Anorexia nervosa (AN) is a substantially distinctive, and severe mental disorder which affects individuals of all sexes, sexual orientations, races, and ethnic origins but, adolescent girls and young adult women are predominantly at risk. Treasure and Alexander (2013) agrees that AN inflicts young girls or mature women and can develop insidiously in teenagers. Similarly, Zipfel, Giel, Bulik, Hay and Schmidt (2015) observe that AN begins during adolescence and is related with a strong fear of weight gain and disturbing body image as well as a compelling desire to be thin. For those who are affected, gaining weight is a terrifying prospect. This acts as a motivation for adverse dietary restrictions or any behaviour that necessitates weight loss such as extreme physical activity or purging. There are potential psychological needs of the victims of AN, the causes, symptoms, treatment options available as well as theories that are instrumental in containing this disorder.
The prevalence of AN in Singapore is associated with some potential psychological needs among the adolescent females. With the Singaporean economy growing and the influence of industrialization, adolescents and adult females are quickly adopting the western culture. The abundance of food has made these groups to associate beauty with thinness, and hence they persistently pursue thinness. The influence of the mass media has also aggravated AN prevalence among adolescents and adult females in Singapore. Western magazines, advertisements, movies and television shows present women who are remarkably thin and underweight, and this has caused many Singaporean adolescent girls to find ways of cutting their weight to be like them. Dissatisfaction with their body shape, size, and weight has exasperated thoughts of dieting and becoming thin.
Cultural factors are vital in the understanding the ways different societies in the world diagnose, describe and treat eating disorders such as AN. In Asia, culture plays a role in the understanding of the prevalence of AN. Pike and Dunne (2015) found that the emergence of eating disorders in Asia over the last few years shows the complicated relationship between culture and pathology. This has also been triggered by the unprecedented growth and extensive economic and social transformations.
The prevalence of AN in Singapore and other non-western countries is attributed to cultural dynamics such as cultures in transition (Soh & Walter, 2013). Because of the many cultures that exist in Singapore, western culture is embraced widely particularly by the young people. The dissatisfaction of the body among the young generation such as university students and Singaporean Chinese school girls has worsened AN prevalence.
The diagnosis of AN is made according to the DSM-5 criteria (American Psychiatric Association, 2013). A person with this eating disorder must display:
Restriction of energy intake comparative to the requirements which result in a significantly low body weight as per the expected in sex, physical health, and age.
An extreme fear of weight gain or becoming fat, even when one is underweight.
Disturbances in the way a person sees the body weight or shape, lack of appreciation of the gravity of the loss of body weight and unjustified influence of shape or body weight on self-evaluation.
Sometimes these factors are not met, but still, a person can experience AN. An unusual form of AN comprises those individuals who meet the above signs but are not underweight despite loss of body weight. Despite this, there is no difference in the psychological and medical impacts between those experiencing AN and the atypical anorexia nervosa.
Etiology and the root causes of AN are complex. The underpinning issues include a combination of several factors such as environmental and biological factors. The presence of factors can intensify a persons susceptibility to AN, and when combined with promoting life events, the probability of developing the disorder is high. These factors can necessitate the overall risk of developing AN, but a person can develop this condition without the occurrence of these risk factors. Environmental factors that are associated with AN include thin people who are constantly reinforced in the mass media as typical stereotypes. Some careers and professions that promote weight loss and thinness such as modeling cause AN. Also, exposure to severe trauma such as childhood sexual abuse in the family or during childhood and peer pressure from co-workers, family, and friends to be sexy or thin cause AN.
Another cause of AN is biological factors. Some persons may have a genetic predisposition towards the developing of this disorder. Multiple genetic influences combine with environmental factors that increase the risk for illness. Juli and Juli (2014) agree that an interaction between environmental and genetic factors seem to illuminate the pathogenesis of AN. Biological factors that trigger this condition are nutritional deficiencies, irregular hormone functions, genetic predisposition by identical twins with AN, and neurotransmitters such as dopamine and serotonin which influence mood and behaviours.
Despite the above causes, there are precipitative factors that hasten the development of AN. Factors such as age and sex precipitate AN. For example, AN is more common in women and girls. Also, teenagers are at risk because of the changes during puberty. Other factors are pressure from peers on comments about body shape or weight, family history, and mass media influence such as fashion magazines, TV, and skinny models.
