Anorexia Nervosa Research Paper

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1 Anorexia Nervosa Research Paper Bryce Beach School of Behavioral Science, Liberty University PSYC 430-B04: Abnormal Psychology Professor Florin Coltea October 2, 2023

2 Anorexia Nervosa Research Paper Introduction It is possible to argue that, in one way or another, every person has struggled with eating habits in numerous different ways. For some, that may manifest as over-eating or improper eating times for others, but it also could look like not eating whatsoever for many. This mindset of not eating any food at all is known as anorexia nervosa. Anorexia is a destructive and complex psychiatric disorder that is characterized by the restriction of food leading to low body weight (American Psychiatric Association, 2013). This disorder has received attention from clinicians, researchers, and society alike since its discovery. It can look quite dissimilar depending on the person, but can often be tied to obsessive-compulsive symptoms. While an abundance of research has been conducted on the disorder, it is important for students seeking higher education to fully comprehend anorexia nervosa and other eating disorders like this, especially if they seek a career that is connected to psychology. In this research paper, there will be an investigation into the six main parts that make up anorexia, which are its historical context, cause of the illness, treatment methods, preventive actions, cross-cultural issues, and biblical worldview. Through these sections, a better understanding of this eating disorder will be fostered. Historical Context Even though we received the first definition of anorexia in 1689, we can see the habits or even the practice of it in history through different societies. Often masked as religious fasting, the disorder was passed off as a person focusing on purity instead of a drive for thinness. Even then we can see from the 1500s-1800s the concept of an exhibition of astonishing starving abilities from individuals. It was almost encouraged as it supported the material and spiritual beliefs of being perfect. With such displays of anorexia, a desire to understand why individuals

3 were reacting this way to eating was finally introduced in the late 17 th century by Dr. Richard Morton. Morton was an English physician who had, up to this point, not dealt with something like anorexia before meeting an 18-year-old woman in England. In his notes, Morton defined the woman as almost to be a skeleton with skin stretched upon it. The woman had no sign of a fever or any type of sickness, but the information that best served Dr. Morton was that the woman’s appetite had become very diminished leading her to have “fainting fits” and a damaged digestive tract (Habermas, 2019). Morton worked closely with the woman for the next two years trying to treat her only leading her to death a mere two years later. From this case, Dr. Morton coined the name “nervous atrophy,” which he characterized by constipation, emaciation, and over-exertion. From Morton’s first definition, we now had a foundation, or framework, to later frame what we know as anorexia nervosa, today. The next major event in the history of anorexia happened almost two hundred years later with physicians Ernest-Charles Lasègue and Sir William Gull. The two together published a series of papers that introduced the term “anorexia hysteria” with multiple case studies of several patients, all described as severely underweight women, who ranged in age from sixteen to twenty-three (Habermas, 2019). Gull described the women’s symptoms to be fatigue, low body mass, amenorrhea, and a severely decreased pulse rate. The term hysteria was used as it was the first time anorexia was linked to be considered a psychological disorder. From these French and English physicians, we were able to gain an understanding that this was not a biological issue but a psychological one, as said before. Much like other fields of psychology, anorexia nervosa became more prevalent during World War I. We can see in Habermas’ article (2019) that through the war French, Italian, and German literature were able to find three approaches within psychiatric thinking that they felt

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4 were sufficient to explain the differences in reports of anorexia depending on the nation. What they were able to find is that minute clinical description, attentiveness to psychological factors, and attentiveness to nutrition served as factors in anorexia. By 1952, the DSM-1 was published as a tool for medical professionals and anorexia nervosa had received its first established criteria for diagnosis. Cause of the Illness Saying that there is one single cause for anorexia nervosa completely neglects the psychological aspects of the disorder as no brain is exactly alike and varies from person to person. Due to this, the causes of anorexia are multifactorial and complex. They involve a combination of different factors like genetic, neurobiological, psychological, and even environmental. While this is not fully proven, there has been evidence found that introduces the idea that anorexia nervosa can have a genetic predisposition depending on the client. Studies have found that individuals with a family history of eating disorders are at a higher risk of developing the condition and variations in certain genes may contribute to an individual's susceptibility. However, a question could be asked if that is their nature or if that was nurtured into them by seeing family suffer from eating disorders. Some psychological factors include body dissatisfaction, perfectionism, low self-esteem, and an intense fear of gaining weight that we can see push people to begin restrictive eating patterns. In Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents, the researchers aim to see how sexual abuse can be a cause of anorexia nervosa (Andrade et al., 2023). While the other causes are majorly important, the idea of sexual abuse being a trigger for anorexia is an intriguing idea to investigate. Experiencing sexual abuse can be a traumatic event that significantly impacts an adolescent's emotional and psychological well-being. Trauma,

