Understanding Anorexia Nervosa using Theories

Clinicians and researchers work on a basis of theories to analyze the given information and understand how the different aspects of a person’s life combine to contribute to maladjusted behavior and ultimately to mental illness.
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Anorexia Nervosa
Individuals with this condition have a distorted concept of their body image. They see themselves as overweight despite being 85% below normal weight. The irrational fear in becoming fat leads to unusual behaviors and physical manifestations. These behaviors include refusing to eat, excessive exercising, and social withdrawal. Physical symptoms include weakness, muscle aches, sleep disturbances, and amenorrhea. Many individuals with anorexia nervosa have obsessive compulsiveness and obsessive compulsive disorders (Crane, Roberts, and Treasure, 2007). Behaviors that support this are seen in how they restrict their food intake. For one, they tend to develop rituals in their choosing, preparing, and ingesting of meals. Although they do not eat the food themselves, they take great delight in preparing the meals for those around them such as spouses and children. When they do consume food rituals such as counting chews per bite and rearranging food on their plate is a constant preoccupation. Another behavior that seemingly supports this is their compulsion for excessive exercise. Individuals with anorexia tend to stick to routine in their daily life as well as in their exercise habits. The try to avoid situations where there might be pressure to eat and when they are with others, they often decline to eat. Because of this, they are inclines to isolate themselves from other people.

Statistics show that the most susceptible ages are 14 and 18 years of age with 90% of which are females (Sarason, 2005). Success rate are also not particularly encouraging. In 1991, only 29% treated resulted in good recoveries; 15% died of suicide and other complications of the disease (Ratnasuriya, Eisler, Szmukler, and Russell, 1991).

Major Theories

As mentioned earlier, clinicians and researchers typically look through the “lens” of theories in order to understand and analyze gathered information. Currently, there are six theoretical perspectives that are commonly used today. These theories are: (a.) the biological perspective, (b.) the psychodynamic perspective, (c.) the behavioral perspective, (d.) the cognitive perspective, (e.) the humanistic-existential perspective, and the (f.) the community-cultural perspective.
Biological Perspective. This perspective calls attention to the role of bodily processes. It assumes that bodily processes such as inherited defects in genes, acquired defects (such as those acquired through injuries and accidents), and hormonal and neurological imbalances can be pinpointed to explain disorders. It recognizes that the body and mind are interrelated and affect each other. In anorexia, hereditary factors specifically physiological mechanisms are suspected. Changes in biochemicals levels that play a role in the control of metabolism and eating such as norepinerprine, serotonin and opioids are seen in people with anorexia (Fava, Copeland, Schweiger, and Herzog, 1989).
Psychodynamic Perspective. The psychodynamic perspective places emphasis on the role of anxiety and inner conflict. It sees thoughts and emotions as important determinants to one’s actions and reactions. Furthermore, one has to look into deeper emotions and feelings to understand troubling behavior. It is interesting to note that while anorexics have a preoccupation with self image, the real issue lies in the lack of self worth (Mayo Clinic, 2010).
Behavioral Perspective. Here, behavior is shown as merely a product and response to environmental stimuli. That is, learning molds behavior thus personality. Behaviorist Ivan Pavlov is known for his infamous classical conditioning experiment. The experiment basically sheds light on the impact of stimuli on behavior. In manipulating external factors behavioral responses change and adjust. Mothers, for instance, may show over concern over their daughter’s weight and physical attractiveness serving as negative stimuli to a daughter’s concept of self worth and identity. Childhood sexual abuse, certain characteristics of family environment, and other early traumatic events are also possible contributors to the condition (Svirko & Hawton, 2007).
Cognitive Perspective. Cognitive perspective based theories examines internal mental processes with an emphasis with mental interpretations and problem solving. In abnormal psychology, it looks for defective thinking as the root of an abnormal behavior. Individuals with anorexia have an impaired ability to process information. The cognitive distortion obviously lies in their ability to interpret their emaciated physical appearances as they continue to think that they are overweight. When clinicians are looking at a disorder through a cognitive perspective, they often use cognitive therapy in conjunction with other treatments. Although there is much variation to different types of cognitive therapy, they normally share three basic assumptions: (a.) Cognitive activity affects behavior, (b.) Cognitive activity can be monitored, and (c.) Behavior change can be achieved through cognitive change (Sarason, 2005).
Humanistic-existential Perspective is an optimistic theoretical approach that emphasizes on individuality and how we have the freedom to make our own decisions. It is has a spiritual context to it not found in other theories. While there is not a lot of back up research to support it, many clinicians see it as an effective approach to rehabilitation. An article by Aida Warah (1993) looks at the anorexic’s compulsion to excessively exercise. It hypothesizes that “overactivity may help the anorexic person achieve a sense of existential permanence by dynamizing her static and too rational mode of being.”.(Warah, 1993).
Community-cultural perspective. This approach looks into the role of culture and community has in contributing to maladaptive behavior or disorder. Western culture and other industrialized countries, for instance, hold thinness as a desirable physical characteristic in individuals especially in women. Obesity is considered undesirable and in fact is associated with many negative stereotypes. A few of which include lazy, unintelligent, and uneducated. Western media also holds a powerful influence in the attractiveness of being thin.