Anorexia nervosa also has predisposing factors that increase the susceptibility to this condition. Notably among these is the genetic predisposition. There is a biological evidence of genetic underpinning to AN. This genetic link is chromosome 1 that is responsible for the complex psychiatric disorder. Also, there are perpetuating factors. For example, teenagers and young women are under pressure from the either family or peers to slim and stay thin. Websites and discussion groups have been created to promote eating disorders. Guidelines on how to lose weight are given including inspirational photos and videos of success stories. These disorder websites have generated a culture that triggers the spread of harmful and unhealthy eating behaviours.
The above factors have enhanced the prevalence of AN, but there is protection against this disorder. In spite of adolescents in Singapore having a problem with AN, what is giving hope is the presence of family, faith, and financial needs. The family was initially perceived as an obstacle in the treatment of AN, but White et. Al (2015) observe that family therapy exists as one of the recommended types of treatment for adolescents with AN.
Family therapists are in agreement that some family interactions offer a perfect remedy for AN, especially teenage daughters. According to Treasure and Schmidt (2013), parents should be mobilized to restore the normal eating habits in the early phase of adolescents with AN. Such implementation should be as soon as the symptoms are seen to avert the disorder becoming chronic. When this kind of protection is present at home, young people become open with parents and will build security and trust. They will start to work with the parents and develop empathy towards them, and hence a reduced isolation which was felt previously (Wallis et. Al, 2017).
The initial warning signs and symptoms of AN may pose a challenge in distinguishing it from the normal dieting. They may be hidden, dismissed as side effects of prescription drugs or attributed to other health conditions. These signs and symptoms are divided into physical, psychological and behavioural. The physical signs include rapid weight loss or regular change in weight, fainting or dizziness, loss of menstrual periods, feeling cold even in warm weather, constipation or the unexplained intolerance to food. Others include feeling tired, low energy in the body besides changes in the face such as sunken eyes.
Psychological symptoms range from anxiety or irritability during meal times, refusal to maintain a normal body weight, depression, anxiety, difficulty in concentrating accompanied by slow thinking and low self-esteem and perfectionism. Other symptoms include increased sensitivity to comments that relate to food, body shape, weight, and extreme dissatisfaction with body image. Behavioural signs are eating in private, secrecy while eating, compulsive exercise during bad weather, and general dietary manners such as fasting, avoiding food groups like fats and carbohydrates. Victims are also known to weigh themselves frequently and look in the mirror obsessively.
There are varied treatment options for AN. Doctors, dieticians, and clinical psychologists are involved in the treatment because AN affects the physical well-being of a person. Psychologists have used theories that assist in giving treatment. For instance, Sigmund Freud advanced the psychodynamic theory which states that the behaviour of human beings are affected powerfully by unconscious motives and have roots in childhood experiences.
Psychological treatment for AN includes Cognitive Behavioural Therapy (CBT) by Aaron Beck and Compassion Focus Therapy (CFC) which was developed by Paul Gilbert. In CBT, the patients dysfunctional behaviour and beliefs are targeted and modified, which help the patient in the developing more adaptive behaviour and thinking patterns. The behavioural component of treatment involves the use of rewards as a form of positive reinforcement which keeps the patient focused on the set goals. Apart from addressing the distorted cognitions, this therapy is useful in teaching the patient how to cope well with difficult situations that may bring stress and distress.
The other psychological treatment for AN is the Paul Gilberts Compassion Focused Therapy (CFT) which that integrates practices from Cognitive Behavioural Therapy. CFT uses compassion and self-compassion in helping people to develop and work with safeness, soothing and inner warmth. Leaviss and Uttley (2015) posit that CFT encourages individuals to practice compassionate behaviours and cultivate compassion motivation in accessing the soothing systems. The central technique here is compassionate mind training which imparts skills and aspects of compassion to change problematic patterns of emotion and cognition associated with anger, self-criticism, shame, and anxiety. CBT principles have been incorporated into CFT. For instance, at the start of the therapy, an assessment is conducted by the therapists and formulates a case as well as a collaborative treatment plan for the patient.
Oakes (2014) notes that CBT remains a viable form of treatment for AN even though there are other treatment options. Despite this, alternative treatments such as yoga, art therapy, and acupuncture are known to treat AN. Art therapy involves taking patients through the healing process by use of writing, music, and art. This therapy plays a crucial role in addressing changes in the body and image distortions because the therapist uses art during the process, therefore, gaining the confidence in the ability of the patient to cope with AN. With time, the patient develops trust and can speak about the disorder.
Psychological theories can be used in the addressing the psychological needs of the young females and adult females in Singapore suffering from AN. These approaches are used to describe and understand human behaviours, emotions, and thoughts. A psychological theory is composed of two key components which include the ability to describe a behavior and must make predictions about future behaviour. Attachment theory by John Bowlby, for instance...
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