Zusammenfassung der Ressource
Anorexia
Nervosa
- What is it?
- Symptoms
- refusal to eat and
maintain a minimum
average expected
body weight
- Fear of
gaining
weight or
becoming fat
- Distorted
perception of
body weight
and shape
- Amenorrhea
- absence of
at least 3
consecutive
menstrual
cycles
- Weight less than 85% of
expected
- Prevalence
- 90% of cases are in
females between 13
and 18 years of age
- rarely begins
before puberty
- sometimes
younger
children can
suffer from it
- DSM-IV states it occurs
in 0.5-1% of females in
adolescence and early
adulthood
- DSM-V may
be different
- Course and
Outcomes
- 20% have one
episode and
then recover
- 60% follow an
episodic pattern of
weight gain and
relapse over a
number of years
- Remaining 20%
continue to be
affected and often
require hospitalisation
- Mortality rate of those
admitted to hospital is
over 10% due to
starvation or suicide
- Explanations
- Biological
- Neurotransmitters
- Hypothalamus
regulates
eating
- Amino acids in food
leads to serotonin
production
- In someone
without AN,
they feel full
with no anxiety
- In someone with
AN, they're
eating less
- the brain
overcompensates
for this by
producing more
serotonin
- therefore if the
person with AN eats
more then they feel
anxious
- They eat less to
remain calm/
produce less
serotonin
- Cycle
- In addition to this, eating
less can result in changes
serotonin receptor ratios
causing more disruption
to serotonin levels
- Evaluation
- Weaknesses
- Hsu (1990)
- there is not yet sufficient
evidence to indicate whether a
change in a neurotransmitter
levels are a cause of anorexia,
an effect or merely a correlate
- old research
- Numerous other
hormones have
also been linked to
eating disorders.
- Stress triggers
production of
cortisol
- very high levels of
cortisol have been
observed in patients
with AN and Bulimia
- Cortisol also inhibits the
release of a powerful
appetite stimulant - results
in decreased appetite
- Strengths
- Kaplan and
Woodside
(1987)
- showed that in
animals , serotonin
seems to induce
satiation and suppress
the appetite
- Bailer et
al (2005)
- found that recovered
anorexic patients
showed increased
levels of serotonin in
the brain.
- this strongly related
to measures of
anxiety in the
women
- both anxiety and
increased serotonin
persist even a year
following recovery
- A lot of research
in this area is
conducted using
brain scans which
are objective
- Haleem
(2012)
- suggested that
serotonin
production was
associated with
a restricted diet
- don't know which
one causes the
other (unclear
cause)
- Kaye et
al (1991)
- found increased levels
of serotonin in normal
weight anorexics but
normal levels of
dopamine activity
- predominantly
serotonin and not
dopamine
- It has been suggested that
if AN is seen as having a
biological cause then there
will be less stigma
attached and less blame
- application
- Social
- Sociocultural
Theory
- highlights the role
that society plays in
laying expectations
on girls and women,
particularly on the
way they should look
- The theory argues that
young girls, in particular,
are likely to see themselves
as unattractive unless
they're able to have the
popular 'ideal' figure
- Their struggle with food is an
attempt to overcome feelings of
low self-esteem that society
sub-consciously induces, and to
attain a sense of popularity
- as a society we have a
preoccupation with losing
weight
- certain subgroups
are more likely to
suffer
- Eg. AN more likely to occur
in dance or modelling
students compared to
other students
- value placed
on being thin
- eating disorder campaigners
argue that the size 0 image
portrays that fashion is for
slim people and that 'people
are actually this size'
- In the UK the
average female
is a size 14-16
- Size 0 promotes a very
distorted view of body
image and leads to
negative comparisons
- Evaluation
- Weaknesses
- Many people live in
societies that favour
'thin' but don't
develop AN
- AN exists in other
cultures, not just
those concerned with
promoting thinness
- Feminist researchers argue
that eating disorders aren't
a modern disease but has
existed under various
names for centuries
- Moreover, eating disorders affect
not just young girls, but older men
