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Anorexia Nervosa by Larry Low      Quiz

Validating Lovability And Other Explanations of Eating Disorders

In 1995, cable television arrived in the Fiji Islands, approximately a quarter of a century after Fiji achieved independence.  A single channel carried programs originating in the United States, Great Britain and Australia.  During the first six months, the viewing audience was relatively small and confined almost in its entirety to the two main islands, Viti Levu and Vanua Levu.  However, within that initial period   the first case of bulimia nervosa surfaced. Researchers at the University of the South Pacific in Suva soon perceived that girls who watched television were 50% more likely than others to see themselves as fat. Since the introduction of television in this South Pacific nation, symptoms of bulimia nervosa have increased at a statistically significant rate. Television, it would seem, doesn't just promote obesity.  It has been suggested that it also can be considered a prime factor in triggering eating disorders in adolescent and teenage girls.

An intriguing study of adolescent girls has verified that exposure to television significantly increases dysfunctional eating behaviour.  Previous attempts to establish a line between media exposure and eating disorders have been constrained by widespread exposure to this form of electronic intrusion thereby making a control group difficult to come by. The Fiji study was led by Dr. Anne Becker, a psychiatrist and medical anthropologist in the Department of Social Medicine at Harvard Medical School, and not incidentally, Director of the Adult Eating and Weight Disorders Program at the Massachusetts General Hospital.  She evaluated the impact of the introduction of Western television on disordered eating among adolescent girls. 

Fijian culture has long supported robust appetites and body shape, evidenced by an endemic compliment paid to a friend one hasn’t seen in some time.  “You’ve gained weight.”

This study represents the first known investigation of the impact of television viewing on a small-scale indigenous society undergoing rapid change.  Subjects were given a 26-item Eating Attitudes Test (EAT-26) and a semi-structured interview in order to confirm self-reported instances of disordered eating.  In addition, some subjects were analyzed for content that could possibly relate television viewing with concerns as to body image.  Subjects living in homes with television were found to be three times more likely to show symptoms of disordered eating. Seventy seven percent reported that TV had influenced, distorted if you like, perceptions of their own body image.

Western media may have a profoundly negative impact on body image and eating behaviour, even in traditional societies in which eating disorders have been thought to be rare.  A worldwide theme appears to be the clash between broadcast-invasive Western behavioural norms and the value systems and self-regulatory mechanisms of these cultures.

In the United States, it has been estimated that more than seven million women suffer from eating disorders.  According to virtually all researchers in the field, a complex of factors is considered responsible. A near-sighted solution is found in uncovering attitudes about weight, food and body shape but the difficulty lies in accurately probing unconscious factors, which must be reconciled before the victim can be considered, if not cured, at least reasonably safe.

Early warning signs include a belief that thinness is equated with happiness.  The eating disorder candidate suffers from mood swings and overeats in response to stress.   Mood swings are related to alternating regimens of strict dieting and overeating.  In addition there is evidence of binge eating with concomitant use of syrup of ipecac to induce vomiting and also marks on knuckles and fingertips.

Bulimia and anorexia are related in that many sufferers have used both methods in an attempt to reconcile the gap between their body image perceptions and their ideal. Both disorders stem from an irrational fear of getting fat.  About 50% of bulimics have already suffered from anorexia.  Anorexics deny themselves food and as well negate the possibility that a problem exists.   Bulimics are aware that there is a problem, compounding their guilt.  Bulimia is often a symptom of: depression, low self-esteem or sexual abuse and is considered to be an attempt by the victim to regain control.

 Bulimic behaviour is addictive because it allows, the victim, in a manner of speaking,  to have her cake and eat it too.  Those who suffer from anorexia nervosa suffer hunger pains, at least in the early stages. The emotional components of both of these disorders are wrapped in guilt, panic and stress.  Eating is normally considered to be a positive emotional experience.  For disordered eating victims, it is anything but. People who suffer from depression can develop bulimia.  There is a link, still ill defined, between eating disorders and depression.  Disorders and Awareness and Prevention report that young girls are more afraid of becoming fat than they are of: cancer, nuclear war, or loss of loved ones

People who suffer from depression often develop bulimia.  There is a link, still ill defined, between eating disorders and depression.  The contribution of chemical and biological factors to eating disorders has not been clearly established.  It is agreed that conditions that trigger bulimia often start in childhood. 

There is no single cause of any eating disorder.   Rather, a complex of factors are at play.  Because any decisions to adopt binge behavioural patterns is an unconscious one, known to the victim only through the workings of the unconscious mind, analysis of the root causes require considerable patience and skill on part of the therapist.  Therapists explain the behavioural pattern as manifesting the existence of other problems in a person’s life.  The first step in the recovery process is to uncover the causes and to teach the victim how to deal with her issues in a healthy way.  There are no miracle cures. Twenty percent of those suffering from an eating disorder die.

