Eating Disorder Anorexia Nervosa: Causes And Treatment
Anorexia is a complex disorder that does not have a single cause but appears to result from the interaction of cultural and biological factors (Davidson, 2013). Anorexia Nervosa is caused by multiple factors but mainly through heredity, biological, psychological and social factors (Davidson, 2013). Anorexia Nervosa is hereditary. Long time ago doctors and therapists blame anorexia and other eating disorders on overly controlling parents and willful behavior of often spoiled, privileged teenagers (Shaw, n.d.). Today, research indicates that you can get anorexia from parents but only through genetics (Shaw, n.d.). During the next several years, an international group of scientists collected an astounding amount of data of family members, follow-up studies of candidate genes have identified several genes that may increase a person’s vulnerability to these disorders (Shaw, n.d.). Example, “Twin studies show that if one twin has anorexia nervosa, the other has a greater likelihood of developing the disorder. Having a close relative, usually a mother or a sister, with anorexia nervosa also increases the likelihood of other (usually female) family members developing the disorder” (Davidson, 2013).
Anorexia is caused by a biological factor. There is some evidence that anorexia nervosa is linked to abnormal neurotransmitter activity in the part of the brain that controls pleasure and appetite (Davidson, 2013). Neurotransmitters are also involved in other mental disorders such as depression. Research in this area is relatively new and the findings are unclear. People with anorexia tend to feel full sooner than other people (Davidson, 2013). Some researchers believe that this is related to the fact that stomach of people with anorexia tends to empty more slowly than normal. Others think it may be related to the appetite control mechanism of the brain (Davidson, 2013). Anorexia eating disorder is also caused by psychological factors. Certain personality types appear to be more vulnerable to developing anorexia nervosa (Davidson, 2013). Anorectics tend to be perfectionists who have unrealistic expectations about how they should look and perform (Davidson, 2013). They tend to have a black or white, right or wrong, all or nothing way of seeing situations (Davidson, 2013). Many anorectics lack a strong sense of identity and instead take their identity from pleasing others (Davidson, 2013). Virtually all anorectics have low self worth (Davidson, 2013).
Anorexia Nervosa is also caused by social factors. Anorectics are more likely to come either from overprotective families or disordered families where there is a lot of conflict and inconsistency (Davidson, 2013). Either way, the anorectic feels a need to be in control of something, and that something becomes body weight (Davidson, 2013). The family often has high, sometimes unrealistic and rigid expectations (Davidson, 2013). Often something stressful or upsetting triggers the start of anorexic behaviors (Davidson, 2013). This may be as simple as a family member teasing about the person’s weight, nagging about eating junk food, commenting on how clothes fit, or comparing the person unfavorably to someone who is thin (Davidson, 2013). Life events such as moving, starting a new school, breaking up with a boyfriend, or even entering puberty and feeling awkward about one’s changing body can trigger anorexic behavior (Davidson, 2013). Overlaying the family situation is the unrelenting media message that thin is good and fat is bad; thin people are successful, glamorous, and happy, fat people are stupid, lazy, and failures (Davidson, 2013).
Anorexia Nervosa eating disorder is significantly more common in young women than in young men and is the second most common mental health disorder in adolescent girls (Wood and Knight, 2019). I believe that people use a stigma that states that girls should be skinny as it is more sexy which leads them to starve themselves. For example, a client who is anorexic might feels like she is too big and constantly watch model TV shows where she sees a lot of skinny girls get commented and she thinks that they look more attractive than her because she has more weight than them and hardy get comment. Commenting on my diagnostic criteria, this client might feel like she is overweight or is thin but still concerned that certain body parts, particularly the abdomen, buttocks, and thighs, are too fat. She may employ a variety of techniques to evaluate her body size or weight, including frequent weighing, obsessive measuring of body parts, and persistent use of a mirror to check for perceived areas of fat. Research shows that stigma is a wall that can lead to a cycle of low self esteem and additional insecurities which could potentially lead to isolation, preventing someone from seeking proper support and help (Morgan, 2014). Research also shows that weight stigma poses a significant threat to psychological and physical health (Morgan, 2014). There is still a commonly held view that an eating disorder is a lifestyle choice and that recovery means dropping some negative behavior (Morgan, 2014).