and women as well - however
doctors and counsellors have
tended to focus attention
primarily on young girls and their
bodies
- the description of girls as
highly prone to vulnerability is a
means to confine young girls to
specific roles that are approved
of by western, patriarchal
societies where gender
inequality still prevails
- Disease creation
becomes a way of
gender control
- Strengths
- Diagnosis of AN has
steadily increased since
the 1950s. This increase
correlates with the use of
slimmer models
- Willemsen &
Hoek (2006)
- found that a black
women who developed
AN had grown up in a
culture that valued
voluptuousness as
being attractive
- she developed AN
after moving to a
western culture
valuing thinness
- Becker et al
(2002)
- found that in Fiji before
TV was introduced that
girls were unlikely to be
concerned with diet
and slimming
- After TV was introduced
they were more
concerned with diet and
slimming
- Treatments
- Social
- Family Based
Therapy (the
Maudsley Approach)
- Outpatient
- opposes the notion that
families are pathological or
should be blamed for the
development of AN
- 15-20 treatment sessions
over about 12 months
- 3 Phases
- Phase I:
weight
restoration
- therapist assesses
family's typical
interaction pattern
and eating habits
- Align patient with
his/her siblings
- assists parents
in feeding their
child
- a family meal
is conducted
- Support & empathy but
remaining verbally persistent
- Uncritical stance that
symptoms are outside
of their control
- Phase II: returning
control over to the
adolescent
- discussions
- parental concerns
addressed
- weight gain with
minimum tension
encouraged
- Evaulation
- Weaknesses
- Ethics
- individual can feel
forced into it/ lack
of right to
withdraw
- can make
anxiety
worse
- If treatment is
inadequate (bad
parents) then it can be
dangerous
- Demands lots of
time from
parents
- during the first 2 weeks, the
patient doesn't go to school
and one parent must be
available around the clock to
feed their child
- Specific for
adolescents and
young adults
- low population validity
- Doesn't address possible
biological cause or possible
influences in the media
- Dimitropoulos
et al (2015)
- study involved
content analysis, 7
interviews and 6
focus groups
involving 34
clinicians
- Found that FBT can
be adapted each time
it is used, found
clinicians varied the
treatment according
to the individual,
including their level
of independence
- If FBT is varied
then it's harder
to study and
draw conclusions
about
- Ideographic
- Strengths
- 2010 study in
JAMA Psychiatry
- comparing Maudsley to
adolescent-focused
therapy. 120 ptts.
- found that the 2 had similar
results when the treatment
ended, but that Maudsley had
better remission rates at 6 and
12 months later
- success rate at 50 to 70%
- Le Grange and
Eisler (2009)
- in a 5 year follow up
found up to 90% of
those involved fully
recovered
- Addresses possible
problems in family
dynamics and
attitudes to eating
- Phase III:
establishing
healthy adolescent
identity
- maintain weight
above 95% of ideal
weight on their
own
- focus on the
impact that
AN has had
- central issues of
adolescence
- appropriate
parental
boundaries
- Biological
- Drugs
- Antipsychotics
- block dopamine
- lowers levels of
anxiety and also
enables weight
gain (convenient
side effect)
- Chlorpromazine
- Olanzapine -
5mg daily
- Evaluation
- Strengths
- Court et
al (2010)
- found that using low-dose
quetiapine (antipsychotic)
showed psychological and
physical improvements with
few side effects, using 33
patients with AN
- Dr Hany
Bissada
et al
- randomised,
double blind,
placebo-controlled
trial
- Olanzopine resulted in
greater rate in
increase in weight,
greater decrease in
obsessive symptoms
- 3 patients with AN, on
5mg of Olanzapine a day -
all restored body weight
and appetite as well as
their body self-image
- Weaknesses
- Ethics
- side effects
may cause
harm
- lack of
right to
withdraw
- Zhu & Walsh
(2002) and
Casper (2003)
- suggest that drugs
have limited value for
AN, possibly because
patients do not take
the medication and
instead try to hide it
- success of
treatment may
depend on it
being carried out
in an
appropriate
setting eg.
