Anorexia Nervosa As The Deadliest Mental Disorder In The Modern USA

There is evidence from the 12th Century of religiously motivated self-starvation where eating food was looked at as a sin and restricting food meant paying devotion towards God. (Bishopp, 2018) In 1689 physician Richard Morton named the disorder the “wasting disease” which may be more accurate than the term “Anorexia” which Sir William Gull explained occurred in both males and females in 1873.(Bishopp, 2018) “Anorexia” is two Greek words meaning “without appetite” which is quite a misnomer as the main aspect of the disorder is going against hunger cues and dangerously restricting calories. (Harvard, 2009) “Nervosa” means nervous and speaks to the Stress Diathesis model where 94% of patients with Anorexia Nervosa (AN) also have a co-occurring Mood Disorder illness of Depression or Anxiety. (NEDA, 2019)

Around the late 1800’s and Early 1900’s AN changed from being looked at from the stance of folklore and tradition to an approach that included both fields of Medicine and Psychiatry.(Bishop 2018) By the 1940s many AN disorder patients were being seen by therapists and Freuds theory of Psychoanalysis was a popular form of treatment that yielded unsatisfactory results. (Bishopp, 2018)

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Behavioral therapy including CBT and DBT which focus on changing thoughts and beliefs had some success but also fell short as one of the hallmarks of AN is an avoidant temperament with a rigidity and resistance to change. (Bishopp, 2019) The disorder itself is a form of habituation where not eating becomes a sort of conditioned response to hunger cues. (Bershad, et al. 2018)

By early 2000, the advancement and addition of new psychological therapies had led to a wholistic or integrationist approach to include the umbrella of biological, psychological and social approaches. (DeAngelis, 2002) The best and most widely studied therapy in the treatment of AN is FBT, or Family Based Therapy because it brings about the fastest and most enduring changes. (Hall et al. 2018) Out of the 13 published randomized control trials on effective therapies for AN, 11 have been done on some type of family-focused approach. (Hall et al. 2018) Maybe that is because the disorder is most likely to present during the most chaotic and susceptible of times, the teenage years. (NEDA, 2018)

The field of Psychology is a science, and therefore, it performs clinical trails and experiments according to the scientific method to bust myths and problem solve. (Curtis, Kelly 2018 p.97) There are five steps within this method, and it will be discussed in relation to a study that was done recently on Anorexia patients. In this case Columbia University asked the question, “Do the brains of healthy people and people with AN work the same with regards to food choice?”. Turning that into a hypothesis became, “The brains of those with AN work the same as the brains of healthy people in regard to food choices.” Steinglass and Shohamy developed an experiment where they administered a food choice task to a control group and to the group with AN during an fMRI scanning. (Bershad et al. 2018) Data collection was compiled with the computers that registered the areas of the brain that the participants accessed when making food choices. The data was analyzed, and it was discovered that the part of the brain associated with habit formation – the dorsal striatum was activated in the patients with AN, but not those without AN. The conclusion reached was that habit formation explains why some patients struggle for years to overcome AN. They also used the findings to help inform treatment and create new therapies in the treatment of AN. (Curtis, Kelly 2018 p.30)

The four F’s are Psychology’s measuring system used to decipher what normality in human behavior and metal processing is. (Curtis, Kelly 2018 p8) Frequency is the first F and has three subcategories; Amount of Time, Behavior and Curve. (Curtis, Kelly p10) Many people choose to go without food or restrict calories for a short amount of time to decrease a pant size or lose their love handles. But in AN, the desire to lose a little weight becomes an obsession and the behavior of restricting calories lasts an average of 5 years. (DeAngelis, 2018 p34) The person with AN has a severely distorted body image and even when they are starving and deathly underweight, they always see themselves as grossly overweight. (NIMH, 2019) The normative bell curve explains that while many people may struggle with yo-yo dieting and body image, those who develop the disorder of AN only amount to .3% of males and .9% of females of the population at large. (NEDA, 2018)

