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Anorexia

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Anorexia

    ANOREXIA NERVOSA

    Copyright

    2005

    williamgladdenfoundation.org

    All rights reserved. No portion of this book may be sold, by any process or

    technique, without the express consent of the publisher.

    INTRODUCTION

“You can‟t be too thin or too rich.” This modern – somewhat cynical proverb says a lot

    about our culture. It is an attitude that sells millions of magazines and diet books, sends many people to diet doctors and diet programs and puts thousands of people on exercise regimens…whatever is necessary to get or stay thin.

This attitude is evident in our culture‟s choice of role models and heroes, many of whom

    are featured diet stories in popular magazines. The magazines at the supermarket checkout counter inform about “The Celebrity-Eat-Everything-and Stay-Slim-Diet,” and

    more.

    Very slim people model clothing. Magazines describe fashion models and their eating habits some models subsisting on a salad a day and lots of ice cubes to keep their pencil-thin figures.

    Our culture says, “Thin is beautiful. Thin is smart. Thin is in. Be thin.” Thousands of impressionable young people mostly young women decide to do just that. They diet

    and exercise to attain this ideally thin body. Generally, they stay within reason, but not always.

    Usually, the brightest and most agreeable children are the ones who decide not just to be thin but also to be the best at being thin, and it becomes an obsession, a disease known as “Anorexia Nervosa.”

An Anorexic stops seeing her own body objectively. She usually “she because 90% to

    95% of anorexics are female sees only a fat, imperfect self even in the face of the near-skeleton that stares back at her from the mirror. Fat is bad. She will not be bad.

    -II-

    This fierce dedication to starvation is, to the victim, the height of virtue. To the parents, siblings, teachers, school counselors and friends, it is terrifying. They see the child or young woman so obsessed that she rarely eats. She vigorously exercises for hours. She agonizes over eating small amounts of food. She looks gaunt and emaciated.

Family members are right to be concerned. This disease and disease it is can be fatal

    if not arrested in time, which is the purpose of this publication. We write it in the hope that parents, families, friends, school officials and teachers will learn the signs of anorexia and guide its victims to arrest it in time. We hope that, with the facts, you will be able to ignore the false reassurances of people with anorexia “Everything is under

    control.” Since anorexia can lead to serious complications, even death, the lives of many young people can depend on this knowledge and understanding.

    The good news is that early detection and treatment usually achieve a full recovery, though it may take some time for the person with anorexia complete recovery, physically and psychologically.

     Cheryl Grady Mercier, M.A.

     Waln K. Brown, Ph.D.

     William Gladden Foundation

    -III-

    TABLE OF CONTENTS

QUESTIONS AND ANSWERS

    What Are Eating Disorders?................................................................................................5 What Is A Definition Of Anorexia Nervosa?......................................................................5 What Does The Term Anorexia Nervosa Mean?.................................................................5 Who Is At Risk For Developing Anorexia Nervosa?..........................................................5 What Causes Anorexia Nervosa?.........................................................................................6 How Common Is Anorexia Nervosa?..................................................................................6 Is There A Certain Type Of Teenager Who Develops Anorexia Nervosa?........................6 Are Anorexic Teens Typically Rebellious And Defiant?....................................................6 Why Would Someone Purposely Starve Herself?...............................................................7 What Are Some Of The Psychological Characteristics Of Anorexia Nervosa?..................7

    What Are Some Of The Physical Complications Of Anorexia Nervosa?...........................7 Can Anorexia Nervosa Be Fatal?.........................................................................................7 Can Anorexics Recover Completely?..................................................................................8 Why Do Some Anorexics Recover Completely And Some Remain Ill Or Die?.................8

    How Does One Identify Anorexia Nervosa Early?..............................................................8 What Kinds Of Treatment Are Available For Anorexics?..................................................8 What Other Intervention Approaches Are Available To Help Anorexics Recover?...........9

    Why Is Family Therapy Recommended For Anorexics?....................................................9 How Can School Counselors Help Anorexic Students?......................................................9 How Can Families Help Anorexic Children Recover?........................................................9

“AVERAGE” PATTERN FOR DEVELOPMENT OF ANOREXIA NERVOSA…10

SYMPTOMS FOR EARLY DETECTION OF ANOREXIA NERVOSA………….12

PSYCHOLOGICAL CHARACTERISTICS AND PHYSICAL

     COMPLICATIONS ASSOCIATED WITH ANOREXIA NERVOSA.................13

ANOREXIA NERVOSA SYMPTOMS THAT MAY

     BE EVIDENT IN A SCHOOL SETTING…………………...…..……………..…14

DOS AND DON’T’S FOR THE FAMILY OF AN ANOREXIC…………………....15

SOURCES OF HELP FOR ANOREXIA NERVOSA……………………………….16

    -IV-

WHAT ARE EATING DISORDERS?

    Eating disorders are problems that have symptoms involving eating behavior. Anorexia, bulimia and, in some cases, obesity, can all be classified as eating disorders. Food is not the issue with eating disorders food is the object through which eating-disordered

    people express other serious concerns and problems.

WHAT IS A DEFINITION OF ANOREXIA NERVOSA?

