Prah, P. M. (2011, February). Eating disorders. The CQ Researcher, 16(6), 137-143. Retrieved from http://www.thecqpress.com

International Association of Eating Disorders Professionals Foundation. (2013). Tackling relapse among anorexia nervosa patients. Retrieved from http://www.eatingdisordersreview.com

Tozzi, F., Sullivan, P.F., & Fear, J.L., McKenzie, J., Bulik, C.M. (2003). Causes and recovery in anorexia nervosa: The patient's perspective. International Journal of Eating Disorders, 33, 143-154. Retrieved from http://www.interscience.wiley.com

-----------------------
[i] A measure used to assess ED approaches and actions in group and clinical inhabitants

[ii] A measure of obsessive-compulsive disorder symptom

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