Anorexia Nervosa Flashcards
definition of AN
a type of eating disorder in which a person, despite being underweight, fears that they might become obese and therefore engages in self-starvation or obsessive exercise to prevent this happening
symptoms
- Behavioural: a refusal to maintain a body weigh normal for age and height (weight itself is less than 85% of that expected)
- Emotional: intense fear of gaining weight, despite being underweight
- Psychological: inability to see own thinness, denial of seriousness of condition
- Physiological: loss of body weight, absence of periods for 3 consecutive months = amenorrhoea
Types
- Restricting: does not eat or purge
- Binge eating/purging: self-induced vomiting or misuse of laxatives or diuretics – however contrast with AN as body weight
Risk factors
- Hard working, high achieving
- Compliant, high need for approval
- High need for control, low tolerance of change
- Perfectionist
- Competitive environment
- Occupation associated with low weight e.g. nutritionist/fitness instructor/model/fashion
Physical risks from starvation/binging/purging
- Affects internal organs e.g. irregular heart beat and cardiac arrest
- Liver and kidney damage
- Infertility
- Bone defects
SLT explanation
- only in affluent societies
- now global
- socio-economic development –> poverty to affluence –> more TV
- media exposes successful, glamorous, happy women as SLIM
- process: attention, observation, motivation imitation
SLT Becker et al
- evaluate the impact of introduction of western television on disordered eating among ethnic Fijian adolescent girls – a relatively media-naïve population in which disordered eating previously was thought to be rare
- % of subjects with EAT-26 scores greater than 20 was 12.7% in 1995
- after the introduction of television, increased to 29.2% in 1998
- respondents living in households with a television set were more than 3 times likely to have an EAT-26 score greater than 20
- 77% reported that television had influenced their own body image
- didn’t find evidence for AN (in Hoek they did) but for disordered eating behaviour, if extreme, could lead to AN
- tv introduction exposed western culture to the Fijian adolescents showing the preference of slim bodies
- observers retain a memory of the behaviour shown on television and were then more likely to imitate the lifestyle of western women i.e. participating in restrained eating to achieve a similar body
- prospective
- reliable measuring classification system
- supported by quantitative data, whilst having all the benefits of naturalistic studies
- cross sectional design but both study populations were drawn from the same: grade levels, schools, similar with respect to ethnicity, gender, age and BMI – not high ecological validity
- extraneous variables e.g. economic or climatic might also have changed in this time
- possibility that the subjects who reported disordered eating symptoms in 1998 had experienced them even before television exposure in 1995, although unlikely
- sample size unavoidably small because of the limited population of ethnic Fijian adolescent girls attending these secondary schools
- not everyone develops an eating disorder, doesn’t explain individual differences, Hoek’s work answers this by measuring: self-identity, personality, anxiety – tried to account for individual differences, but theory still does not (put this study 1st, Hoek 2nd)
SLT Hoek at al
- Examined whether AN emerges in societies undergoing socio-economic transition
- Studied the incidence if AN on the Caribbean island Curaçao between 1995-8, where 79% of the population were identified as black (born and raised on the island)
- Contacted community health and service providers e.g. dieticians, school counsellors, general practioners
- 22 ppts identified as ‘probable-incident subjects’, were then extensively interviewed and assessed by trained interviewers according to the eating disorders section of the Structured Clinical Interview for DSM-IV
- final diagnosis was a consensus diagnosis arrived at by two members of the research team
- Found all subjects with AN had been abroad for a year or more – greater exposure to western culture, subjects observed the western idea of beauty i.e. being thin, they retain a memory and imitate the western lifestyle to achieve thinness, engaging in restrained eating
- 11 incident cases: 2 white and born in the Netherlands, 9 of mixed race
- 3 had been to the United States
- 8 had been to the Netherlands
- 7 of the 11 earned significantly more than the average for women their age
- no cases of AN among the majority black population – perhaps due to contrast in the idea of beauty i.e. big is beautiful, have not been exposed to contrasting beliefs to engage in extreme behaviour