    Anorexia nervosa is a serious disease or eating disorder characterized by an obsession with thinness. It includes deliberate self-starvation and has both physical and psychological components. Though known about for centuries, the number of reported cases of anorexia nervosa has risen dramatically over the last 25 tears.

WHAT DOES THE TERM ANOREXIA NERVOSA MEAN?

    The term literally means “loss of appetite because of nerves.” However, the term is somewhat misleading. People who have anorexia nervosa usually feel hungry until the late stages of starvation. They CHOOSE not to eat.

WHO IS AT RISK FOR DEVELOPING ANOREXIA NERVOSA?

Anorexia and most other eating disorders traditionally affects young women in

    adolescence and early adulthood. Cases of anorexic young men and older women also occur, although to a lesser degree. Experts estimate that between 5% and 10% of eating disorder patients are male.

    -5-

WHAT CAUSES ANOREXIA NERVOSA?

    Experts believe that food itself is not a cause of anorexia; rather, anorexics fear growing up or may be rebelling against parents whose standards seem too high. There is also evidence of hormone imbalances in anorexics that indicates possible biological causes. However, researchers think that the stress of severe dieting may be the cause of these hormone imbalances. Other pressures may come from our culture. In one survey, 75% of the women described themselves as “too fat” even though only 25% were clinically

    obese. This pressure to be the perfect size is an expectation young people pick up from our culture.

HOW COMMON IS ANOREXIA NERVOSA?

    Once considered very rare, in the last 25 years there has been a dramatic increase in youth diagnosed with anorexia nervosa. Some experts now estimate that one in every 100 white females between the ages of 12 and 18 suffers from anorexia.

IS THERE A CERTAIN TYPE OF TEENAGER WHO DEVELOPS ANOREXIA

    NERVOSA?

Many studies describe the “typical” eating-disorder patients as a young, white female

    from a middle or upper class family that places much emphasis on high achievement, personal appearance, perfection and eating patterns. However, in spite of this “typical” profile, reported cases of anorexia include people of all races, family backgrounds and economic classes.

ARE ANOREXIC TEENS TYPICALLY REBELLIOUS AND DEFIANT?

NO, most anorexics are “model children”: well-behaved, eager-to-please, good students

    who get along well with others. They rarely admit to having problems and do not ask for extra help. Underneath the illusion of perfection, the person with anorexia is usually an insecure, critical perfectionist who feels unworthy of praise. The anorexic‟s low self-

    esteem and feeling of powerlessness lead her to discount personal accomplishments.

    -6-

WHY WOULD SOMEONE PURPOSELY STARVE HERSELF?

    Although nobody knows exactly what triggers anorexia, it is possible that controlling one‟s own body by refusing to eat and exercising almost to collapse provide the anorexic with an illusory sense of control or power.

WHAT ARE SOME OF THE PSYCHOLOGICAL CHARACTERISTICS OF

    ANOREXIA NERVOSA?

    Many, but not all, who develop anorexia, tend to be perfectionistic and compulsive. As the illness progresses, traits that often become apparent include indecisiveness, stubbornness, feeling helpless, unsociability, irritability, depression and obsessive behavior. The anorexic‟s self-perception may be extremely distorted. The most common

    example is the anorexic‟s interpretation of her body. Even though all evidence reveals emaciation, the anorexic can declare she is “too fat.” Compulsive behavior can include

    excessive orderliness, cleaning, studying or exercise, as well as complicated rituals as to what, how and when food may be consumed. Anorexics may seem obsessed with food while literally starving to death.

WHAT ARE SOME OF THE PHYSICAL COMPLICATIONS OF ANOREXIA

    NERVOSA?

    Excessive weight loss to the point of emaciation is the most apparent physical manifestation of this disease. Many describe people in the acute stages of anorexia as “skeleton-like.” Menstruation stops in many female anorexics. Gastric complaints such

    as constipation, ulcer-like symptoms and bloating are frequent. Skin abnormalities include dryness, fine downy hair all over the body, yellowish skin and hair loss. Other symptoms include joint swelling, muscle aches and cramps, lowered body temperature, hyperactivity or inactivity and changes in body chemistry. Some of the body chemistry changes can affect internal organs including the heart. The heart muscle weakens as the body uses all available energy. This can lead to irregular heart rhythm and congestive heart failure. It is important to emphasize that early treatment can usually avoid

    permanent damage.

CAN ANOREXIA NERVOSA BE FATAL?

    YES, anorexia is potentially fatal. Prolonged starvation can cause dehydration, malnourishment, muscle spasms and chemical imbalances that may lead to cardiac arrest. Left untreated, these disorders may lead to death.

    -7-

CAN ANOREXICS RECOVER COMPLETELY?

    YES, many anorexics recover completely. Between 50% and 70% of diagnosed and treated anorexics recover completely or have marked nutritional improvement within two to five years. Somewhere between 50% and 90% of female anorexics regain menstrual function. Psychological recovery is harder to document. Improved treatment methods and early detection make the anorexic‟s recovery more likely.

WHY DO SOME ANOREXICS RECOVER COMPLETELY AND SOME

    REMAIN ILL OR DIE?