Family problems can also arise because of the rapid loss of weight. Example, the parents of the client with anorexia nervosa may be constantly worried about how much weight their child is losing because they know that it is very unhealthy for her and she might not be eating a proper diet as well. She might also not want to listen to her parents as they try to explain to her what is wrong with the way she is going about to lose weight. Commenting on the diagnostic criteria, when her parents notices rapid weight lose in their child, she is either lacking insight into or deny that it is a problem. Studies found that Anorexia nervosa affects not only the subject’s relation to food but also her relation to others and especially to her parents (Lacoste, 2017). The anorexia nervosa subject would use as a tool for her eating disorder and bodily shape to address others, to manifest her distress or her desire, to put the others, and especially the parents, in a position to answer or to do something for her distress (Lacoste, 2017). Anorexia nervosa type patients presented significantly lower mentalization levels and lower quality of current relationships with their parents compared with non-eating disorder controls (Lacoste, 2017). When the verbal dialog seems to be difficult, the adolescent would choose another communication tool. Additionally, the adolescent could also try to take power from her parents by her eating behavior (Lacoste, 2017).
A client with Anorexia Nervosa may participate in multiple physical activities. Example, the client might have been working non stop every day by going to the gym, hiking, swimming and attending dance classes to loss weight. This makes it hard for them to control engaging in these activities when seeking help from a professional. Commenting on the diagnostic criteria, a client with anorexia nervosa show excessive levels of physical activity. Increases in physical activity often precede onset of the disorder, and over the course of the disorder increased activity accelerates weight loss. During treatment, excessive activity may be difficult to control, thereby jeopardizing weight recovery. Research shows that hyperactivity is a frequent symptom in the course of anorexia nervosa (Achamrah, Coëffier & Déchelotte, 2016). Furthermore, recent experimental studies established a link between anorexia nervosa and hyperactivity, suggesting the existence of commonalities in neural pathways, most likely in the nucleus accumbens, a brain structure involved in the reward system and feeding behavior (Achamrah, Coëffier & Déchelotte, 2016). Some other studies have reported that anorexia nervosa patients with hyperactivity report higher levels of anxiety, depression, and perfectionism, higher levels of anhedonia, higher self-esteem but lower body esteem, and lower levels of reward dependence and novelty seeking (Achamrah, Coëffier & Déchelotte, 2016).
A client with Anorexia may misuse substances to cope with issues resulting from anorexia. Example, the client might use alcohol or unprescribed drugs incorporated with her diet and exercising to cope with depression and anxiety that is caused by her disorder which is also making her lose weight in the process. Commenting on the diagnostic criteria, the client with anorexia nervosa may misuse medications, such as by manipulating dosage, in order to achieve weight loss or avoid weight gain. From a research, the root causes of eating disorders and drug addiction are similar (Carolyn, 2015). Research suggests a strong genetic component to both, as well as links to certain chemical processes in the brain, personality traits such as impulsivity, social pressures, family dynamics, media messages, environmental triggers and emotional trauma (Carolyn, 2015). Eating disorders and addictions constantly develop during stressful times in an effort to cope with difficult emotions or to self-medicate underlying mental health issues such as depression or anxiety (Carolyn, 2015). Compared to 9 percent of the general population, up to 35 percent of drug abusers have eating disorders, compared to 3 percent of the general population (Carolyn, 2015).
Nutrition rehabilitation is one of the main treatments for anorexia nervosa. Nutritional and weight restoration is a core component of many treatment programs for AN (Marzola, Nasser, Hashim, Shih & Kaye, 2013). The purpose of nutritional intervention is to increase muscle anabolism and decrease proteolysis (Achamrah, Coëffier & Déchelotte, 2016). Anorexia patients tend to eat significantly fewer calories by restricting caloric intake and avoiding calorie dense foods (Marzola, Nasser, Hashim, Shih & Kaye, 2013). They easily lose weight, and need to eat an even larger amount of food to gain weight (Marzola, Nasser, Hashim, Shih & Kaye, 2013). The start of weight gain, caloric intake should increase slowly for inpatients because the first goal is safe clinical stabilization before beginning weight gain (Marzola, Nasser, Hashim, Shih & Kaye, 2013). Refeeding is necessary because of extreme resistance, administration of nutrients should be done slowly, starting with no more than five hundred calories a day in the form of a complete liquid diet for several days, then gradually increasing the caloric load in a step wise matter (Marzola, Nasser, Hashim, Shih & Kaye, 2013).
Also, incorporating some physical activities helps because most patients with AN engage in excessive physical activities (Achamrah, Coëffier & Déchelotte, 2016). However, preserving some kind of physical activity during refeeding of patients with anorexia nervosa should be safe and beneficial for the restoration of body composition, the preservation of bone mineral density, and the management of mood and anxiety (Achamrah, Coëffier & Déchelotte, 2016). A physical rehabilitation program with refeeding is beneficial for achieving a significant weight and, moreover, functional gain (Achamrah, Coëffier & Déchelotte, 2016). Preservation or restoration of lean body mass is a key determinant of outcome, performance, and quality of life (Achamrah, Coëffier & Déchelotte, 2016). Malnutrition results from complex and multifactorial mechanisms, including inflammation, anorexia, and alterations of protein and lipid metabolism leading to cachexia. Its management requires, therefore, a multimodal approach that addresses these different mechanisms and includes nutritional supplementation, pharmacological agents (anabolic hormones, anti-inflammatory drugs, specific nutrients), and an appropriate physical exercise program, which will enable the nutritional supply to translate to lean body mass gain (Achamrah, Coëffier & Déchelotte, 2016). Studies show that patients who attended a supervised physical activity program during malnutrition treatment exhibited a reduction in exercise compulsivity and dependence (Achamrah, Coëffier & Déchelotte, 2016).
