.::Eating Disorders Essay::.

Critically discuss explanations of one or more eating disorders

Anorexia nervosa (a term coined by Sir William Gull in 1873 and literally meaning 'a nervous loss of appetite') and bulimia nervosa ('ox hunger') are the focus of this essay.

Anorexia nervosa is defined as a loss of at least a quarter of one's body weight, amenorrhea [absence of 3 or more consecutive periods] in postmenarchal females, and an obsession with food and a fear of fatness. It can be found in approximately 1% of females, nine tenths of sufferers are female and 95% have started puberty. Bumia nervosa is classed as binge eating followed by efforts to remove the food's effects - such as vomiting, laxatives or excessive exercise. Both anorexia and bulimia are life threatening disorders and there are differences of opinion as tho which disorder carries the most damaged psychopathology.

A common view of eating disorders is that htey arise from society's pressure to be thin and its negative attitude towards fatness. This gives a good explanation for the gender divide in eating disorders, their increasing incidence as models grow thinner as well as their increased prevalence in Westernized society.

Indeed, Mumford, Whitehouse & Coudry studies 369 girls in Pakistan and found that only one of them had diagnosable bulimia, and none had diagnosable anorexia.

However, Hoek spent 3 years in a Caribbean island where fat is still considered beautiful, searching for cases of eating disorders. While doctors reported none, through studying 144,000 records of mental health patients and 291 in depth, Hoek found 8 diagnosable cases of eating disorders. This is the same rate as in Europe where the media promotes thinness.

Other researchers have found different explanations for the gender divide. One possible third factor could be sexual abuse which is more common in fdemales. Between one third and one half of eating disorder sufferers have reported sexual abuse, suggesting that abuse is a major factor in the development of eating disorders (the most liberal estimates suggest that 1 in 10 people are abused). Perhaps sexual abuse leaves sufferers with a feeling of betrayal by their bodies, particularlt a result of their body giving a sexual response which they may find repulsive. Starvation may thus be a way of avoiding being attractive and sexually mature; maintaining a boyish figure and amenorrhea may prevent abuse and/or pregnancy.

Some have said that eating disorders have grown after the "women's lib" movement which gave women more responsibility as well as moew fredom. This trap led to an increase in the desire for control, as well as a great increase in conflicts,, eventually resulting in more eating disorders.

After suggesting that anorexia resulted from a fear of oral impregnation, Bruch (1982) developed an idea of eating disorders as a way for children made to feel ineffectual to gain confidence and respect for themselves. Feelings of ineffectualness could result from abuse or neglact or from a particular parenting style.

Minuchin et al isolated four factors thought to be present in families of sufferers of eating disorders. These were enmeshment, over-protection, rigidity and lack of conflict resolution. This helps to explain why the anorectic hopes to gain control of her body as the only thing possible to control. Others believe starvation to be a teenage rebellion against the family.

Bruch believed bulimia to result from a conflictual mother-daughter relationship: the daughter binges out of an unconscious desire for her mother and usually then vomits out of an unconscious dislike, even hatred or a desire to reject her mother.

Dally believes eating disorders occur when sociocultural, family and psychosomatic factors overwhelm the individual, causing them to regress to an earlier age. Perhaps the sufferer wishes to be dependent on family members. Other psychologists see eating disorders as a way to avoid family discord. By distracting attention from the problems such as marital disagreement they hope to keep the family together. There is no doubt that this is true in some cases, but it is unlikely to be a factor in all cases of eating disorders.

Behavioural explanations see eating disorders as a downward spiral. An individual loses weight initially, which generates positive attention about their appearance. This reinforces weight loss until the individual develop anorexia or bulimia. However, this explanation does not account for people who do not experience reinforcement and yet continue to develop an eating disorder. For example, anorectics with little social contact or bulimics who remain overweight or normal weight. Also it may not explain why eating disordered individuals have a distorted body image or why they continue to starve when they are emaciated and are receiving negative attention. Of course, perhaps the negative attention is in itself a reinforcer - “any attention is better than none”.

