Anorexia Nervosa (AN)

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Anorexia Nervosa (AN)
Symptoms Cause

• AQA A Specifications states cover only one
  eating disorder

Dieting to be beautiful can go disastrously
wrong
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Clinical Characteristics of Anorexia Nervosa
(AN) DSM IV tr

• Nervous loss of appetite.
• Display an abnormal attitude towards food.
  (Eating Attitudes Test E.A.T.)
• Primarily a female disorder, usually occurring
  during adolescence.
• There is a refusal to maintain normal body
  weight.
• Individuals need to weigh less than 85 of their
  normal body weight to be diagnosed as anorexic
  (Body Mass Index or BMI check online)
• The distorted body image is not evident to
  anorexics themselves (Body Dismorphia Disorder or
  BDD)

Online http//psychcentral.com/quizzes/eat.htm
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Secondary symptoms Anorexia causes a general
physical decline including

• Cessation of menstruation (amenorrhoea)
• Low blood pressure
• Dry and cracking skin
• Constipation
• Insufficient sleep
• Depression and low self-esteem
• Up to 20 cases of Clinical AN are fatal (1-5)
• A BMI of below 18.5 is an indicator 15 is
  clinical

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When does it change from Diet into an
autonomous Disorder (DSM IVr)?

• When the BMI (Body Mass Index) is equal to or
  less than 15 (below 85 expected weight by height
  and frame)
• However the BMI is only an indicator, it must
  be accompanied by a distorted body image, an
  abnormal relationship with food, a morbid fear of
  gaining weight, cessation of periods (3 months)
  and denial that there is a problem

What does autonomous mean?
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Why is 15 such an important figure

• At puberty a 15 increase in body fat (puppy
  fat) is required to trigger the release of
  hormones necessary for the development of
  secondary sexual characteristics.
• (Wider hips, breasts, periods, etc)

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What happens if you drop below 15 BMI

• Secondary sexual characteristic hormones are no
  longer produced and the body returns to pre-pubic
  child-like asexuality.
• (Narrowing of hips, cessation of periods,
  breasts shrink, testicular atrophy (males) and
  these can be permanent!)
• NB. The physiological effects of hormones are
  temporary and to maintain effect continuous
  production is necessary

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Combined Causal Factors of AN (AO2)

• The aetiology (cause progression) of AN is
  probably not singular, but more likely a
  combination of factors including
• Biological
• Psychological
• Familial
• Socio-cultural
• Eg. The diathesis model
• Genetic Predisposition Environmental Trigger
  Disorder

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AN Biological explanations

• (1) Genetic origin Familial studies have shown
  that first-degree relatives of AN have an
  increased risk (MZ 56 concordance) of
  developing an eating disorder (Holland et al.
  1988)
• At age 11 there were no genetic influences on
  disordered eating. However, by age 17 the
  heritability of disordered eating was more than
  50 percent. The recent findings implicate puberty
  in the dramatic increase in genetic effects
  across time. (Meta-analysis from the Minnesota
  Twin Study Klump 2007)
• So AO3 evaluate MZ Twin Studies and what does
  it suggest (eating behaviour is partially 50
  inherited/biologically determined).

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(2) Set Weight or Point Theory The set-point
theory argues that an individual's metabolism
(metabolic hormones and fat cell enzymes.) will
adjust homeostatically to maintain a weight at
which the body is comfortable AO2 So our
weight/appearance is biologically controlled ?
inherited/biologically determined
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• (3) Hypothalamic dysfunction
• An on and off command for eating
• The lateral zone function as hunger centre
• The ventromedial zone operates as satiety
  centre
• AO2 So our eating (hungergt full-up) is
  biologically controlled ? inherited/biologically
  determined

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Biological explanations cont...

• (4) Imbalance of serotonin neurotransmitters
• Increased Serotonergic activity Acts to suppress
  appetite
• There is considerable evidence that increased
  serotonin activity in the brain is associated
  with appetite suppression. In fact, drugs which
  act on serotonin pathways in the brain are
  commonly used for the short-term management of
  obesity
• (AO2) Therefore, inherited naturally high
  Serotonergic sensitivity would suppress eating
  and be a potential causal factor in the
  development and maintenance of AN

Link Increase in serotonin makes you happy and
suppresses hunger
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Biological explanations summary... (AO2)

• If anorexia can be shown to be genetic, then
  it must be inherited and we have little choice
  (Genetic Determinism). This then raises the
  question, what physical abnormality is passed on?
• Hypothalamic abnormality?
• Serotonergic abnormality?
• But dont forget to be critical of twin studies
• Studies are MZ and not MZa (reared apart),
  therefore they would share identical family
  environments (eg. shared learning from an
  anorectic mother?)
• This coupled with small sample size brings
  the strength of evidence for genetic
  predisposition into question.
• There must be other explanations (eg.
  psychological or triggers)

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Some AO3 points to consider

1. In all research, the researcher is trying to
   operationalise (IVs) a factor and claim it is
   the cause (DV) is this ok?
2. Most research was performed in the Industrialised
   West. Is this ok?
3. Are twin studies reliable?
4. Are biological explanations the only ones
   available (isolationism)?
5. Does the question of reductionism/determinism
   arise?