Psychotherapy is the most common treatment for anorexia and has the greatest research support they include family based treatment (Grohol, 2018). Family based treatment is commonly used for patients with anorexia nervosa. family-based treatment also called the Maudsley method, is used for adolescents and focuses upon weight gain, the treatment initially places parents in charge of making decisions about appropriate eating and related behaviors, with the support of a family therapist (Yager, 2019). FBT is divided into three phases. The first phase is focused completely on weight restoration and nutritional rehabilitation of the child by means of parental oversight and management of the food and intake, when primary caregivers are actively fighting for the child and against the eating disorder (Sterling, Crosbie, Shaw, & Martin, 2019). The second phase is achieved only after the child shows compliance with parental refeeding and appropriate weight gain. This phase includes the careful process of beginning to hand back some of the child’s involvement in food/eating as appropriate for age; autonomous eating is carefully considered in its impact on the child’s health. If the child’s attempt to feed himself or herself, whether choosing a snack or plating a meal, leads to weight loss or medical instability, caregivers are asked to step in again (Sterling, Crosbie, Shaw, & Martin, 2019). The final and briefest phase is the parental shift from banishing the eating disorder to supporting the child. This is where the child and primary caregivers address obstacles, increase autonomy in food selection and consumption, and work on relapse prevention in a more collaborative approach (Sterling, Crosbie, Shaw, & Martin, 2019).
Study aimed to explore the perspectives of young people and their parents regarding the developmental impact of AN, and the role of FBT in addressing developmental challenges (Medway, Rhodes, Dawson, Miskovic-Wheatley, Wallis, & Madden, 2018). Young people who ended FBT a minimum 1 year prior, and their parents, completed face-to-face semi-structured interviews, and data were analysed using a narrative inquiry method (Medway, Rhodes, Dawson, Miskovic-Wheatley, Wallis, & Madden, 2018). All the participants described AN as highly disruptive to adolescent development, with phase one of FBT accentuating this experience (Medway, Rhodes, Dawson, Miskovic-Wheatley, Wallis, & Madden, 2018). In phases two and three, FBT helped facilitate adolescent development in three key ways including, supporting return to adolescent pursuits, facilitating autonomy and providing freedom to develop post-FBT (Medway, Rhodes, Dawson, Miskovic-Wheatley, Wallis, & Madden, 2018).
SSW Roles and Referrals
As a social worker I will maintain the best interests of my client with anorexia nervosa as my primary professional obligation. Example, when she tells me what treatment that would work best for her to recover from her disorder, I will make sure I respect her decisions and not impose any of my decisions on her because she is the expect of her problems. I will use the information she has provided for me to find programs or organizations that would give her the services that she wants. As a social service worker I will respect the intrinsic worth of my client in my professional relationships with them. Example, I will treat my client in a caring and respectful way, being mindful of her differences and cultural and ethnic diversity while providing services that they need. As a social service worker I will carry out my professional duties and obligations with integrity and objectivity. Example, I will make sure to provide my client with all the information about the services available for her to take advantage and let her pick and choose what would work best for her. Also, I will not judge my client and I will make sure to follow my ethical responsibilities and guidelines to the best of my ability to support my client in any way possible.
As a social service worker I will have and maintain competence in the provision of a social service work service to a client. Example, when my client is receiving rehabilitation treatments based on her choice to recover from her disorder, I will make sure to follow up with her and constantly checking up on her to see if the treatment she is receiving is helping her get better or if she wants to engage in a different treatment or program that might help her. As a social service worker I will not exploit the relationship with my client for personal benefit, gain or gratification. Example, I will not accept gifts from my clients for helping her to assess the necessary services that she needed to recover from her anorexia disorder. As a social service worker I will protect the confidentiality of all professionally acquired information. I will disclose such information only when required or allowed by law to do so, or when clients have consented to disclosure. Example, when my client tells me that she wants to kill herself because her disorder interferes in her everyday life, I will let her know that we can work together to resolve the issue. Also, I will have to disclose this information to a third part so that she can get help right away. As a social worker, I will advocate change in the best interest of my client, and for the overall benefit of society, the environment and the global community. Example, when my client is not able to assess a service that would help her recover from her disorder because she does not meet some of their requirements, I will write a letter, call or send an email to the organization on behalf of my client so that she would be able to access those services.