    About 18% of diagnosed anorexics remain ill. Deaths from complications of the disorder or from suicide are between 3% and 25%. Most of the research indicates that poorer recovery rates are associated with greater weight loss, older age when the disease began and the presence of binge eating and/or purging (vomiting or laxative abuse). Another factor associated with poorer recovery is duration of illness. The longer a person has been anorexic, the poorer the chances of recovery. That is why early detection and treatment are important.

HOW DOES ONE IDENTIFY ANOREXIA NERVOSA EARLY?

    Although none of the following factors alone necessarily indicate anorexia, several of them over an extended time suggests the possible need for help. The indications of anorexia include loss of menstrual periods; avid dieting when not overweight; preoccupation with food, calories, nutrition and/or cooking; hunger denial; excessive exercising; claiming to “feel fat” when not overweight; strange food behaviors; frequent weighing; and use of laxatives or vomiting to control weight.

WHAT KINDS OF TREATMENT ARE AVAILABLE FOR ANOREXICS?

Treatment for anorexics must focus on two areas improved nutrition to relieve the

    physical symptoms, and confronting the underlying problems and feelings that contribute to anorexia. A treatment plan might include medical consultations and/or hospitalization (depending on the anorexic‟s physical condition), individual psychotherapy family therapy, behavior modification or biofeedback training. Family therapy is recommended in nearly all cases where the family agrees to cooperate.

    -8-

WHAT OTHER INTERVENTION APPROACHES ARE AVAILABLE TO HELP

    ANOREXICS RECOVER?

Two other helpful interventions are diet counseling and self-help groups. DIET

    COUNSELING can be beneficial, even though most anorexics seem to have knowledge about diet and calories. This counseling is a helpful addition to but never a substitute

    for psychological counseling. A registered dietician can develop an individually tailored plan for the anorexic. SELF-HELP GROUPS can be helpful if the anorexic

    decides that they are important to recovery. In general, self-help groups provide group identity and emotional support while teaching positive thinking. Self-help groups require regular attendance and become an integral part of the anorexic„s life. Regular attendance provides understanding and support during stressful times.

WHY IS FAMILY THERAPY RECOMMENDED FOR ANOREXICS?

    Anorexia nervous usually affects the entire family. Family therapy helps family members understand why the anorexic feels that losing weight is so important. Furthermore, anorexia often starts during the teens, when the anorexic is still deeply involved with and heavily influence by the family. Family therapy creates a supportive environment wherein family members can help the anorexic master this eating disorder.

HOW CAN SCHOOL COUNSELORS HELP ANOREXIC STUDENTS?

    School counselors who are knowledgeable about anorexia and other eating disorders can help a student‟s family identify the problem in its early stages. Listening to, supporting,

    encouraging and suggesting options to affected students and their parents are also helpful. School counselors, through guidance programs that encourage healthy self-esteem and sound interpersonal relationships, can help prevent anorexia and other eating disorders from developing.

HOW CAN FAMILIES HELP ANOREXIC CHILDREN RECOVER?

    First, the family should seek help and be willing to work with counselors, therapists and doctors to understand the underlying reasons for this disorder. Second, the family should deliberately and carefully examine and modify its approach to food and eating. Third, parents should encourage independence and decision-making by the anorexic child. Emotional support is necessary but should not be overwhelming. Fourth, parents should seek support from a professional or self-help group because of the tremendous stress the eating disorder puts on them and their marriage. Fifth, families should remember that the anorexic child needs patience, kindness and firmness, recognizing that the ultimate responsibility for eating and weight is with the child and the therapist.

    -9-

    “AVERAGE” PATTERNS FOR THE DEVELOPMENT OF

    ANOREXIA NERVOSA

    Anorexia nervosa is an eating disorder that usually develops over time and is not immediately apparent to either the anorexic or the people around her. The anorexic slowly develops a pattern of behavior that associates eating with a poor body image. Food is “bad.” Thin is “good.” If this negative association between food and body image continues, the person‟s physical condition suffers and may lead to death. What follows is

    an “average” pattern for the development of anorexia nervosa.

    (PLACE DIAGRAM HERE)

POSSIBLE PREDISPOSING FACTORS Although no one knows the exact “cause”

    of anorexia, there may be some predisposing factors in its development. Experts agree that food itself is not the central issue in anorexia. Other factors may dispose a person to anorexia. PSYCHOLOGICAL PROBLEMS can include a fear of adulthood and its

    responsibilities, or subconscious rebellion against a family whose goals and standards seem unattainable to the child. BIOLOGICAL FACTORS may influence the

    development of the disease because hormone levels in anorexics are abnormal, although this may be the result rather than the cause of anorexia. SOCIAL PRESSURES also

    play their part in anorexia. Our culture‟s pursuit of thinness and the strong competitive drive to be the best and the most attractive may contribute to the development of this disorder.

    DIETING STARTS The problem often starts when the person decides a diet will help with some change that has occurred in her life. The change may be puberty, a new school, an argument with a friend or a chance remark by an important person in her life. This change often makes the person feel she has lost control of everything.

    -10-

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