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Psychological explanations of anorexia nervosa

• Research into cause

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Psychological explanations of AN

• Behaviourist Explanations (AN as a Learned
  behaviour)
• Classical conditioning (Learning by
  association)
• Eating can be associated with anxiety since it
  can make people overweight
• Losing weight ensures that the individual
• reduces these feelings of anxiety ? Feel fat/ugly
  so diet and associate happiness with weight loss
  and unhappiness with weight gain

Psychological explanations of AN
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• Operant conditioning (Learning as a consequence
  of action)
• The individual avoids food to gain a reward such
  as feeling positive about themselves
• In early stages individuals can be admired or
  congratulated for losing weight and looking slim
  and healthy (positive regard)
• Gain reward or satisfaction as a consequence of
  their actions (control of their food intake)
• ? they associate their ACTION with happiness and
  failure (eating something) with unhappiness

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• SLT People imitate people they admire
  (Media/Peers etc) vicarious reinforcement
  (later reward for gaining the look)

They adjust behaviour to achieve the looks of
others and gain the rewards
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Consider some simple questions ..

• Q) Why do you like to look good when you go out?
• Q) How do you know if you look good?
• Q) What influences you when you go clothes
  shopping?
• Q) Why are females more anxious about visiting a
  hair dresser than a dentist?

Jeggins
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Psychological explanations of AN (AO2)

• Behaviourist Explanations studies...
• A review of 25 studies showed that a slender
  beauty ideal causes body dissatisfaction and
  contributes to E.D. (Groesz et al, 2001)
• The effect was most marked in girls under 19
• The slim ideal becomes equated with success and
  health whereas average weight or overweight
  becomes synonymous with failure, and this slowly
  becomes the dominant belief in society (Harrison,
  2001)

Psychological explanations of AN
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Psychological explanations of AN

• Behaviourist Explanations studies...
• Women feel undue pressure on their appearance and
  reported that 27 of girls felt that media
  pressure them to strive to have a perfect body
  (Forehand, 2001)
• Increase in eating disorders in Fiji with the
  introduction of American television programmes,
  which emphasise a westernised idealised body
  shape (Fearn, 1999)

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Psychodynamic explanations (Freud)

• Adolescents dont want to grow up and separate
  from their parents
• They become fixated at the oral stage1 when
  they were completely dependent on their parents
• Anorectics lose weight, lose secondary sexual
  characteristics, become childlike again (asexual)
  and return to the safety of being a little girl
  again (AO2 Gender Bias)
• In Freudian terms, eating and sex are
  symbolically related2
• A refusal to eat (the only control, they feel
  they have) represents a refusal of sexuality

1. Stages of Psychosexual development
2. Eating as manifest representation of sex
   (ego-defence)

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Cognitive Williamson et al (1993) Distorted
Body Image

• Two groups of participants
• High risk AN (diagnosed)
• Low risk AN (healthy No near relatives with AN)
• Task Put stretched photographs of self back
  to correct size

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Findings..

• High Risk Group significantly over-estimated
  real size
• Low Risk Group significantly under-estimated
  real size (flattered)
• Conclusion
• Anorectics cognitively misrepresent their own
  body image (Body Dismorphic false belief system
  BDD). Therefore no matter how much weight they
  lose, they still feel fat.

Anorectics can never reach their goal!
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ED as an addiction

• Smoking
• Drinking
• Dieting
• Reversal Autonomy
• (See article McCarthy, 2009)

So the dieting behaviour is learned, reinforced
and gains AUTONOMY and then the dieting controls
the person.
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Some AO2/3 points to consider.

• The Behaviourist Approach suggests that AN is a
  learned, reinforced product of involuntary
  associations (classical) or as a consequence of
  actions (operant) be critical (/-) of this
  approach.
• SLT suggests we learn vicariously and model our
  behaviour on the consequences of observation be
  critical (/-) of this approach.
• Psychodynamics (based on Freudian principles)
  suggests a dysfunction during the oral stage of
  psychosexual development be critical (/-) of
  this approach.
• In all cases consider the approach, research
  methods (inc culture), isolationism and the
  reductionism/determinism debate.

NB The cognitive example supports one factor.
Addiction is an alternative way of looking at
EDs and 1 2 above are nowadays combined as
Social Cognitive Theory.
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Assignment...

• Outline symptoms of AN, then describe/evaluate
  two psychological and two biological
  explanations.
• ( 25 marks)
• Instructions
• The essay style answer should have an
  Introduction (introduce/define). Then AO1 (9
  marks) and AO2/3 (16 marks) as sub-headed
  sections followed by a short conclusion
  (summary). You WILL need to focus on AO2/3 (check
  commentary and chapter summary pp 94-95
  textbook Cardwell Flanagan).
• Ideally word processed (1 to 1.5 A4 or
  500/600 words).

Psychological explanations of AN
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