In the 1945 Minnesota semi-starvation experiment, 36 conscientious objections were given little food for 6 months. A surprising result was that these men developed eating disordered thinking, gaining an obsession with food and weight loss. (showing the importance of food to one’s mental health is the fact that four of the men developed
depression and one bipolar disorder).

While it is true that starvation exacerbates disordered thinking, the aftermath of the Minnesota study has been damaging. For years it was believed that force feeding anorectics with no additional psychological support would cure anorexia (all of the men in the Minnesota study recovered soon after the experiment ended and they were allowed to eat normally). What these psychologists were not taking into account was the fact that the men in the Minnesota experiment were stopped from eating whereas anorectics and bulimics starve themselves. Thus weight must be gained at a steady rate together with a lot of psychological therapy looking into reasons why the eating disorder began and how it can end.

A simple medical explanation of eating disorders claims that the hypothalamus is disordered in these individuals. The eating disorder gets continually more chronic as the hypothalamus is affected by continual high levels of stress hormones adrenaline and cortisol because of the anxiety of eating disorders.

Indeed, one eating disorders specialist has compared the feelings of an anorectic to the feelings of someone trapped in a burning building; all thoughts of food, sex and social relationships are banished as the individual needs to concentrate on escape - fight or flight.

Perhaps eating disorders are addictions. For the anorectic starvation initially induces euphoria (explaining the ancient Indian practice of starvation as entrance to the tribe). Lack of sleep (one requires at least 1100 calories to be able to sleep) then exacerbates this high. The anorectic then seeks to regain this feeling. However, without reinforcement after subsequent weeks months or years of starvation the addiction should subside. Either this can be explained by partial reinforcement effect or the addiction must also be to other things - for example to weight loss or attention.

Bulimia has been linked to pain relieving endorphins naturally found in the body. This gives it similarity to heroin addiction where the person seeks the endorphin high.

A gene, 5HT2A, has been found to be twice as likely to be carried by an anorectic than anyone in the general population. This gives strong evidence of a genetic predisposition to eating disorders.

The nature of this predisposition has been widely discussed. Perhaps the gene codes for an eating disorder but perhaps it codes for a characteristic which leaves someone vulnerable to eating disorders - for example perfectionism or competitiveness.

Claude-Pierre believes a disposition to be ‘confirmed negativity condition’ which, given the correct psychological factors in childhood will trigger a ‘negative mindset’. This negative mind is the underlying mechanism which may result in any disorder. This psychological stress may be directed (by society and by the media) into eating disorders. Claude-Pierre has been very successful in her treatment of eating disorder sufferers, including her own daughters. She treated many people who had previously been chronically disordered, particularly with anorexia. The most famous of these are Samantha Kendall and Lena Zavaroni. It is worth remembering that both of these people died. Apparently Zavaroni disliked Claude-Pierre’s Montreux clinic while Kendall promoted its success. The Montreux clinic has recently undergone (and is perhaps still undergoing) legal proceedings regarding its practice which has lead to a dramatic difference of opinion between those who are convinced by (and have often been cured by) Claude-Pierre’s work with the negative mind of sufferers, and those who are shocked y some of the allegations against her and her clinics.

So, the most successful theories of eating disorders consider all the factors. The individual has a predisposition to eating disorders. perhaps a genetic predisposition to the disorder or factors relating to the disorder (such as competitiveness or obsessive compulsive personality disorder found in many anorectics) or perhaps a psychological predisposition of childhood evens such as abuse or marital discord (or both genetic and childhood factors). This predisposition gives an underlying distress which can be directed (perhaps by the media’s pressure on thinness or its vast coverage of eating disorders) into eating disorders. his can then be reinforced by weight loss, increased confidence, hormones in the body or attention (or a combination of the above), leading to a fully developed, and often chronic, eating disorder.