Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Anorexia nervosa is an obsessive-compulsive disorder characterized by a body weight at or below 85 percent of normal and an intense fear of weight gain. Anorexia nervosa is typically a physical manifestation of underlying emotional conflicts such as guilt, anger, and poor self-image. Eating disorders such as anorexia nervosa are the third most common chronic condition among girls ages fifteen to nineteen. Approximately 90 percent of people with anorexia are female.
Anorexia nervosa often occurs following a successful dieting experience, and frequent dieting may contribute to the development of the disorder. Dieters may experience positive feedback regarding weight loss and feel compelled to continue losing weight.
Although the term “anorexia” means “loss of appetite,” most anorectics continue to experience hunger but ignore the body’s normal craving for food. Anorectics frequently identify specific areas of the body that they believe are “fat,” despite their emaciated condition. Secrecy and ritual eating habits may be signs of anorexia nervosa. Sufferers often lie to family and friends to avoid eating meals and may eat only a set diet at a specific time of day.
Many people with anorexia are high achievers, exhibiting perfectionist or “people-pleasing” personalities. In addition, a strong correlation exists between anorexia nervosa and athletic activities that emphasize the physique, such...
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
Treatment of anorexia nervosa generally consists of medical treatment, including electrolyte balance, and diagnosing and addressing any related health problems, such as heart problems, depression, and osteoporosis; psychotherapy, either group, family, individual, or some combination; and nutrition counseling, as most people with anorexia need to focus away from weight loss and toward nutritional gain.
Research indicates that eating disorders are one of the psychological problems least likely to be treated, and anorexia nervosa has the highest mortality rate of all psychosocial problems. The National Institute of Mental Health estimates that one in ten anorexia cases ends in death from starvation, suicide, or medical complications such as heart attacks or kidney failure.
Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.
It is frequently necessary first to treat the acute physical symptoms associated with anorexia nervosa. Most patients—especially those with severe cases—benefit from treatment in a controlled environment that allows medically...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Anorexia is a multifaceted problem that has physical, emotional, and cultural components. More than three-quarters of adolescent girls in the United States report being unhappy with their bodies and, on average, 25 percent of women are on a diet at any given time.
Most eating disorders were not recognized as illnesses until the late nineteenth century. Conditions such as anorexia nervosa gained the attention of medical professionals during the 1960’s and beyond as a result of the media’s obsession with thinness.
The media are prime contributors to this trend. Television and magazines send confusing messages to young consumers, such as depicting painfully thin models promoting high-fat snacks. Most models weigh about 23 percent less than the average American woman, and up to 60 percent of models suffer from eating disorders. In addition, the media frequently portray overweight people as having a lower socioeconomic status than people who are thin. Obese people are generally portrayed as comical, while thin people are often depicted as more intelligent, sophisticated, and successful, and as happier with their lives.
It appears likely that the incidence of eating disorders will continue to escalate as the media persist in depicting an idealized female body image significantly below normal body weight.
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Broccolo-Philbin, Anne. “An Obsession with Being Painfully Thin.” Current Health 2 22, no. 5 (January, 1996): 23. Bulimia and anorexia nervosa are two eating disorders that affect young people. Depression can be a major factor in determining whether a person develops an eating disorder, as can a poor self-image.
Brumburg, Joan Jacobs. Fasting Girls: The History of Anorexia Nervosa. Rev. ed. New York: Vintage Books, 2000. An award-winning exploration of the history of women’s ambiguous relationship with food, tracing the problem back to the sixteenth century and examining the modern medical and social aspects of the problem.
Costin, Carolyn. The Eating Disorder Sourcebook. 3d ed. New York: McGraw-Hill, 2007. Costin is the director of an eating disorders clinic, and a recovered anorectic. The book offers unique information about risk factors, prevention, medications, and various treatment for eating disorders.
Gordon, Richard A. Eating Disorders: Anatomy of a Social Epidemic. 2d ed. Malden, Mass.: Blackwell Scientific, 2000. Explores the roles that biological factors, sexual abuse, and the fashion industry play in eating disorders; new findings about males with eating disorders; and how eating disorders are shaped in children.
Lucas, Alexander R. Demystifying Anorexia Nervosa: An Optimistic Guide to Understanding Healing. Updated ed. New York:...
(The entire section is 290 words.)
Anorexia Nervosa (Encyclopedia of Medicine)
Anorexia nervosa is an eating disorder characterized by unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The name comes from two Latin words that mean nervous inability to eat. In females who have begun to menstruate, anorexia nervosa is usually marked by amenorrhea, or skipping at least three menstrual periods in a row. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV (1994), defines two subtypes of anorexia nervosa restricting type, characterized by strict dieting and exercise without binge eating; and a binge-eating/purging type, marked by episodes of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. DSM-IV defines a binge as a time-limited (usually under two hours) episode of compulsive eating in which the individual consumes a significantly larger amount of food than most people would eat in similar circumstances.