alongside FBT
- Antidepressants
- increase serotonin
- treat depression
and anxiety that
accompanies AN
- Serotonin re-uptake
inhibitor (SRIs) works by
blocking action of serotonin
transporter - increased
serotonin concentration
- Eg. Fluoxetine
- help with
maintaining
weight and
recovery
- Eg. Citalopram - helps
with depression,
obsessions and
compulsions
- Eg. Venlafaxine
- weight gain when
combined with
CBT
- Evaluation
- Weaknesses
- Crisp et
al (1987)
- found that
clomipramine
(antidepressant)
didn't give any
significant weight
gain for 16 patients
with AN, compared
with a placebo
- Myung Team
Experiment
- examined feeding
behaviour in rats after 2
weeks of administering
Fluoxetine daily
- led to a substantial
reduction in food
intake
- Fluoxetine has been
found to reduce food
intake and weight gain
- Fluoxetine side
effects include:
vomiting, nausea,
diarrhoea, feeling of
anxiousness
- Strengths
- addresses
biological
cause
- Guardia et al (2012)
- Imagining one's own
and someone else's
body actions:
Dissociation in AN
- Aim
- to continue previous
research by the same
team that had found
that patients with AN
found it difficult to
gauge their own body
size and misjudged
their ability to fit
through a door frame
that was clearly big
enough for them
- The study wanted to
test this
phenomenon further
by considering
whether this
perceptual problem
existed beyond the
individual to other
people
- Do anorexics
misjudge the
body size of
other people?
- Procedure
- 25 female ppts from a
clinic for eating disorders
in Lille, France, all of
whom met the DSM-IV
criteria for AN were used
alongside 25 healthy
matched female controls
who were all students
(opportunity sampling)
- A door frame was projected
onto a wall to give the illusion
of an opening that the ppts
could possibly walk through
- 51 width shapes were
projected varying from 30cm
wide to 80cm wide - these
were presented in random
order, and each one
presented 4 times to each ppt
- Every ppt was asked to predict
if they could walk through
each door frame at normal
speed without turning to the
side (first person perspective)
- They were then asked
whether another female
researcher standing in the
room could fit through the
frame (third person
perspective)
- Results
- the group of patients with AN
showed a significant
overestimation of body size in
themselves, judging that they
would be unable to fit
through door frames that
were considerably bigger
than their actual body size
- However the same was
not found in 3rd party
judgments. They were
much more accurate in
whether the researcher
could fit through
- the researchers also found a
correlation between the
'passability' judgments made
by the AN group and their
pre-illness body weight/ size
- The control group have a
much lower perceived ratio
showing their image of their
body weight is much smaller
and that they don't have body
dysmorphia
- No difference between 1st
and 3rd person perceived
ratios - showing the AN
group have body
dysmorphia that doesn't
extend to other people
- Conclusion
- results suggest that body
overestimation can affect
judgments about the capacity
for action but only when they
concern the patient's own body
- This could be related to
impairments of overall network
involved in the emergence of
the body schema and in one's
own perspective judgments
- Overestimation of the body schema
might occur because the CNS hasn't
updated the new, emaciated body,
with maintenance of an incorrect
representation based on the
patient's pre-AN dimensions - the
brain doesn't perceive their current
size accurately
- It was also discovered that
patients who had lost weight
in the 6 months prior to the
study showed a greater
difference between their
own and the 'other person'
passability perceptions.
- suggests that when
anorexics lose weight their
CNS can't update the body
image schema quickly
enough to provide an
accurate representation of
current body size.
- This might explain why
patients with AN continue
to see themselves as bigger
than they are and strive to
continue to lose weight
because the brain doesn't
perceive their current size
accuratlely
- Evaluation
- Strengths
- Highly controlled
- replicable
- establish
cause and
effect
- high internal validity
- Shows consistency
with other studies'
findings
- Showed each shape 4
times - consistency
through test and retest
- Application
- Can help with
treatment of AN
- backs up idea of
body dysmorphia
- lab exp
- standardised procedure
- Matched pairs -
reduces individual
differences
- Reduced order
effects by showing
door frames in a
different order to
each ppt
- Control group have
similar results for 1st
and 3rd perspective -
increased validity
- Ethics
- debrief
- right to
withdraw
- informed
consent
- confidentiality
- Weaknesses
- small
sample
- gender
bias
- low
population
validity
- DSM used in
France - patients
may be
misdiagnosed
- possible
culture
bias
- large error
margins that
overlap in
graph
- may not show SD
- wide spread of data
- unrealistic
setting
- low ecological
validity
- possible
demand
characteristics
- Unrealistic
task
- low
mundane
realism
- scale used may
mean more
mundane
realism than
previous studies
- opportunity
sampling
- only get one type
of person
- possible
individual
differences
- Ethics
- possible embarrasment
- dangerous to
use AN patients