Anorexia Nervosa: not just a catwalk problem

There’s been a lot in the news lately about Anorexia – mainly relating to size zero models on the catwalk. But that’s really just the tip of the iceberg. One in 100 women and one in 1000 men in Britain will suffer at some time from this condition, from which only about four in ten sufferers will fully recover. 5% will die from causes associated with it, such as blood chemistry problems, dehydration, infections and suicide. Other distressing results include osteoporosis, bowel problems, swelling of hands and feet, teeth problems, anaemia, depression, delayed puberty and loss of sex drive.

The diagnosis of Anorexia includes the refusal to maintain body weight over a minimally normal weight for age and height, and weight loss leading to less than 85% of expected weight. It usually involves intense fear of gaining weight or becoming fat, even when underweight, and amenorrhoea in females with absence of at least three menstrual periods.

Although the condition affects mainly girls between 15 and 25, children as young as ten, and some much older people can develop Anorexia. Sufferers exhibit a range of deviant behaviours including vomiting secretly after eating, lying about how much they eat (and everything else to do with food) and hiding their thinness by wearing baggy clothes. Many Anorexics refuse to admit they have a problem and therefore do not seek help until forced by family and friends who notice how thin they’ve become. Even then, it can be difficult to persuade them to see a GP because their need to lose weight overrides any health concerns they may have.

Causes
There is no clear underlying cause for the condition, but the general pressure from society on women to be thin is almost certainly partly to blame and this is probably why Anorexia is more common in western societies. Nearly 50% of pre-pubescent schoolgirls admit to dieting or other methods of weight control. Girls whose bodies develop earlier than their friends may confuse maturity with overweight, or suffer teasing and bullying about their size and shape. If this should happen at a time of stress such as parental divorce, changing schools, or bereavement, it can lead to obsessive thoughts and a feeling of being out of control. Any young person concerned with their weight or diets before the age of 14, has suffered from stress, behaviour problems, lacks self-esteem, or has relationship problems with parents and siblings is vulnerable to developing anorexia. Children who experience concerns from family members over weight, shape or size have a greater chance of developing eating disorders.

The onset of Anorexia may be a way of dealing with emotional upset. Anorexics are often lacking in self-confidence, are perfectionists, seek approval from others, cling to parents, have a fear of growing up and dislike sexual activity. Most of them seem to have been ‘good’ children, but are afraid of risks and adopt rigid routines. Many don’t ‘fit in’ and are insecure, and often take excessive physical exercise. About a third of Anorexics have had some form of sexual abuse in their childhood.

There may be some genetic factor involved, since studies among families with identical twins have shown that if one twin has it, there is a 50% chance of the other twin having it. This suggests it runs in families, but that may be down to environmental and behavioural factors. The fact that not every twin gets it shows there must be other factors present.

Treatment
There is no single therapy or treatment that has proved significant in the successful treatment of Anorexia. There are countless hospitals, clinics, organisations and self-help groups but all are limited in their ability to offer effective and long-lasting relief to the sufferer.

Hospitals relying on strict treatment regimes are often criticized for taking control away from the patient, and many patients who have experienced such treatment often express a wish to die rather than be re-admitted.

There is much dispute among clinicians in finding a common ground for therapeutic action, especially as the commitment to objective science necessarily disregards any moral perspective the patient may have on food, or the psychological factors supporting their behaviour. And there are always those who believe that self-discipline, competitiveness, willpower and hard work will prevail, entirely ignoring the fact these are often the very things that caused the condition in the first place. Even when some success in weight gain is achieved through hospitalisation, experience shows that entering one of the ‘talking therapies’ will have a more positive outcome, and this is where most people seeking advice from their GP will be directed.

Age Regression Therapy
This is often beneficial in discovering the original childhood experience that triggered the condition. In hypnosis they may find the answer to their self-loathing and why they want to be invisible, feel ugly, embarrassed, sensitive, awkward. They may feel greedy and fat because they were always been told so and bullied. It could be a mother who always insisted the child ate all their dinner because ‘other children are starving’. It could be they were sexually abused.

Parts Therapy
This introduces the client to the various, separate personalities within their psyche and allows each personality, while in hypnosis, to express their own view on the problem. This gives the client a better understanding of themselves and frequently achieves a successful resolution of the underlying causes of the condition.

Cognitive Behaviour Therapy
CBT is probably the most useful therapy in treating Anorexia as old patterns of thoughts, feelings and behaviour can be reformed in a more helpful, less destructive way. The client learns to change the way they think about themselves, the world and their relationship with it.

A major problem with treating Anorexics is that they are usually very impatient to get results which leads to unrealistic expectations, especially with regard to the time when positive change begins. Whichever treatment is used, it will almost always take place over a fairly lengthy time. Extreme caution is needed and the exact causes of the individual’s condition need to be fully understood to achieve long-lasting success.

Copyright: Adrian Walker 2008