5 including sexual abuse, can lead to various psychological difficulties, including eating disorders like anorexia nervosa for individuals. Julia Andrade and her team found that adolescents who have been sexually abused may develop disordered eating patterns as a way to cope with emotional distress and regain a sense of control over their bodies (Andrade et al., 2023). This is an interesting standpoint as it attributes an environmental factor, but with sexual assault added to the cause, it leads to a complex inlay of anorexic behaviors tied to their negative feelings about their body as they feel their body is not their own anymore. Other causes that contribute to this eating disorder include media influence, peer and family influences, and even life transitions and stress. When finding the cause for the disorder in a client, make sure to explore every avenue of their lives through clinical interviews to best understand that client’s unique combination of triggers. Treatment Much like the causes, treatment for anorexia nervosa typically involves a multifaceted approach that addresses the physical, psychological, and social aspects of the disorder to best counteract any type of cause. One of the first treatments offered is family-based treatment. In a study published by the Journal of the Canadian Academy of Child & Adolescent Psychiatry, psychologists, Elizabeth Quon and Brynn Kelly (2023) discuss that family-based treatment is broken into three phases: refeeding, returning control, and establishing independence. In the refeeding phase, the focus is on medical stabilization and restoring the individual's weight to a healthy level. Parents will often take a centralized role in supervising and supporting meals to ensure their child is receiving the nutrition they need. During the returning control phase, control over eating is gradually returned to the person with anorexia once their weight has stabilized. The step usually makes the

6 adolescent feel as if they have a sense of autonomy once more it feels especially rewarding when it is given by the parents. Lastly, during phase three, the focus shifts to having the adolescent re- engage in age-appropriate independence that helps to normalize eating behaviors. While this is quite an effective treatment, with patients gaining an average of ten kilograms in the study, the researchers understood that there were drawbacks that made this treatment not the most accessible (Quon & Kelly, 2023) . Some of those drawbacks include the client not being an adolescent or not having supportive or present parents (Quon & Kelly, 2023) . Cognitive-behavioral therapy is also a good choice for treatment as it is a widely used evidence-based psychotherapy for anorexia nervosa in both adolescents and adults. This treatment is especially effective since it focuses on changing thought patterns and behaviors related to body image, food, and weight, allowing for distorted beliefs to be challenged and replaced with healthier coping strategies. Another treatment that can be added to another treatment is nutritional treatment where registered dietitians help the individual by introducing a healthy relationship with food that provides education on how to balance meals and even meal planning. A final treatment that is important to mention is described by Quon and Kelly (2023) as group therapy. The treatment provides a supportive environment where individuals with anorexia can share experiences, gain support from peers, and learn from others facing similar challenges. Group therapy can address issues that cause a person’s anorexia and help them to see they are not alone. Prevention Stopping anorexia nervosa and the potential for relapse are essential components of providing comprehensive care. While preventing the initial onset of anorexia can be challenging,

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7 some strategies can reduce the risk of relapse in individuals who have already experienced the disorder. Nikki Pagano and her team of researchers in her study looked at different perspectives on relapse prevention following patients who have recently experienced intensive treatment of anorexia through the use of a focus group study. In the study, the researchers were able to find that there are three topics related to relapse prevention for anorexia: recovery aids, recovery hindrances, and identification of members of the support system (Pagano et al., 2023). Early intervention can help prevent the disorder by catching the disorder in its early stages. Encouraging individuals to seek help and support as soon as they notice signs of disordered eating or body image concerns can prevent years of eating disorders and trauma before they have a chance to begin. Providing individuals who have recovered from anorexia with ongoing education about the disorder can help to empower said individuals to recognize potential setbacks and act early. One of the last prevention tactics is a small but mighty one and they are to simply reconnect with your interests. Psychological illnesses like eating disorders can often pull you away from what makes a person happy (Pagano et al., 2023). By reconnecting with hobbies and interests the individual can bring a purpose back into their lives and prevent relapsing. Cross-cultural Issues Much like music, traditions, and clothing, mental disorders can also be affected by the culture and customs of a particular social group, people, or nation. Unfortunately, for anorexia nervosa, there are more cross-cultural issues than there are benefits. An example that explains this well is found in A Historical Perspective on the Cultural Connotations Surrounding Eating Disorders by Meera Shanbhag. In her study, Shanbhag discusses the binging and purging tendencies of the Roman Emperor Claudius, where she says he would “thoroughly cram himself with food,” after which a “feather was put down his throat, to make him throw up the contents of