Significant medical problems readily arise when a female suffers from anorexia nervosa.  Lack of estrogen can lead to osteoporosis, a process referred to as the female triad.  In those suffering from bulimia, dehydration caused by purging results in dry skin, brittle nails and hair, loss of hair and bleeding gums.  Repeated vomiting can rupture blood vessels in the face, legs and arms.  Serious harm can be done to the heart and kidneys and tooth decay from stomach acid reflux is substantial.   

Another approach to the study of anorexia nervosa has been undertaken by two female psychologists, resident in Phoenix, Arizona, Rosalyn M. Meadows and Lillie Weiss.  The pair of PhDs works with women with eating disorders and sexual problems.  The gist of their argument is that women, in order to be loved, are still repressing their basic needs.  Food represents the most primitive form of loving and nurturing and women must maintain their image of self-control even around other women.  They seek approval and validation from them as well as from men, but even more so because they are in competition with each other, battling for love.  The anorexic girl, Meadows and Weiss say, is a very good girl, in that she has overcome the desires of her body through denial.   Fasting reflects the self-denial and deprivation women will undergo to meet the criteria for lovability.  The price for giving in to her desires: guilt, depression and self-loathing.  Being thin, symbolizes self-control and restraint.

Many patients meeting the full criteria for anorexia nervosa need to be treated as inpatients for several weeks to months. Patients are first stabilized medically, and then started on nutritional rehabilitation. The best approach to feeding is persuading patients to accept healthy amounts of food, prescribed as medicine, with the promise that they will not be allowed to become fat. Feeding may cause abdominal distress as well as mild peripheral swelling.  Education and support help patients understand their illness and need for treatment.

Nutritional rehabilitation is only the prelude to definitive management. The central challenge is persuading patients to think differently about their body size and nutritional needs, and to appreciate the role that their illness has come to serve in their life. Management is also directed toward identifying and treating coexisting mood, anxiety, and personality disorders, and alcohol or other substance abuse. After the patient's weight has been restored to a healthy range, intensive practice in patterns of healthy daily living consolidates the treatment gains. Treatment of individuals under 18 years old seldom succeeds unless it includes the whole family. Aftercare usually requires two to three years, and may involve individual, group, or family treatment.

The death rate from anorexia nervosa is as high as 18%, primarily from medical complications and suicide. Most patients, who survive, eventually improve but improvement occurs over an extended time frame measured in years rather than in months.  Coexisting psychiatric conditions, especially mood disorders, personality disorders, and substance abuse, often prove to be the most difficult aspects of long-term treatment. Mortality can be reduced by prompt medical stabilization of low weight. The good news is that with effective treatment the disorder is curable.

Bulimia is derived from the Greek words for "ox" and "hunger."  A specific criterion for bulimia is repeated episodes of binge eating during which patients feel that they cannot control their eating. Purging occurs in 80% of cases. The term "nervosa" was recently added to "bulimia" to emphasize the features that it shares with anorexia nervosa, primarily the relentless pursuit of lower weight and the morbid fear of fatness. Patients with bulimia may be over, under, or at ideal body weight, with normal weight range most common. A diagnosis of anorexia nervosa takes precedence over bulimia if weight is below 85% of normal.

Like anorexia nervosa, bulimia nervosa usually begins by dieting. Dieters tend toward bulimia rather than anorexia when their hunger overcomes their attempt to restrict food and they begin binge eating, which is not in itself abnormal in food deprivation when faced with abundant nutrition. The clinical disorder emerges when a morbid fear of fatness entrenches itself, and patients suffer psychological distress or medical complications after binge eating and subsequent purging and especially when binges are provoked by emotional distress rather than hunger.   In a substantial minority of patients, bulimic behavior is part of a broader pattern of abnormally impulsive behavior, including alcohol or other drug abuse, sexual promiscuity, and stealing. Bulimia sufferers are usually surprised and relieved to find that eating moderate quantities of food three times a day does not make them fat, as they had feared.

After bingeing and purging is stopped and any medical complications are treated, the focus of management turns to long-term inhibition of binge/purge behavior with cognitive-behavioral therapy.

Media images bombard us with messages as to what the ideal body looks like.  From early childhood, role models provide unconscious input as to what attitudes are desirable in dealing with body shape.   Abuse often leads to a negative impact on body image.  Praise and criticism received during childhood affect our self-image.   The manner in which we are perceived by significant others has a subliminal effect on our own body image.

Exercise for strength, fitness and health and not for weight control.