Anorexia nervosa was not officially classified as a psychiatric disorder until the third edition of DSM in 1980. It is, however, a growing problem among adolescent females. Its incidence in the United States has doubled since 1970. The rise in the number of reported cases reflects a genuine increase in the number of...
(The entire section is 1841 words.)
Anorexia nervosa (Encyclopedia of Mental Disorders)
Anorexia nervosa (AN) is an eating disorder characterized by an intense fear of gaining weight and becoming fat. Because of this fear, the affected individual starves herself or himself, and the person's weight falls to about 85% (or less) of the normal weight for age and height.
AN affects females more commonly than males-90% of those affected are female. Typically, the disorder begins when an adolescent or young woman of normal or slightly overweight stature decides to diet. As weight falls, the intensity and obsession with dieting increases. Affected individuals may also increase physical exertion or exercise as weight decreases to lose more pounds. An affected person develops peculiar rules concerning exercise and eating. Weight loss and avoidance of food is equated in these patients with a sense of accomplishment and success. Weight gain is viewed as a sign of weakness (succumbing to eat food) and as failure. Eventually, the affected person becomes increasingly focused on losing weight and devotes most efforts to dieting and exercise.
Anorexia nervosa is a complex eating disorder that has biological, psychological, and social consequences for those who suffer from it. When diagnosed early, the...
(The entire section is 1742 words.)
Anorexia Nervosa (Encyclopedia of Children's Health)
Anorexia nervosa is an eating disorder characterized by self-starvation, unrealistic fear of weight gain, and conspicuous distortion of body image.
The term anorexia nervosa comes from two Latin words that mean "nervous inability to eat." Anorexics have the following characteristics in common:
- inability to maintain weight at or above what is normally expected for age or height
- intense fear of becoming fat
- distorted body image
- in females who have begun to menstruate, the absence of at least three menstrual periods in a row, a condition called amenorrhea
There are two subtypes of anorexia nervosa: a restricting type, characterized by strict dieting and exercise without binge eating; and a binge-eating/purging type, marked by episodes of compulsive eating with or without self-induced vomiting and/or the use of laxatives or enemas. A binge is defined as a time-limited (usually under two hours) episode of compulsive eating in which the individual consumes a significantly larger amount of food than most people would eat in similar circumstances.
(The entire section is 2311 words.)
Anorexia Nervosa (Encyclopedia of Alternative Medicine)
Anorexia nervosa is an eating disorder characterized by unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The name comes from two Latin words that mean "nervous inability to eat." In females who have begun to menstruate, anorexia nervosa is usually marked by amenorrhea, or skipping at least three menstrual periods in a row. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV (1994), defines two subtypes of anorexia nervosa restricting type, characterized by strict dieting and exercise without binge eatingnd a binge-eating/purging type, marked by episodes of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. DSM-IV defines a binge as a time-limited (usually under two hours) episode of compulsive eating in which the individual consumes a significantly larger amount of food than most people would eat in similar circumstances.
Anorexia nervosa was not officially classified as a psychiatric disorder until the third edition of DSM in 1980. It is, however, a growing problem among adolescent females and its incidence in the United States has doubled since 1970. The rise in the number of reported cases reflects a genuine increase in the number of persons affected...
(The entire section is 1970 words.)
Anorexia Nervosa (International Dictionary of Psychoanalysis)
The term "anorexia nervosa" was coined by William Gull in 1873. Although the term has existed for little more than a century, the clinical description of the syndrome is much older. Among other works, we can find a description in Avicenna in the eleventh century, and we have no difficulty recognizing it in Richard Morton's 1694 account of "nervous consumption." The first complete description in terms identical to those of Gull can be found in an article written by Dr. Louis Victor Marcé in 1860.
The classic clinical picture of anorexia brings together three factors: weight loss of more than 10 percent, amenorrhea, and the absence of a manifest melancholic or delusional mental disturbance. But the emphasis has changed from these classic symptoms to more specific symptoms, such as a confused body image, denial of being thin, desperate desire to be thin, and fear of putting on weight. Also, two major types of anorexia nervosa have been distinguished: purely restrictive forms and forms associated with bulimic episodes accompanied by weight monitoring, self-induced vomiting, and excessive use of laxatives and diuretics. Anorexia nervosa frequently occurs during adolescence, especially among females (ten girls for every one boy). It affects between 1 and 2 percent of the female adolescent population.
