Clinical - anorexia Flashcards
What does anorexia nervosa mean?
severe loss of weight because of emotional reasons
What are the 7 symptoms of anorexia?
- distorted body image
- refusing to eat
- excessive exercise
- restriction of calorie intake
- preoccupation with body size
- fear of gaining weight
- not knowing their weight is dangerous
What is the DSM4 criteria to be diagnosed with anorexia?(4 points)
- refusal to maintain body weight at or above a normal weight for your age and height (being below 85%)
- intense fear of gaining weight or becoming fat, even though underweight
- distorted body image or denial that they have a problem
- amenorrhoea - the absence of at least 3 consecutive periods
what 2 things has changed between the DSM4 and DSM5 criteria of anorexia
- amenorrhoea has been removed
- its now been separated from binge eating
what is pica?
- eating non food substances e.g sand, wood and clay
what is atypical anorexia?
when you don’t have all the symptoms e.g you don’t have a pathological fear of losing weight but express a preference of being thin
what age group are most at risk of anorecia?
adolescents
what percentage of cases are females?
90-95%
What are 4 famous cases of anorexia?
- Girl from the carpenters
- Lilly Allen
- Kate Beckinsale
- Lady Gaga had it from the age of 15
what 2 explanations am I using?
social and psychodynamic
there are 2 parts to the social explanation of anorexia. What are they?
socio cultural approach and the feminist approach
what is the socio cultural approach?
- anorexia is caused by western societies belief of beauty
- the media states you have to be size 0 to have the ‘ideal body shape
- all images in the media are skiny
- people get ‘fat shamed’ if they put on a pound
- nobody tells you its fine to be fat
- tv presenters are thin so from a young age children are told to be thin
Evaluation of the socio cultural approach
+ anorexia is more common in the west
+Crisp (1976) found there ar emore eating disorders where an emphasis is placed on thinness e.g models and dancers. As there is an emphasis on thinness in the west t explains more cases of anorexia.
+ arab and Asian women are more likely to develop anorexia if thy move to the west
+Owen and Lauren-Jeller (2000) examined the playboy centrefolds and found over 50% of them were underweight and 50% could be classified as anorexic
x only a fraction of people to these images get an eating disorder
x the average dress size in the west has increased over the last 60 years
what is the feminist approach?
- anorexia is the result of a patriarchal society telling women what they should look like
- 90-95% of those with eating disorders are female
- Obach says femininity involves self denial. Western culture promotes a chocolate bar and then a thin weight watchers advert. This is ‘naughty but nice’ if you choose the chocolate which is self denial.
evaluation of the feminist approach
+ looks at how eating disorders are bound up with the way femininity is constructed in society
+ helps understand women with eating disorders- they’re not abnormal, instead look at the contradictions in society
x doesn’t explain why males get ti
xdoesn’t explain why some get anorexia and some get binge eating
x lacks scientific support unlike biological
there are 2 parts to the psychodynamic approach, what are they?
the effective/ineffective parent and trauma in the oral stage
what is the effective/ineffective parent explanation?
- effective parents feed their chid when its hungry and comfort them when they are anxious
- ineffective parents don’t correctly interpret their childs needs therefore feed them when they are anxious. When they are hungry they might comfort them instead.
- this confuses the child about their own needs so depends on somebody else to tell them when they are hungry
- when they become a teenager they are scared of being independent and making the decisions but one thing they can control is when they eat
evaluation of the effective/ineffective parent explanation?(6 points)
+Dare and Fisher (1997) found patients described their parents as overbearing and dominant
+Manke (1994) found patients felt they had little control over their lives because of their parents
+steiner (1991) found parents of anorexic people try to define their children’s needs themselves
x lacks scientific evidence so is subjective
x research done by case studies which are subjective
x doesn’t explain anorexia in males, adults or why it’s more common in the west
What is trauma in the oral stage explanation?
- Freud believed that trauma in the oral stage such as prolonged separation could cause feeding problems
- people develop anorexia to revert back to childish behaviour e.g refusal to eat
- this could be an unconscious effort to remain pre pubescent and fear of becoming sexually mature
- anorexia can stop periods which prevents an aspect fo female development
- they may wish to maintain a boy like appearance
Evaluation of the oral stage explanantion (4 points)
+ eating disorders usually develop around adolescence when the genital stage is in motion and past issues are being revisited. This gives it high face validity
x doesn’t explain people who develop anorexia but don’t experience trauma in the oral stage
x based on an unconscious process which you can’t test
x very subjective
what are the 2 treatments for anorexia?