Maladaptive Behavioral Patterns

A behavior is considered maladaptive when it leads the individual to experience a great deal of anxiety, stress, and unhappiness when presented with stressful situations and inner conflict. Individuals with maladaptive behavior tend to have a narrow spectrum on how to act and react. When significant changes happen in his environment, he is unable to adapt and respond appropriately sticking basically to his original way of thought and action. Long term maladaptive behaviors, especially when having an onset from childhood are considered personality disorders. Other features of personality disorders include: (a.) stability-with the behavior being fairly consistent and evident, (b.) pervasive-apparent in social, personal, and occupational areas in life, and (c.) “clinical significant maladaptions resulting in personal distress or impairment in social and occupational functioning” (Sarason, 2005).
Personality disorders falls under three major categories. The first category is odd and eccentric behaviors. Under this category characteristics are the paranoid (tense and guarded), schizoid (restricted emotional expression), and schizotypal (unsettling and peculiar thoughts, appearance, and behavior). Its clinical features include social deficits, absences of close personal relationships, and holds poor prognosis. The second category is dramatic, emotional, or erratic behaviors. Under this are the histrionic (seductive behavior and instant gratification), narcissistic (Self absorbed, expecting special treatment), borderline (unable to be alone), and antisocial (exploitive, manipulative, lack of guilt). Characteristics that they share are social and interpersonal instability yet having the condition improve as they age. The last and third category is anxious or fearful behavior. They include the avoidant (avoiding unfamiliar people, places, events to avoid being embarrassed), dependent (fear of abandonment, needs to be with somebody at all cost), and the antisocial (preoccupied with details, perfectionist).

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Theories provide clinicians and researchers an angle on how to understand and analyze gathered information leading to the understanding on how different aspects of a person’s life combine to contribute to maladjusted behavior and mental illness.





References
Sarason, I.G. and Sarason, B.R(2005). Abnormal Psychology: The Problem of
Maladaptive Behavior, 11th Edition. New Jersey: Pearson Custom Publishing
Ratnasuriya, R. H., Eiser, I., Szmukler, G.L., and Russell, G.F.M. (1991) Anorexia
nervosa: Outcome and prognostic factors after 20 years. British Journal of
Psychiatry, 158, 495-502.
Fava, M.,Copeland, P.M., Schweiger, U., and Hersog, M.D. (1989). Neurochemical
abnormalities of anorexia nervosa and bulimia nervosa. American Journal of
Psychiatry. 146,963-971.
Mayo Clinic. Anorexia Nervosa. Retrieved January 7, 2010. From
http://www.mayoclinic.com/health/anorexia/DS00606
Elena Svirko, & Keith Hawton. (2007). Self-Injurious Behavior and Eating Disorders:
The Extent and Nature of the Association. Suicide & Life - Threatening
Behavior, 37(4), 409-21. Retrieved January 9, 2010, from Research Library.
(Document ID: 1334726021).
Warah, Aida. (1993). Overactivity and boundary setting in anorexia nervosa: An
existential perspective. Journal of Adolescence,16(1), 93. Retrieved December 12,
2009, from Research Library.(Document ID: 7187817).
Anna M Crane, Marion E Roberts, & Janet Treasure. (2007). Are obsessive-compulsive
personality traits associated with a poor outcome in anorexia nervosa? A systematic
review of randomized controlled trials and naturalistic outcome studies. Review of
medium_being_reviewed title_of_work_reviewed_in_italics. International Journal
of Eating Disorders, 40(7), 581. Retrieved January 11, 2010, from Research Library.
(Document ID: 1354035261).