8 his stomach” (Shanbhag, 2020). The researcher here shows how in Roman culture, it was typical for those high in power to become addicted to their vices of luxury by binging and purging with the wealthy population. What we can see is that societal pressure pushed those in power to specific body ideals or norms that they were, essentially, required to follow. Beauty ideals of a culture can also affect an individual’s perception of body image. In cultures that prioritize thinness, people may be more susceptible to developing anorexia or other eating disorders to meet the standards set upon them. Culturally religious factors can play a part as well in the development of eating disorders. Sarah Jacobs, also known as the Welsh-fasting girl, claimed to have survived without any food or water for two years as Jacobs was very devout in her religious readings (Shanbhag, 2020). This shows how pivotal parts of our culture, including our religion, can play a major impact on the choices we make, like willingly developing an eating disorder. Cross-cultural issues don’t just affect the individual but also the counselor. In multicultural societies, language barriers can hinder communication about mental health concerns, making it difficult for individuals to express their struggles and for healthcare providers to understand and address them effectively (Shanbhag, 2020). Some mental health professionals may lack cultural competence when it comes to recognizing and treating anorexia nervosa in people from many diverse cultural backgrounds. When a professional lacks cultural sensitivity, it can allow for misdiagnosis or inadequate care to take effect. Biblical Worldview While scripture does not explicitly say anything about anorexia nervosa or any other eating disorder, there is still wisdom we can pull from scripture that supports how we are to treat something like an eating disorder. In scripture, specifically in 1 Corinthians, we are told that our

9 bodies are temples of the holy spirit (English Standard Version, 1 Corinthians 6:19-20). These verses encourage us to steward our bodies well. From this, we can conclude that intentionally harming or neglecting one's body through extreme fasting and self-starvation is against this teaching and is sinful. In Kyunghee Pyun’s article (2023), she depicts how the artist Linda Mary Montano’s work in the 1981 film Anorexia Nervosa analyzed the experience of women self- starving in the Catholic Church through the tradition of holy fasting, which shows the extremes of a biblical practice. Now, we are told to fast in scripture as the Jews in Susa were told to in Esther, but with that comes discernment (ESV, Esther 4:16). Above all, Proverbs 11 says, “It is said that there is safety in a multitude of counselors” which shows that when we are in pain and we are struggling with something like anorexia, we are to seek help as that is how we can win this fight (ESV, Proverbs 11:14). Conclusion Through this evaluation of the mental disorder that is anorexia nervosa, we have been able to understand better that this eating disorder is not just about food, weight, and appearance but the biological, psychological, and sociocultural factors that manipulate it. This research paper has explored the various aspects of anorexia nervosa, including its historical context, cause of the illness, treatment methods, preventive actions, cross-cultural issues, and biblical worldview. It is essential to foster a greater understanding and awareness of anorexia nervosa in society and reduce the stigma associated with eating disorders. As we move forward, more research is needed to deepen our knowledge of anorexia nervosa. However, through the collaborative efforts of researchers, psychologists, and healthcare professionals alike, we can reach the possibility of reducing the prevalence and impact of anorexia nervosa and fostering healthy eating habits in our society.

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10 References American Psychiatric Association. (2013). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425787.x10_Feeding_and_Eating_Disorders Andrade, J. A., Salaroli, L. B., Noll, P. R. e S., Noll, M., Feitosa, S. O., Raimundo, R. D., Oliveira, A. G. de, Mendonça, C. R., & Abreu, L. C. de. (2023). Indicators of eating disorders in sexually abused Brazilian adolescents: Family and school contexts. Children , 10 (8), 13-93. https://doi.org/10.3390/children10081393Links to an external site. English Standard Version. (2016). BibleGateway.com. https://www.biblegateway.com/passage/? search=version=ESV Habermas, T. (2019). The role of psychiatric and medical traditions in the discovery and description of anorexia nervosa in France, Germany, and Italy, 1873-1918. Journal of Nervous & Mental Disease , 179 (6), 360-365. https://search.ebscohost.com/login.aspx? direct=true&db=cul&AN=113062129&site=ehost-live&scope=site Pagano, N., Glasofer, D. R., Attia, E., Ruggiero, J., Eziri, K., Goldstein, C. M., & Steinglass, J. E. (2023). Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study. International Journal of Eating Disorders , 56 (7), 1417– 1431. https://doi.org/10.1002/eat.23952 Pyun, K. (2023). Religiosity and spirituality in Linda Mary Montano’s anorexia nervosa. Religion and the Arts , 27 (1), 179-203. https://doi.org/10.1163/15685292-02701016 Quon, E.C., Kelly, B.M. (2023). Weight outcomes for adolescents with atypical anorexia nervosa in family-based treatment. Journal of the Canadian Academy of Child & Adolescent

11 Psychiatry , 32 (3), 161-171. https://search.ebscohost.com/login.aspx? direct=true&db=asn&AN=169695478&site=ehost-live&scope=site Shanbhag, M. (2020). A historical perspective on the cultural connotations surrounding eating disorders. Inquiries Journal , 12 (9). http://www.inquiriesjournal.com/articles/1792/a- historical-perspective-on-the-cultural-connotations-surrounding-eating-disorders

Anorexia Nervosa Research Paper

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