Family therapy and free association
What is family therapy?
- A therapist shows family members how to deal with the disruptions caused by eating disorders and teach them about it so they can understand it more
- parents take charge of refeeding the patient and siblings are there for support
- no blame is put on the patient
- the disorder and patient are separated
there are 3 phases to the treatment:
1) weight restoration
2) return to independent eating
3) healthy adolescent development
what are the 3 stages of family therapy?
1) weight restoration
2) patient returns to independent eating
3) healthy adolescent development
evaluation of family therapy (6 points)
+ prevents long term hospitalisation and doesn’t affect the patients social life
+ doesn’t blame the patient
x only seems to work for those who have had the illness for 3 years
x family and patient have to play an active role - not good if busy with work etc
x doesn’t work if the patient doesn’t think they have anything wrong with them or if they have a lack of motivation to get better
x unethical to force somebody to have therapy if they don’t see anything wrong with them
What is free association?
- the aim is to enable anorexics to cope better with internal conflicts that are causing disturbances
- by uncovering the unconscious conflicts the patient can work through them
- the patient talks freely in the hope they will uncover something
- The therapist then analyses what they say and what it could mean is happening in their unconscious mind
Evaluation of free association (6 points)
+in depth and includes accounts from childhood onwards
+ allows access to the unconscious mind which can uncover supressed feelings
x very bias and subjective as it’s one persons analysis
x you can’t test the unconscious mind
x case studies don’t provide enough supporting evidence
x may be distressing getting the patient to revisit early trauma
what is the learning approach treatment for anorexia?
token economy
describe token economy as a treatment for anorexia?
- When in hospital or clinics it can be used
- patients are rewarded for eating regular meals and not throwing up afterwards
- as the patient gains weight additional hospital privileges may be gained
- punishment will also be used to extinguish unwanted behaviours
- primary reinforcers include: trips out, cigarettes, more time with family, access to television
- secondary reinforcers are the token themselves which are traded in for primary reinforcers
evaluation of token economy as a treatment for anorexia? (
+based on operant conditioning which skinner proved works
x doesn’t last when out of the institute
x doesn’t reach the cause of the problem
x staff can use it to make their lives easier
x rewards have to be consistent and clear
x unethical if basic needs are used as rewards
+ Okamoto et al (2002) found the majority of participants increased their weight when taking their medication meant they got a token
HOWEVER x this shows it doesn’t work alone and drugs are needed too
What Is the key issue?
Is anorexia a western society disorder
what evidence is there that it is a western society disorder?
- Arab and Asian women are more likely to get an eating disorder if they move to the west
- there are more cases in the west
- In Nigeria they don’t have eating disorders
- the western media is all about being thin
- when western tv was introduced to Fiji eating disorders went up (bradshaw 2002)
what 2 studies do i need to know?
Kortegaard et al (2001) and Fichter and Pirke (1986)
what was the aim of Kortegaard (2001)
To see if anorexia has a genetic component by looking at the cooccurrance rate in MZ and DZ twins
what was Kortegaard (2001) method
He sent a questionnaire to 30,000 danish twins asking have they ever had anorexia, have they ever been described as anorexic and have they ever expirienced bullimia
what was the conclusion of Kortegaard (2001)
mz twins have a higher chance of of developing anorexia suggesting theres a genetic component
what was the evaluation of Kortegaard (2001) (4 points)
+large sample so generalisable
x subjective as respondents answer about themselves
x doesnt show cause and effect
x the concordance rate isnt high enough to suggest it is genetic factors alone
look up Fichter and Pirke (1986) study
fewwffef
what ethcial considerations were there with the leaflet
- no distressing images
- no putting the blame on the patient
- no distressing content
- no forcing them to ear
- no mention of death
why did i chose the target audiance i chose for the leaflet
becuase teenage girls are the most common people to get it
what are the 5 advantages and disadvantages of using secondary data
\+ quicker as research already exists \+ cheaper x wont be specific to what yuo want x dont know the sample or hwo it was collected x you dont know how relaible it is
