Eating Disorder Anorexia Nervosa

Glossary:

Acupuncture - an ancient Chinese therapy using needles and herbs to revivify the body's energy flow.

Aromatherapy - the use of essential oils to relieve stress and relax.

Anorexia Nervosa - a medical condition and or mental health condition that causes lack or loss of appetite for food.

Bronfenbrenner's Ecological Systems Theory - explains how the basic qualities of a child and his or her environment interactions influence how he will grow and develop.

Cognitive Behavioral Therapy - a type of psychotherapy which helps change negative patterns and thoughts by altering them.

DSM-5 - Manual of Mental Disorders.

Eating disorder - Abnormal or disturbed eating habits.

Homeopathy - the stimulation of the body's natural defences (antibodies) to the illness, by introducing the problem substance into the body.

Hypnosis - sleep like state to alter state of consciousness to recover suppressed memories or to modify behaviors by suggestion.

Meditation - the encouragement of mental relaxation to create inner calmness.

Naturopathy - herbal treatment to help the body heal itself.

Selective Serotonin Reuptake Inhibitors - prescribed antidepressants in order to improve mood.

Transtheoretical Model (TTM) - the model focusing on decision making and intentional change.

Eating Disorder: Anorexia Nervosa

Eating disorders are serious illnesses that can affect people of all ages, sex, gender, race, ethnicity and socioeconomic group this disorder specifically targets the person's mental and physical health but with the right treatment and support this illness is treatable. According to the National Eating Disorder Association (2018) Anorexia Nervosa (AN) is an eating disorder that is characterized by weight loss, lack of appropriate weight gain in growing children; difficult maintaining an appropriate body weight for height, age, and stature; and in many individuals distorted body image. In order to be diagnosed with Anorexia Nervosa (307.1) according to the DSM-5 (American Psychiatric Association, 2013, p.171) a person must display (a) restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, development trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimal expected, (b) intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight, (c) disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. There are two subtypes of AN one is Restricting Type (F50.01): During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations on which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. The other subtype is Binge-eating/Purging Type (F50.2): During the 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). Historians and psychologists (Richard Morton, 1689) have found evidence of people displaying symptoms of anorexia for hundreds and thousands of years, and even though this disorder often starts during adolescence, more and more children and older adults are being diagnosed with anorexia. Parents and friends, social workers, and other health professionals are unable to tell if a person is struggling with anorexia by just looking at them. A person suffering from anorexia does not need to be emaciated or underweight to be struggling. Studies have found that larger bodied individuals can also have anorexia, even though they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

Conceptual Framework Pertaining Anorexia Nervosa

There are a few theories social workers use in order to help their clients with AN, but the theory I would use is the Bronfenbrenner's Ecological Systems Theory, which divides the person's environment into five different levels: Microsystem, Mesosystem, Ecosystem, Macrosystem, and Chronosystem. The Microsystem is the closest to the person and the one in which they have direct contact (i.e., home, school, or/and work), includes interaction with family members at home, caregivers, and peers (classmates, friends, and/or co-workers) at school or at work, this is the most influential level of the ecological theory. The next level on the ecological theory is the Mesosystem; the interactions between the different microsystems which is the linkage of family, caregivers, peers group (i.e., child's parents actively involved in child's friendships or individual's friendship with peers out of the work environment). The third level on the ecological theory is Ecosystem; is the environment in which the individual is not involved, which is external to his or her experience, but nonetheless affects him or her anyway (i.e., parent stresses over work and comes home and takes it out on the child, or spouse stresses out at work and comes home and takes it out on his or her spouse). The other level on the ecological system theory is Macrosystem which is the culture in which the individual lives in instances with an individual suffering with AN how does the family and friends view AN, stigma and stereotype, as well as society's expectations of how people should look. The last level is Chronosystem; consists of all of the experiences that a person has had during their lifetime (i.e.; environmental events, major life transitions, and/or historical events). A person who suffers from Anorexia Nervosa, they do not have a single identifiable cause there are a various different factors that can play in the person's likelihood of having AN like psychological, social, biological, and external factors which as the social worker we should be able to identify them and make a change and help them cope in a better way by then using Cognitive Behavioral Therapy (CBT) which CBT aims to reinforce better eating behavior and encouraging more positive thinking about him or herself try to change the black and white thinking as well.

Community Wellness in Anorexia Nervosa

The National Eating Disorder Association (2018) states that at a given point in time between 0.3%-0.4% of young women and 0.1% of young men will suffer from anorexia. A study published by the Biological Psychiatry (2007) studied 9,282 English speaking americans and asked them about mental health conditions in which eating disorders was one of the options and they found out that 0.9% of women and 0.3% of men had anorexia during their life. In another study (Journal of Abnormal Psychology, 2010) that was followed for eight years using a group of 496 adolescent girls age 12 until they were 20, researchers found that 5.2% of the girls met the DSM-5 criteria for AN, and other eating disorders. In another study done by Eric Stice and Cara Bohan (Eating Disorders in Child and Adolescents Psychopathology, 2012) they found that between 0.9% and 2.0% of females and 0.1% and 0.3% develop AN, and subthreshold AN occurs in 1.1% to 3.0% of adolescent females. In an article Prevalence and Implications of Eating Disordered Behavior in Men (2014), males have a higher risk of dying than women because they are diagnosed much later because of stigma and stereotyping that AN is a women's eating disorder, males do not develop eating disorders even though they make up 25% of individuals with AN. Research has proven that the prevalence of AN is amongst adolescent females but other research has shown me that stigma and stereotyping also plays a part in our society which has made AN a women's mental health ,therefore, men may be excluded from eating disorder, which is not the case; AN does not discriminate.

