Understanding Anorexia Nervosa
Another mental health issue worsened by the pandemic.
The Covid pandemic has caused a steep rise in mental health issues. For example, there is a rise in PTSD, depression, and anxiety. There is also a rise in the prevalence of eating disorders. Since the pandemic ended, there has continued to be an increase in anorexia nervosa among females. It is important to note that the statistics reveal an increase in all mental health issues for males and females of all ages, including eating disorders.
Tragically, the epidemic of shootings in the United States has added to the trauma everyone is experiencing.
As early as age ten and twelve, girls become aware of their weight and begin dieting and exercising. If they develop anorexia, it can last until age 35 and sometimes becomes a lifetime problem. NEDA, the National Eating Disorder Association, estimates that one in every 100 girls develops anorexia.
As the reader can see in the illustration, regardless of how skinny the anorectic becomes, when she looks in the mirror, she sees herself as obese.
In Middle School, many girls will not eat their lunches. The reason is that they feel embarrassed about eating in front of boys. In addition, they are reluctant to eat in front of other girls for fear of appearing greedy. Losing weight becomes a competitive issue for many females who judge themselves by how much thinner they are compared to other girls in school.
Anorexia is a disorder characterized by a female weighing less than 15% of normal body weight for age and height. These females do not think of themselves as thin. No matter how much weight they have lost, they think of themselves as fat. As a result, they severely restrict their food intake and obsessively exercise to lose weight.
These young women are extremely intelligent and achieve excellent grades in school. They are perfectionists, demanding and expecting the best possible performance from themselves in all areas, such as academics, athletics, and social interaction.
Along with the symptoms of anorexia, most of these young people experience extreme anxiety, depression and self-loathing, distorted body images, and obsessive-compulsive symptoms.
Symptoms of Anorexia:
Anorexia is a dangerous disorder resulting in the deaths of almost 6% of victims of this illness each decade. Even as these tragic women are dying of starvation, they insist on believing they are fat.
Symptoms:
1. Severe restriction of food intake.
2. Complete denial of the fact that they are skinny.
3. A deadly fear of gaining weight.
4. Loss of menstrual cycle.
5. Loss of secondary female characteristics, so that hips become narrow, breasts shrink, and hair loss occurs.
6. Nails become brittle.
7. Osteoporosis or thinning of bones occurs, increasing the danger of fractures.
8. Compulsive exercising of all types.
9. Blood pressure drops to dangerous levels with the danger of fainting.
10. Body temperature drops so that these people often feel cold.
During meals, these young women may fill their plates with food but push them around and take in very few calories. They will then complain of feeling full, particularly if anyone at the dinner table points out the plate remains full of uneaten food.
These girls also wear long oversized clothing that hides their actual appearance. If asked why they wear "baggy" clothes, they will say they want to hide their fat. Of course, they are hiding their skinniness but seem unaware of this.
The Why of Anorexia:
Anorexia Nervosa has existed as long as civilization. There are historical reports of this disorder among the Ancient Egyptians and Romans through the Middle Ages and up until the present time. The question is, what causes this disorder?
Many theories have been advanced, and research continues on the causes and cures for this eating disorder. Here are a few of the theories on the causes of anorexia:
1. One explanation for anorexia is that limiting caloric intake becomes the one way many girls believe they can control their lives. Raised to be nurturing and believing they have no power, these young people discover that the one area in which they can exert full control is by controlling their food intake and weight.Â
It is important to understand that these girls always feel extremely hungry and think about food. For them, the achievement is to resist hunger pangs and obsessive thoughts about food by exercising and refusing to eat what they consider "unhealthy food."
2. In addition, this becomes the one certain way that these perfectionist girls can reach the goals they set for themselves. The problem is that there is no limit to the weight goal, which is why too many die of malnutrition.
3. Another explanation is related to the value of sexual beauty. Today, in an age where the media and fashion industry puts such a high value on women being skinny, these young people emulate the females they see on television, in the movies, and in teenage magazines. Also, they take seriously the constant messages (meant for obese people) that it is healthier to be thin than heavy. Attempting to achieve physical beauty as defined by society and to be as healthy as possible, these young women diet and exercise and become obsessed.
