1. Write a report on your findings from the set task. The report should take the following format (include headings):
ï‚· Introduction - what the report will cover (approx 100 words) ï‚· Definition of Eating Disorders (approx 200 words) ï‚· Types of Eating Disorders (approx 300 words) ï‚· Symptoms of Eating Disorders (approx 300 words) ï‚· Method how you conducted your research (approx 300 words) ï‚· Results What you found from your analysis of the results (approx 300 words) ï‚· Conclusion did your research demonstrate that certain people were used in the media? Do you think this impacts on how people believe they should look? Do you think this impacts on eating disorders? (approx 300 words) Explain the scope and nature of eating disorders in adults, and consider the responses that might be taken to such conditions.
Eating disorders are characterised by an abnormal attitude towards food. This attitude causes the person to change their eating behaviour and habits. A person with an eating disorder can focus excessively on their body shape and weight, which can result in them making choices about food that are unhealthy and damaging to their health. The two main categories of eating disorders are anorexia nervosa (characterised by a distorted body image) and bulimia nervosa (characterised by binge eating and subsequent purging) with other forms falling under the DSM category of Eating Disorders Not Otherwise Specified.
It is thought that around 1 in 250 women and 1 in 2000 men develop anorexia nervosa at some point in their lives. It usually develops at around the ages of 16 or 17, whilst bulimia nervosa usually develops around the age of 18 to 19. It is five times more common than anorexia, with 90% of sufferers being female. Binge eating affects males and females equally and usually appears later in life, between the ages of 30 and 40. It is not clear exactly how many people binge eat.
Causes of Eating Disorders It is not known exactly what causes eating disorders, but social pressure to be thin is thought to be a big factor. In many cases it begins with the individual dieting and then gets out of control. Young people often feel they have to look a certain way, but the causes are more complex than this. Risk factors include:
Family history of eating disorders/depression or substance misuse Overly concerned with being slim Pressure to be slim due to a job (model, dancer etc) or society Being criticised for body shape or weight Being criticised for eating habits Other characteristics, such as anxiety disorder, low self esteem, perfectionist personality, obsessive personality Some experiences, such as emotional or sexual abuse, death of someone close Difficult family relationships or friendships Stressful situations (work, school, university)
ANOREXIA NERVOSA (AN)
Anorexia nervosa is an eating disorder characterised by the pursuit of being thin. In the past, the onset of AN was thought to be between the ages of 13 and 17, but in recent years, there are indications that the average age of onset may have lowered to between 9 and 12 years of age in some countries. There is some suggestion that when onset is pre-pubertal, the severity of the concomitant mental disturbances is greater. Conversely, when it is associated with later onset (13-17 years) there appears to be better outcomes. It is more common in adolescent females than males. It is around ten times more likely in females, but it can affect anyone irrespective of their gender, race, age or socioeconomic status. Patients with AN generally have a BMI (body mass index - weight in kg/height in m x height in m) of less than 17.5 (at least 15% below average for their height and build).
In light of its serious nature, it can be a life threatening illness. Anorexia means a poor appetite. Nervosa is something that occurs through the mind and nerves. Therefore, the name 'anorexia nervosa', suggests that a poor appetite occurs as a result of the person’s thinking and emotions, particularly anxiety.
Whilst it is often thought that there is an associated loss of appetite in anorexia, people with AN do not lose their appetite. They still like food and feel hungry, but they do not think of food in the same way as we would expect. People with AN will try to keep their weight as low as possible. Their preferred weight is often much less than that which a healthy person would consider to be normal for an average person of the anorexic’s age and height. Their fear of gaining weight is so great that they cannot eat normally. They believe themselves to be too fat and therefore resist attempts to help them gain weight.
ï‚· They often restrict the food they eat and may use laxatives or make themselves sick. They will want the food to pass through their body as quickly as possible, so make use of laxatives (to empty the bowel) and diuretics (to remove fluid from the body). But actually laxatives and diuretics have little effect on the calories absorbed from food. ï‚· Some people with AN will make themselves sick after eating. Signs that a person is vomiting regularly include: o Bad breath o Dental problems due to the acid in vomit damaging their teeth and mouth o Leaving the table straight after meals o Hard skin on knuckles from putting their fingers down their throats. ï‚· Sometimes they will binge eat, often eating foods they normally avoid, and then make themselves sick. They then feel great remorse for having eaten so much and make further intensified efforts to lose weight. ï‚· They will often go to great lengths to hide their behaviour from their families, pretending they have eaten, they have eaten earlier or they have eaten more than they did. ï‚· They may also over-exercise to burn more calories than they consume in a day. This will often involve them being involved in high impact activities such as dancing, running and aerobics. Some will even try to use any opportunity to burn calories, such as standing rather than sitting. ï‚· They may spend a lot of time thinking about food. They may actually find it hard to think about anything other than food. Some people with AN may spend a lot of time reading recipes and looking at cookery books. ï‚· Some people with AN may drink lots of fluids, particularly those with caffeine or fizzy drinks as they give a low calorie energy burst. ï‚· Some people with AN will also take drugs to control their weight loss, such as cocaine or amphetamines.
