Comorbidity in Anorexia Nervosa

Anorexia Nervosa is defined as a disorder whose main characteristics are an unreasonable fear of gaining weight, disturbances in the perception of one’s body shape or size, and the relentless pursuit of thinness, leading to significantly low body weight (Burke, 2016). Anorexia was added to the DSM-5 in 1980 under its own category of Eating Disorders with two subcategories: Binge eating/Purging type and Restricting type. Binge eating/Purging type anorexia can be diagnosed by behaviors of eating excessive amounts of food, misusing laxatives or diuretics, and self-induced vomiting.

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Restricting type anorexia can be diagnosed by behaviors of decreasing calories, excluding food from a diet, and exercising to lose calories.

To diagnose an individual with Anorexia they have to meet at least three certain criteria. A body mass index, also known as a BMI, uses the weight of an individual combined with their height to identify whether or not they are at risk to develop problems with weight. An individual who has a body mass index of 18.5 or less, has amenorrhea, or the loss of menstrual cycles for the previous three months, and one cognitive symptom meets the criteria to be diagnosed with Anorexia (Berg, 2012). Combined with the above criteria and behavior patterns, doctors look for more detailed information such as sleep patterns, diet status, behaviors to prevent weight gain, and more specific cognitive symptoms. Frequent cognitive questions involve whether there is a present disturbed body image, fear or weight gain, and body disconnect with size and weight. Physical effects of both subtypes of Anorexia can have severe consequences on the major organs, bones, muscles, and overall ability for the body to function. This can lead to more severe consequences such as death.

There have been numerous studies conducted on the comorbidity between anorexia nervosa and the prevalence of mental health disorders. Many individuals who suffer from anorexia nervosa can be diagnosed with other mental health disorders, including anxiety, depression, obsessive-compulsive disorder, and schizophrenia. Research has allowed psychologists to correlate whether or not the comorbidity of these disorders will show higher rates or if the symptoms will be more severe.

The first Disorder, one that has shown higher rates with anorexia, is Obsessive-Compulsive Disorder. Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder and involves obsession or compulsion that affects a person’s daily life. Their obsessions are often repeated thoughts, irrational feelings, and false beliefs that disturb functioning. Compulsions are behaviors that help lessen the obsessive thoughts that disturb normal functioning. Examples of these behaviors include counting, repeated checking, cleaning, or organizing.

If an individual suffers from both anorexia and OCD, their behaviors from both disorders have a tendency to overlap. In restricting type anorexia, symptoms include counting calories and excessive exercising. These behaviors are driven by an overwhelming fear of gaining weight. These thoughts and fears are classified as obsessive when it disrupts an individual’s ability to get them out of their mind. They are classified as compulsive when an individual spends a significant amount of time each day counting calories and exercising. To help calm the fear of gaining weight, the individual feels the need to do so to “calm” their mind to be able to function better. Obsession compulsive disorder as a comorbidity can also show symptoms not related to their eating disorder, as OCD is often driven by the need to be perfect. In a study conducted by Christopher Thornton and Janice Russell, they worked to identify whether or not OCD and dieting disorders displayed comorbidity. The sample consisted of 68 patients, 35 with anorexia, and the other 33 with bulimia. All patients were assessed for obsessive-compulsive disorders. The comorbidity rate for those with anorexia nervosa was 7 percent (Thornton, 1995). Though it remained unclear as to why this percentage was so high, it proved their hypothesis to be true and provides evidence to this research.

The second focus of comorbidity in anorexia is Depression. Depression is classified as an extremely unhappy, miserable mood that is oftentimes accompanied by other symptoms of physical and cognitive nature (Burke, 2016). One of the most severe subcategories of depression is major depression. The criteria to be diagnosed with this disorder is specific and persistent. Individuals have to have five symptoms lasting two or more weeks of both physical and cognitive states. These can include lack of interest, low energy, sleep and food disturbances, and thoughts of suicide. Individuals also suffer from Anhedonia or the loss of joy and pleasure of activities that were once enjoyable. Depression is one of the most common types of mental health disorders present with anorexia. In 2012, The Royal Children’s Hospital in Australia completed a study researching prevalence rates for depression and anxiety in children/adolescents. Results of a large study of females 11-68 years old showed that 94% of those with anorexia had a comorbid mood disorder (Blinder, 2006). The same study was completed with a small study of 10-15-year-old males and showed that 73% of the individuals also had depression (Lucka, 2006). A larger study of females 12-18 years with early on-set anorexia was performed and the co-occurring rate was 60 percent and age 7-13 males was percent. Further tests provided evidence that subtypes of anorexia and depression had high similar rates in children and adolescents.

A third co-occurring disorder in anorexia is anxiety. Anxiety disorders are a group of mental disorders in which fear or anxiety are the subcategories. Fear is a response to danger, whether it be physical, mental, or behavioral. In Burke’s Abnormal Psychology anxiety chapter, he uses the example of being stuck in a car on a track with an oncoming train. The fear is physical. Emotional fear may include falling in love and behavioral may include public speaking. Anxiety consists of fear when there is no actual present danger. David Barlow used the term anxious apprehension to describe his idea of anxiety. This idea states that anxiety is future-oriented. When an individual suffers from anxiety it can have many negative consequences. The person may suffer from many different fears, however, when the fears become prevalent in an individual’s life it can lead to an anxiety disorder. Using the same article published by Elizabeth Hughes, there is evidence to show a co-occurring rate in children and adolescents. There were four different studies done by Strover and Swanson focusing on anxiety disorders between males and females. These four anxiety disorders were OCD, generalized anxiety disorder, social anxiety, and separation anxiety disorder. Male anxiety disorders ranged from 29 percent to 36 percent and female anxiety disorders ranged from 31 percent to 60 percent.

Based on the findings of the studies for depression and anxiety, it is evident that there are high rates of both disorders in children and adolescents, especially those with early onset anorexia. There is research to suggest that the difference between depression and anxiety is that anxiety disorders may suffer from anxiety disorder before the first onset of anorexia (Bulik, Sullivan, Fear, and Joyce, 1997(Hughes, 2011)).

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