4. There is increasing evidence of a genetic basis for anorexia. If some forms of anorexia are inherited, a cure could be available. Obsessional thinking, combined with one type of eating disorder in the family, seems to set the stage for anorexia.
5. Dysfunctional family life is also a likely cause of anorexia. Fathers who criticize their daughters for being overweight add to the danger that they will become anorectic. In addition, authoritarian homes where parents are very strict and where there is a lot of arguing and hostility increase the likelihood of girls developing this disorder.
Families have boundaries, and members have role definitions. However, some observe that in many of the family systems from which anorectic girls come, boundaries between generations and between individuals are often violated. Therefore, girls who become anorectic suffer from developing a genuine sense of autonomy and independence because of intrusions by their parents. Without a strong sense of separateness, exerting control over food intake by not eating becomes the only way many females can develop any sense of power and control.
Treatment:
Treatment of anorexia is extremely difficult, partly because of the strong denial by the patient. It is hard to convince someone they need treatment when the patient cannot see they have a problem. For this reason, the younger the patient when the therapeutic intervention occurs, the better the result.
Medication is administered to reduce the serious depression that accompanies anorexia. In treating anorexia, the question that must be asked and carefully weighed is whether hospitalization is necessary. Usually, if weight loss is to such a degree that health and survival are in danger, then hospitalization is required. The particular type of hospitalization is specifically for eating disorders where, on an inpatient level, the issues of food intake and weight loss are discussed in psychotherapy and groups.
Outpatient treatment is called for if the young woman can be maintained at home. With anorexia, a team of treatment specialists is needed to help the young person with this illness. The team comprises the following:
A. Psychiatrists for antidepressant and anti-anxiety medications.
B. Psychotherapist for individual and group sessions. The therapist can come from psychology, social work, or psychiatry as they are trained in eating disorders. Family sessions with the patient are an important and integral part of the treatment.
C. Nutritionist who is trained in the treatment of anorexia and bulimia. The nutritionist monitors daily food intake by requiring the patient to complete a comprehensive log of everything eaten daily besides moods and feelings concerning the food intake. Also, education is provided about food categories, calories, value, and instructions about what and how much to eat at each meal.
D. Medical Doctor to do weekly weigh-ins and health checks.
E. It is important for the patient to understand that failure to maintain at least a minimum weight can cause hospitalization.
There is constant consultation among all treatment team members so that everyone is fully aware of the patient's status and what changes in strategy are called for. These regular consultations also help prevent the patient from causing friction among team members by playing one off against the other.
One of the interesting but disturbing things about the family of anorectic girls is how unaware they are of how little the patient is eating and how much weight is lost. Someone outside the family often must make the parents aware of what is happening. Whether there is a genetic factor in this eating disorder, much of it is tied to family dynamics, so family therapy is a necessary adjunct to inpatient and outpatient treatment.
For many parents faced with a child who is showing symptoms of anorexia, the temptation is to scold, punish, and argue. These are the worst possible strategies because they will be met with either direct or passive resistance. Once denial by the parents is broken through, they realize they have an anorectic child.Â
Punishment and force do not work because they result in more resistance and a greater resolve to lose weight. These very intelligent young women can directly argue with anyone under the table, using reason and their illogical form to defeat anyone attempting to convince them they are thin or do not eat. The result is that parents end up feeling even more frustrated and helpless.
What Can Parents Do Once They Are Aware?
Rather than using confrontation and conflict to force eating, parents need to go with their daughter to the family physician, have her weighed and take referrals from the MD to the nearest eating disorder facility. The best policy is avoiding arguments and allowing professionals to deal with the issue.
Engaging in all-out warfare fails. However, this does not mean parents should say nothing and pretend all is well. One psychologist recommends to his parents that anorectic kids use "hit and run" tactics. Brief reference be made either to not eating or to look too thin and then retreat and say nothing more. These short sorties are the best policy.