Dialectic Nature of Social Work Practice in Anorexia Nervosa: Conflicts & Dilemmas

Anorexia happens in stages even though it is not felt by the individual, and every individual's experience is completely different than another individual's everperience. Therefore a social worker does not have one concrete method to help his of her client with AN. All individuals go through the Transtheoretical Model (stages of change): Precontemplation, contemplation, preparation, action, maintenance, and relapse. During the precontemplation stage, the individual is unable to acknowledge their problematic behavior and does not want to change. A person who is suffering from AN during this stage denies allegation from friend and family members that have noticed some of the warning signs and symptoms (i.e., exercising excessively, drastic weight change, binge-eating/purging, restricting eating, and worried about appearance). Therefore this individual is hostile; projects anger and frustration towards those trying to help him or her. During the contemplation stage, the individual is well aware that he or she has a problem and has started to think about getting help. In order for an individual to get to the contemplation stage he or she has to go through an event in there life that they are not willing to lose or go through (i.e., lose a friendship, become terminally ill, it can vary for every individual). They no longer want to use this disorder as a coping mechanism for dealing with stress or challenges in their life because they know it has become a concern. During the preparation stage they begin to connect with change talk for example, I do not want to die, therefore I am ready to change my eating habits and get some help. After preparation it is action, this stage is where the individual has made a change in their behavior, environment, and thoughts. They are committed to the change and also continue practicing their behaviors (i.e., sticking to their meal plan and/or their exercising plan). The maintenance stage the individual is focused on relapse prevention and building on positive changes by improving their health and happiness within themselves and happy with their physique. The individual builds new behaviors, new ways of thinking, healthy self care and coping skills with the help of social workers, support groups, and health professionals. Then, there is relapse, in this stage the social worker, health professions, support system, and individual find out their triggers what works and doesn't work for the individual suffering with AN because they return to their same old patterns, thoughts, and behaviors. A conflict can be the willingness of a person with AN, if the person does not wish to change, there will be no change, even if the child, adolescent is forced to go to a social worker by a parent or anyone concerned with their health also the health professions', social worker's, support systems' and individual's consistency in wanting to be better.

Anorexia Nervosa: Psychiatric & Allopathic Medicine

Even though AN is a mental illness AN can impact the body, extreme AN can lead to medical problems (i.e., anemia, disturbance in heart rhythm, kidney problems, dental problems due to the vomit acid affecting teeth, and osteoporosis low bone density). These medical problems will need various of testing and to be monitored by medical practitioners with experience in AN. Medical professionals like paediatrician, dietician or nutritionist, dentist, and physiotherapists to help care and treat individuals with AN. Nutritional counseling helps the person identify their fears about food and physical results of not eating well as well as helping the individual get educated on how to eat right, how to track what they are eating and eat in a healthier way instead of not eating at all. Then there is mental health management where we come in social workers or psychologists, which help the individual with various kinds of therapy, counseling, and psychological interventions (i.e., psychotherapy building the individual's self-esteem self-confidence, anxiety, depression and interpersonal relationships, other therapies like: CBT, Dialectical Behavioral Therapy DBT, Intensive Short Term Dynamic Psychotherapy ISTDP, Mindfulness Based Therapy, Group Therapy, Family Based Therapy, The Maudsley Approach, and Support Groups. Drug Treatment may be used to treat hormonal or chemical imbalances, individuals experiencing AN may use Selective Serotonin Reuptake Inhibitors (SSRI) such as Zoloft, Prozac, Aropax, and Paxil. These antidepressants in AN are useful to stabilize weight recovery, as well as help with their anxiety and depression that coexists with this eating disorder.

Alternative Understandings & Approaches to Anorexia Nervosa

According to the organization Eating Disorders Victoria (2016) alternative approaches to AN can be Naturopathy, Acupuncture, Aromatherapy, Meditation, Hypnosis, and Homeopathy. These alternatives can be useful to the individual with AN in addition to psychological, nutritional, and medical treatments by reducing anxiety levels or help the individual reconnect with their own body.

References

1. Breanna. (n.d.). Anorexia Nervosa. Retrieved from
   https://www.eatingdisorders.org.au/eating-disorders/anorexia-nervosa
2. Espie, J., & Eisler, I. (2015). Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient. Adolescent health, medicine and therapeutics, 6, 9-16. doi:10.2147/AHMT.S70300
3. Lamy, L. (1970, January 01). Today's world from a psychologist's perspective. Retrieved from https://todays-psychology.blogspot.com/2011/12/bronfenbrenners-ecological-systems.html
4. Ribnick, Lauren. (2012). Engaging Clients in Eating Disorder Treatment; Reducing Dropout. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/msw_papers/79
5. Statistics & Research on Eating Disorders. (2018, September 14). Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
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7. Whitaker AH. An epidemiological study of anorectic and bulimic symptoms in adolescent girls: implications for pediatricians. Pediatr Ann. 1992 Nov;21(11):752-9. PubMed PMID: 1484750.

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