Body Image and Self Esteem People with AN may also have poor self image and a distorted body image:
ï‚· Many people with AN will think that their value as a person is related to the way they look and their weight. They may think that others will look at them more positively if they are thinner or that people will like them more. ï‚· People with AN often have a distorted image of themselves, thinking they are fat when they are actually very thin. They may wear loose, baggy clothes to hide how thin they are.
ï‚· They may also have low self-esteem and little self-confidence, resulting in them withdrawing from relationships with friends and family. ï‚· They may find it hard to concentrate, which can affect their school work or job. ï‚· They may lose interest in their activities. ï‚· They may use a form of behaviour called “body checking” which means they regularly and repeatedly: o Check their body in the mirror o Measure themselves o Weigh themselves
Physical Symptoms of Anorexia These include:
ï‚· Lanugo hair (fine downy hair growing on their body) ï‚· Sparse or thin pubic hair ï‚· More hair on their face ï‚· Irregular heartbeat leading to poor circulation ï‚· Fatigue ï‚· Changes to sleep patterns ï‚· Feeling bloated ï‚· Constipation ï‚· Pain in abdomen ï‚· Low blood pressure ï‚· Light headedness/dizziness ï‚· Hypothermia (low body temperature) or feel cold ï‚· In younger girls, puberty and growth spurts may be delayed ï‚· In older girls and women, they may experience amenorrhoea (stop having periods) ï‚· Infertility.
Subtypes Two subtypes of anorexia are commonly recognised:
Restricting Type - during the current episode the individual achieves weight loss mainly through dieting, fasting and excessive exercise.
Binge-eating or Purging Type - during the current episode the individual regularly binge eats and/or purges (at least once a week).
Treatment for Anorexia AN is a complex condition. The first step is for the person to go to the doctor. A person with AN will often refuse to recognise that they have a problem, so a big step is actually getting them to recognise that their behaviour is not normal. People with AN will receive psychological treatment and help with nutrition and eating. In serious cases, the person may be hospitalised or go to a specialist eating disorder clinic. Treatment can be effective if the person is open to receiving it, but individuals with the condition are still associated with higher rates of suicide than the general population. Suicidal ideation is thought to be exacerbated by malnutrition and depression linked to AN. Hospitalisation is part of the normal course of treatment if:
ï‚· The patient's weight is dangerously low ï‚· They have severe depression (and/or suicidal ideation) ï‚· They have experienced rapid weight loss ï‚· Attempts to treat in the community have not worked.
The first step of any treatment plan is to work out a diet to assist the patient to gain weight. To achieve this weight targets are set which must be gained and maintained. This usually means setting a target for a BMI of 20 though often a compromise may have to be met. Weight gain is often set at between 0.5 and 1kg per week and it may span over several months to achieve the target.
Accompanying therapy is usually aimed at helping the individual to increase their levels of selfesteem, improve personal relationships, and help them to become more active in controlling their urges. CBT may also be beneficial in helping individuals to overcome the self-destructive beliefs associated with anorexia. Where younger patients are involved family therapy may also be useful.
BULIMIA NERVOSA (BN)
Bulimia nervosa is characterised by periods of binge eating, extreme measures of weight control (e.g. induced vomiting), and a distorted idea of body shape and weight like that observed in anorexia.
The binges are where the individual eats excessive amounts of food over a short space of time and is unable to control the urge to do this. The period over which food is consumed may last up to two hours but the amount consumed is much more than would be considered normal within this timeframe. For instance, an individual might go out for dinner and then continue eating after they arrive home. These binges are like those which can occur in anorexia nervosa.
Inappropriate compensatory attempts to control weight gain often follow binges and might include:
ï‚· Self-induced vomiting ï‚· Taking diuretics ï‚· Use of enemas ï‚· Consuming laxatives ï‚· Fasting ï‚· Over-exercising ï‚· Taking other dietary medications
For a diagnosis of bulimia to be made, the binges and weight control measures must not occur exclusively during episodes of anorexia nervosa and they must occur on average twice a week for three months.
Associated Behaviours Individuals with BN will usually try to conceal their binge eating and compensatory behaviours from others because they feel shameful. Sometimes a binge may be premeditated and often the consumption of food is extremely quick. An individual may continue to binge until they feel uncomfortably full or experience pain.