Without ever dealing specifically with eating disorders, Freud did in fact establish all of the perspectivesysteria, melancholia, and "actual" neurosisround which the pathological manifestations of anorexia can be understood metapsychologically. As a hysteria, anorexia involves a double polarity: oral fixations of the libido serve as a point of regression, and sexual fantasies become oral and are then repressed. As a melancholia, anorexia involves melancholy over the issue of object loss and a loss of instinctual needs. Freud speaks of an anesthesia that leads to melancholic thinking, which opens up a research path related to the next perspective. As an "actual" neurosis, anorexia poses a threefold question about the importance of the current situation, of somatic and infrarepresentational factors, and of the inadequacy of the ego and capacities for working matters out.
Melanie Klein and her students have stressed the importance of archaic fantasies of sadistic devouring, destruction, and poisoning in anorexia. Psychoanalysts dealing specifically with eating disorders initially considered them to be primarily a symptom and took little interest in the organization of the personality. But because of the complexity of cases and the frequent severity of the evolution of the disorder, the pathology of the personality assumed a growing importance in their work. The Göttingen symposium, organized by J. E. Meyer and H. Feldmann (1965), recognized anorexia nervosa as having a specific structure and viewed it not so much as an attempt toward compromise formation but rather as an attempt to deal with psychotic failures in the organization of the ego by reestablishing the mother-child unit.
Evelyne Kestemberg et al. (1974) have provided a remarkable description of the specific modes of the regression and instinctual organization in anorexia. This organization is characterized by recourse to a primary erogenous masochism in which pleasure is linked directly to a refusal to satisfy a need. Pleasure does not accompany the feeling of having something inside oneself; rather, anorexia eroticizes not satisfying a vital need. Similarly, relationships become dominated by pleasure in their being not satisfied. The hedonization of refusal becomes the guardian of the feeling of being or existing in one's own right, corporeal activity and the body being thus liberated from all external holds. The most complete form of this hedonization of refusal is "hunger orgasm."
Different studies stress the importance of the dependence/autonomy conflict and the fundamental vulnerability of anorexics. This vulnerability is associated with powerful passive desires and, as a consequence, a constant fear of intrusion, particularly an invasion of the body by the object on which these desires depend. To pose the problem in terms that highlight the paradox of anorexia: anorexics destroy themselves to prove their own existence. The destructive effect is not sought after for its own sake, and in this respect anorexia is not a suicidal behavior, although it can be seen as the result of unleashing aggression and turning against the self an incorporation fantasy of an object experienced as destructive for the self. Anorexia is the consequence of using a physiological need indispensable for survival to preserve a feeling of autonomy. In doing sond this is the second paradoxnorexics find themselves in fact more dependent on an environment from which they sought to free themselves. By making refusal the instrument of their liberation, they alienate themselves from the object of the refusal, which they can neither lose nor interiorize.
The anorexia-bulimia tandem leads to questions about whether a problem of dependence underlies other behaviors grouped under the label "addictive behaviors": drug addiction, alcoholism, pathological gambling, and shopping, as well as abuse of psychotropic drugs and kleptomania. The fragile narcissistic bases of such addicts makes their object relations difficult to manage, because these object relations become too exciting and too dangerous. Addiction to products or behavioral practices offers addicts a need-satisfying relational substitute that is always accessible and which they believe they can control, while in fact they fall into its grip.
The eating disorder represents a substitute for the object whose loss could plunge these patients into a collapse. This attempt to find a substitute object in addictive behavior represents a perverse organization of a relationship to the object in which the object is not recognized as having its own desires and differences, but is acknowledged only for purposes of narcissistic reassurance. An analogy exists among these patients' relationship with food, their relationship with their own bodies, and their object relations, as well as their modes of emotional investment in general.
Family-therapy approaches illustrate the sensitivity of these patients to the influences of their environment. These eating disorders can be seen as existing at an intersection between individual psychology, family interactions, the body in its most biological aspect, and society in general. An essentially mental disorder may thus have grave somatic consequences, and these consequences may in turn affect the anorexic's psychic state and thus contribute to maintaining the disorder.
Addictive behaviors raise questions about the type of society in which we live, particularly with the increase in the frequency of these disorders accompanying the increase in consumerism in our societies.
See also: Adolescence; Autistic capsule/nucleus; Bulimia; Flower Doll: Essays in Child Psychotherapy; Kestemberg-Hassin, Evelyne.
Agman, Gilles; Corcos, Maurice; and Jeammet, Philippe. (1994). Troubles des conduits alimentaires. In Encyclopédie medico-chirurgicale (Psychiatrie vol., fasc. 37-350-A-10). Paris: Encyclopédie medico-chirurgicale.
Brusset, Bernard. (1998). Psychopathologie de l'anorexie mentale. Paris: Dunod.
Kestemberg, Evelyne; Kestenberg, Jean; and Decobert, