Anorexia
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This document provides an overview of anorexia, including defining it, examining statistics and prevalence, identifying signs and symptoms, exploring causes and effects, and describing treatment options. It aims to help learners understand this mental health difficulty. Key points covered include that anorexia primarily affects females aged 14-18, involves an intense fear of gaining weight and distorted body image, and has biological, psychological, and socio-cultural causes.
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Anorexia
- 1. Kaleidosco pe Yorkshire Understanding Anorexia
- 2. Aim For learners to begin to understand more about the mental health difficulty, Anorexia
- 3. Objectives Define and describe Anorexia and briefly examine other eating disorders Identify statistics and prevalence relating to Anorexia Examine signs and symptoms of Anorexia Identify the effects of Anorexia Describe the causes of Anorexia Examine treatment and support options Consider supportive tips for working with people with Anorexia
- 4. What is Anorexia? 6 Definitions – 3 are definitions of Anorexia, 3 are not Bulimia Anorexia Nervosa - The name comes from two Latin words that mean nervous inability to eat.
- 5. Anorexia and Bulimia the differences Anorexia Refusal to maintain weight that's over the lowest weight considered normal for age and height. Intense fear of gaining weight or becoming fat, even though underweight. Distorted body image.
- 6. Cont…. Bulimia Recurrent episodes of binge eating A feeling of lack of control over eating during the binges. Regular use of one or more of the following to prevent weight gain: self- induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise. Persistent over-concern with body shape and weight.
- 7. Statistics / Prevalence ? % of people diagnosed with Anorexia are female Answer: 90% The peak age range for onset of the disorder is ? years Answer: 14 – 18 yrs
- 8. Stats cont…… About ? percent of people with anorexia recover completely. Answer: 75% Anorexia is much more prevalent in western culture than in non-western countries. True or False Answer: True
- 9. Stats cont…. ?% of people with anorexia also have depression Answer: 63% ?% of people with anorexia also have Obsessive Compulsive Disorder ( OCD ) Answer: 35%
- 10. Admitted cases of Anorexia in NHS hospitals 2005 – 2006 – 620 2004 – 2005 – 517 2003– 2004 – 532 2002 – 2003 – 552 2001 – 2002 – 497 2000 – 2001 – 469 1999 – 2000 – 482 1998 – 1999 – 465 1997 – 1998 – 484 1996 – 1997 – 419
- 11. Signs and Symptoms Eating and Food Behaviours: Dieting despite being thin Obsession with calories Lying about eating Preoccupation with food Strange / secretive food rituals
- 12. Signs and Symptoms Appearance and body image signs and symptoms Dramatic weight loss Feeling fat ( but obviously underweight ) Obsession with body image Critical of appearance Denial
- 13. Other signs and symptoms Diet pills Compulsive exercising
- 14. The effects of Anorexia
- 15. Causes Biological Psychological Factors Socio-cultural Factors Life changes Families Occupational demands and pressure Anorexia and Control
- 16. Taryn’s Story “I could go on and on about why I “became” anorexic, but for now I’ll try to give you the simplest answer I can: Growing up my mother expected a lot from me. I was to be smart, beautiful, talented, polite, and the best at absolutely everything. I was pressured to be perfect all the time. When my mother passed away when I was fifteen, to numb out the pain I began dieting which turned into an eating disorder. Ever since puberty I thought I was fat (even though I had always been underweight), so by numbing out the pain with starvation I could kill two birds with one stone,” - Taryn
- 17. Men Failure with diagnosis Occupation Cultural / Social factors Control
- 18. Famous people who have had Anorexia Karen Carpenter Kate Beckinsale Melanie Chisholm ( Mel C ) Calista Flockhart Jane Fonda Anna Freud Alanis Morrissette Ally Sheedy Lena Zavaroni
- 19. Treatment and Support Hospital Therapy Medication Self help Developing healthy eating habits
- 20. Supportive tips Encouragement to accept treatment and support Tread lightly Gently express concerns Listen without judgement, and with respect and sensitivity Read about anorexia and understand the condition Support when attending medical appointment
Editor's Notes
- I am going to hand you 6 different definitions, 3 of these are definitions of Anorexia, 3 of them are not. What I want you in pairs to do is to decide which are the 3 anorexia definitions. What are the other 3 definitions explaining?, what condition – Bulimia
- Females and Males – Males do suffer from Anorexia, obviously 10%, we will examine later why men become anorexic when we study the causes of the condition. Peak age – This might be due to life changes, biologically and socially, but also due to low self esteem, perfectionism, and evidence points to a child’s early relationship with their care giver, for example, their mother, for example problems with mother – child attachment, again we will pick up on some of this social psycholoigical perspectives later.
- Recovery – Positive prognosis, but studies show differing figures which have produced different results. One study by Steinhausen indicated that 50% of people with anorexia never require an inpatient level of care. Of the remaining 50% who require inpatient care it was estimated that an additional 50%–70% will recover, the study also stated that the overall spectrum of patients with anorexia nervosa showed that 75%–85% will completely recover. In other studies it shows recovery rates at 90%. Recovery as we will discover later depends upon a variety of treatment interventions and support networks. Culture– This might be due to the media in western society, which portrays thin women as beautiful and desirable, obsessed with body image, dieting and thinness, there are however studies that indicate that there is a rise in numbers of anorexia in non westernised cultures, this maybe due again to access to westernised media and culture.
- Only up to 2006, but a worrying rise in one year, 2004 – 2005 to 2005 – 2006, the rest of the years that are small peaks and troughs. Why the sudden rise?
- Some call these warning signs, what I would like us to do is to split into 2 groups, I would like 1 group to list as many eating and food behaviour signs and symptoms and one group to list as many appearance and body image signs and symptoms. Dieting despite being thin – Follows a severely restricted diet. Eats only certain low-calorie foods. Bans “bad” foods such as carbohydrates and fats. Obsession with calories, fat grams, and nutrition – Reads food labels, measures and weighs portions, keeps a food diary, reads diet books. Pretending to eat or lying about eating – Hides, plays with, or throws away food to avoid eating. Makes excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”). Preoccupation with food – Eats very little, but constantly thinks about food. May cook for others, collect recipes, read food magazines, or make meal plans. Strange or secretive food rituals – Often refuses to eat around others or in public places. May eat in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).
- Dramatic weight loss – Rapid, drastic weight loss with no medical cause. Feeling fat, despite being underweight – May complain about being overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs. Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight. Harshly critical of appearance – Spends a lot of time in front of the mirror checking for flaws. There’s always something to criticize. They’re never thin enough. Denies being too thin – Refuses to believe that his or her low body weight is a problem, but may try to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).
- Using diet pills, laxatives, or diuretics – Abuses water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss. Compulsive exercising – Follows a punishing exercise regimen aimed at burning calories. Will exercise through injuries, illness, and bad weather. Works out extra hard after eating something “bad.”
- Mental Health / Psychological – Like we stated in the DD training, this can also be a chicken and egg, did the mental health problem drive the anorexia, or the anorexia, did the behaviour lead to a mental health problem, anorexia can though increase depressive symptoms, anxiety, making pre-exisiting symptoms worse. Moodiness, sadness, irritability, memory problems, social withdrawal, difficulty maintaining relationships. Refer to handout
- Flipchart exercise – What do we think causes Anorexia? There is no sole cause. Anorexia is a response to a complex mix of cultural, social, familial, psychological, and biological influences unique to each person. Biological – Some studies suggest people have a genetic predisposition to Anorexia, in other words if another family member has suffered then there is a likelihood that a person may develop the condition. Some research shows that baby girls who are born premature will have a higher risk of getting anorexia later in life than baby girls born after spending 40 weeks in the womb. This is especially true in babies who are very small when they are born. Research has shown that higher than normal levels of serotonin in the brain (a chemical, or neurotransmitter used by nerve cells to communicate and which controls appetite and mood), are sometimes found in people with anorexia nervosa. However, there is some debate over whether the increased levels of serotonin are a consequence of anorexia rather than a cause. Genetics don’t tell the whole story. There is usually some life event, incident that appears to trigger a person to develop anorexia. Psychological factors – People with anorexia have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsession (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (personal high-standards and the need for control) have been cited as commonly reported factors in research studies. Maybe mental health problems that have an impact,. Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders are the most likely conditions co-exist with anorexia, and high-levels of anxiety and depression are likely to be present in most individuals with anorexia. Socio-cultural factors - Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media. There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia, around 50%. prior sexual abuse is not thought to be a specific risk factor for anorexia however. Life changes – Puberty, pressure at school, college or work, difficult family relationships, physical or sexual abuse, other stressful life events that can lead to stress, e.g. bereavement and divorce, separation etc. Families – Over involvement from parents in a child’s life, or overprotectiveness could lead to someone seeking control, this control maybe achieved through food and abstaining from eating, controlling by rigid dieting. Abandonment Issues: If a divorce or separation takes place in the household considerable stress can occur. If the child grows up in a tremendously body conscious household. For example, if the mother and/or father is constantly dieting, exercising, and/or commenting about weight issues, the child might begin to emulate the parent's behavior (as a means of acceptance). Mourning Period (bereavement): An eating disorder may arise as a result of a death. Because of an inability to mourn, the individual will attempt to numb his/her feelings through restriction Ridiculed about weight: If an individual was constantly made fun of (name-calling, jokes, etc.) when he/she was growing up, they might be inclined to develop an eating disorder (coping mechanism). Demands and Pressure – Aswell as pressure felt at school, college and work, and within the family, some jobss and recreational activities and occupations lend a hand to anorexia developing in people, any guesses which professions might figure highly here? – modelling - The average woman is 5"4' and weighs 140 pounds. The average model is 5"11' and weighs 117 pounds, ballet dancing,acting, jobs involving a high level of fitness, exercise and stamina, athletics, running, cycling, gymnastics. Anorexia and Control For the person with anorexia, control is a powerful influence on day-to-day life. The need for control manifests in the person's life in many ways, some of which are more damaging than others. Restricting food intake can give the person with anorexia a huge sense of superiority and power, which makes all the restricting seem worthwhile. Controlling food intake helps the person control other people. Anorexia provides a kind of control that others cannot touch. You can’t make a person eat, sometimes the frustration in others can make someone feel like they have controlled that persons emotions, and with someone with a lack of control in their life can appear very powerful. Anorexia provides a sense of control over the events of each day. When a person is constantly looking for ways to avoid food intake, the day can become very predictable. Each meal is often the same, day after day, Exercise can fit into the same level of routine. In many cases, there are no decisions about whether to go out with friends or not: The answer is always no, because eating with others is too dangerous. People with anorexia control their emotions extremely well. It is rare to see someone with anorexia be emotionally vulnerable, or openly angry ( unless challenged ). Anorexia can make a person feel very good about themselves, because they have learnt to controltheir life in some way. In reality Anorexia is controlling the person and until a person can relinquish that control then the problem will still exist.
- Eating disorders have mostly been investigated within the female population. To a large extent this is because of the apparent prevalence of eating disorders in women. On closer inspection however gender distributions of eating disorders show about 10 per cent of people with anorexia are men. Diagnosis - Evidence suggests that the gender bias of Doctors mean that diagnosing anorexia in men is less likely despite identical behavior. Men are more likely to be diagnosed as suffering depression with associated appetite changes than anorexia. Men are also reluctant to discuss whether they have an eating issue, this might be because our society sees anorexia as a female problem, for men to reveal might be developing such a condition can cause shame and embarrassment. Occupation – Men can be in occupations like women can demand thinness and weight loss which can trigger anorexia, horse racing, modelling, dancing, distance running and driving etc. Social / Cultural – One reason why men might develop the condition could be that the media often sends information and pressure for men to be fit an musuclar, this cultural pressure may be a trigger and factor for men. Control – We picked up on control, its worth reiterating, both men and women who feel out of control in their lives may develop anorexia as a way of feeling in control. Controlling their food intake gives a sense of control that is otherwise lacking.
- Karen Carpenter (musician): Went on a water diet to lose weight and, as she put it, to appear more attractive. Continued to diet even after losing 20 lbs, until her death at the age of 32. She died of cardiac arrest due to anorexia and weighed only 80 lbs. Kate Beckinsale: Actress Kate Beckinsale struggled with an eating disorder during her teen years, before she decided to start acting. She has frankly spoken in interviews about her eating problem. Thanks to the support of her family and therapy Kate was able to recover from anorexia. Melanie Chisholm: Singer Melanie Chisholm (Melanie C - former Sporty Spice from the Spice Girls) publicly admitted suffering from an eating disorder and depression. Throughout the time she was in the "Spice Girls", Melanie alternated between starving herself and excessive exercise. "My mum assumed my tiny body was a result of being busy with the band and working out regularly." Calista Flockhart: Actress Calista Flockhart admitted after years of being in denial that she struggled with anorexia while filming the TV show 'Ally Mc Beal'. "I started under-eating, over-exercising, pushing myself too hard and brutalizing my immune system.“. Jane Fonda: Award-winning actress Jane Fonda revealed several years ago that she had been a secret bulimic from age 12, and struggled with anorexia and bulimia for 30 years. Jane became one of the first Hollywood actresses to break the silence and talk openly about eating disorders and campaigned to raise awareness about anorexia and bulimia. Anna Freud: Sigmund Freud's daughter, who was also a psychotherapist, documented that she struggled with anorexia when she was younger . Alanis Morissette: Canadian singer Alanis Morissette has admitted that she has struggled with anorexia and bulimia between the ages of 14 and 18 when she was trying to break into the music business. She wrote the song "Perfect" (from Jagged Little Pill album), inspired by her eating disorder recovery. Ally Sheedy: Actress Ally Sheedy (best known for her role in the 1985 hit "The Breakfast Club") struggled with anorexia and bulimia in the past and at one point also was addicted to pain killer medications. Lena Zavaroni (actress) - died from her eating disorder anorexia
- The road to recovery starts with admitting you have a problem. This admission can be tough, especially if you’re still clinging to the belief–even in the back of your mind–that weight loss is the key to happiness, confidence, and success and food is being used a control measure when in other areas of your life control is not there. So what can be done to help someone with anorexia. I am going to hand you a piece of flip chart paper to 2 groups, what I would like you to do is draw a tree with branches on the paper. The branches should represent the differing treatment and support that people with the condition can access, include what a person can do themselves. Hospital – For people who have severe anorexia, hospital maybe the only option, the person may be suffering from chronic weight loss, organ dysfunction, malnutrition. Therapy – Many types. Nutritional counselling - a nutritionist or dietician teaches the patient about healthy eating, proper nutrition, and balanced meals. The nutritionist also helps the person develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight. Cognitive - Explores the critical and unhealthy thoughts underlying anorexia, focus on increasing self-awareness, challenging distorted beliefs, and improving self-esteem and sense of control. Behavioural Therapy - Promotes healthy eating behaviors through the use of rewards, reinforcements, self-monitoring, and goal setting. Family - Examines the family dynamics that may contribute to anorexia or interfere with recovery. Group -. Helps to reduce the isolation many anorexics may feel. Group members can support each other through recovery and share their experiences and advice. Medication – Maybe useful for some. Antidepressants (such as amitriptyline) is one example of drug treatment and may speed up the recovery process. Self help – There are many things someone could try to combat the problem, friends and family support, write down feelings and thoughts, keeping a diary or journal, make a list of positive qualities - talents, skills, and achievements, focus on what a person likes about their body – appreciating the things they like about their appearance. Challenge the negative self talk - if self-critical or pessimistic, a person might stop and challenge the negative thought, asking themselves what evidence they have to support the idea. What is the evidence against it? Just because someone believes something, doesn’t mean it’s true. Answering these questions might help someone see things in a more realistic light. Healthy eating habits – Not easy for a person with Schizophrenia to develop or maintain, but with enough support and guidance a person might start to be able to sticking to a regular dietary routine, start challenging the strict rules they place upon themselves and avoiding restrictive and starvation diets and behavour associated to these. This takes a whole re-learning process and this is not as simple as it might sound.
- Encouragement – If a person is willing to contemplate treatment and support, the person should be positively praised and supported to make that step, awareness leading to action is not an easy process for someone to get to grips with. Tread lightly - defensiveness and denial is involved in anorexia, you may need to tread lightly. Gently express your concerns - and let the person know that you’re available to listen and that suppport is always there to access. Listen - listen without judgment, no matter how out of touch the person maybe about their image and appearance.