- further support from Katzman et al studying the same population reporting the majority of those with AN had spent time overseas
- well regarded measuring system used
SLT IDA
IDA
• can account for gender differences because it is about exposure to role-models
• the increase in prevalence of AN increases support for SLT as media exposure has also been increasing
• accounts for cultural differences – high prevalence of AN in western industrialised countries than poor countries, higher proportion in immigrants to western society
• further research needed: does it explain a high incidence in socio-economic
Practical applications
• ‘transitional’ societies should encourage adolescent girls to adopt own ethnic and cultural values – would be immune to western values
Psychological explanations
- thinking processes between stimuli and response responsible for behaviour and emotion
- mental illness/ psychological abnormality –> faulty cognition
- AN - anxious, obsessive, preoccupied with looks, distorted body image
- desire for control - food intake is easy
- gain a sense of control through restricting eating and an increase in self-worth, +ve reinforces restricted eating
- hunger is a threat - -ve reinforces
PSY Slade and Russell
- aimed to see if there was a difference between the way that people with AN and a control group estimate their body width and height and the width and height of some objects
- anorectics overestimated their width by 25-55%
- control group estimated body width accurately
- no difference between anorectics and control group in their estimations of the height and width of other objects
- therefore strong link between AN and distorted body image
- control group were significantly older than AN ppts, there is an optimum age level where AN is most common so the older sample does not represent this age
PSY Cooper and Turner
- looked at the emotional aspects of body self-perception in anorexic patients using a standard questionnaire, the Eating Disorder Belief
- AN patients reported more negative beliefs about themselves than dieters or a control group with no unusual eating behaviour
- AN patients more likely to believe that acceptance from others was conditional on their body type and more likely to base their own self-esteem on their body type
- cause and effect: faulty cognitions may be a result of eating disorder affecting development
PSY Cooper et al
- Using a modified Stroop test, they tested participants’ ability to name colours of both neutral and food-related words
- Those with AN took significantly longer to name the ink colour for food related words than neutral words
- Those with AN took longer than controls with no eating disorder
- Shows how much attention is being paid to the words: the more meaningful they are to the patient, the harder it is to focus attention only on the colour of the ink
- People with AN spend more time thinking about food and have more of an emotional response to food than controls, so take longer to complete the Stroop task with food related words
- order effects: ppts will practise the task, improving at it which will alter the validity of the results
PSY IDA
IDA
• Can explain why only some dieters develop AN – we are all exposed to the ideals of thinness but only those with faulty belief systems are affected
• Cause and effect: unclear whether the cognitive biases that lead them to overestimate their body size, exist before the onset of the eating disorder and play a part in their development or the cognitive biases only develop after the onset of eating disorders
Practical applications
• Potential to lead to useful therapies
• Enabling clients to tackle self-defeating statements and to start eating again
• Cognition should be the focus of the therapy, CBT involves changing the way people think
• If CBT can alter the faulty cognitions people have when suffering from eating disorders, this relieves their symptoms, supporting the idea that faulty cognitions lead to eating disorders
• However, Wilson’s 20005 review of treatment for AN found that CBT was the most effective treatment but it was still limited in its effectiveness and did not help all sufferers
Biological explanations
- serotonin responsible for personality traits associated with eating disorders
- 2 types: excitatory/switch on 5-HT2A and inhibitory/switch off 5HT1A
- childhood (before onset): high anxiety/perception of image
- teenagers: imbalance caused by hormonal changes/environmental stressors which exacerbate the imbalance
- altered levels reduce appetite
- altered serotonin activity –> high anxiety, obsessive thoughts, reduced appetite –> restricted eating reduces tryptophan –> basic buildings blocks to serotonin so reduced serotonin –> lowers anxiety –> any increase in food increases tryptophan –> increases 5-HT and anxiety –> disincentive