Function refers to the ability of the person with the disorder to meet the requirements of their life or to follow their passions. (Curtis, Kelly 2018 p13) Is the person able to have relationships, do well in school, participate in social gatherings or hold down a job? (Curtis, Kelly 2018 p13). In a person with AN, the lack of calories in the diet, particularly fats, affects all the areas that contribute to a healthy life. (NIMH, 2019) The brain robbed of the fat it needs to function begins to take a toll not only on the ability to learn and perform once simple tasks, but also on the person’s ability to keep relationships while they turn further and further inward. (Bishopp, 2018) Keeping up the rituals of “meal preps” and deciding how best to restrict calories begin to dominate the life of someone with AN. (Bershad et al, 2018)

Feeling pain is a measure how the disorder causes someone to feel pain because of the thoughts, behaviors and emotions they are experience from the disorder. (Curtis, Kelly 2018 p13) A person with AN has a voice inside their head which behaves much like an abusive relationship. (Waterhous,2018) It tells them what they can eat, to restrict, that they don’t deserve food, and that they are bad if they eat it. (Waterhous 2018) This “other brain” causes severe anxiety and thoughts of worthlessness. (Waterhous 2018)

Fatal refers to the eminent threat the disorder places on a person’s life or health. (Curtis, Kelly 2018 p.14) AN is the deadliest of all mental health disorders with a mortality rate of up to 10% where 1 in 5 deaths is attributed to suicide. (NEDA 2018) AN may be a disease of the mind, but the seriousness of the disease is largely because of the physical ramifications the disorder has on the body.(NIMH 2018) The advanced disorder can kill without warning, even when labs appear normal there may be an electrolyte imbalance the malnourished body cannot remedy, or sudden cardiac arrest from the chronic stress on the body’s systems. (NEDA, 2018)

Using the DSM-5 as a guide, the patient will present with behaviors of restriction of food intake leading to sudden weight loss, Intense fear of gaining weight or becoming fat, and disturbance in the way one’s body or shape is experienced. (APA 2013) If Anorexia is suspected, evaluation by medical and psychological professionals is required. The body will be evaluated, and an EKG and blood panel will be taken. A psychological evaluation is needed and may include self-assessment questionnaires. (Mayo, 2019) It can be difficult to tell by looking at someone if they have anorexia. Many bodies and shapes are different and just because someone isn’t extremely thin, doesn’t mean their anorexia isn’t as serious. The detection and Diagnosis of AN has come a long way while further study is still needed.

References

1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, 2013 American Psychiatric Publishing taken from http://www.psychologycharts.com/list-of-mental-disorders.html
2. Bershand, Mariya, Glasofer, Deborah R, Stienglass, Joanna & Attia, Evelyn, Decision-Making, the Brain, and Anorexia Nervosa. Eating Disorders Resource Catalogue 2018 p6-9
3. Bishop, Dr. Emmett; Let’s Get Real About the Future of Eating Disorder Treatment; How Far We’ve Come, February 26, 2018, Retrieved From https://www.eatingrecoverycenter.com/blog/February-2018/lets-get-real-about-effective-eating-disorder-treatment-eating-recovery-center’s-dr-emmett-bishop
4. Bishop, Dr. Emmett; Let’s Get Real About the History of Eating Disorders; February 24, 2018, Retrieved from Eatingrecoverycenter.com/blog/February-2018/lets-get-real-about-the-history-of-eating-disorders
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8. Harvard Mental Health Letter, Treating Anorexia Nervosa, published August 2009 retrieved from https://www.health.harvard.edu/newsletter_article/Treating-anorexia- nervosa
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10. Mayo Clinic, Anorexia Nervosa, 2019 Retrieved from https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597
11. National Eating Disorder Association, Anorexia Nervosa 2018 taken from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
12. National Institute of Mental Health,(NIMH) Eating Disorders, March 2019 Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
13. Waterhous, Therese S. PHD, The Eating Disorder Voice, p22 Eating Disorder Resource Catalogue, 2018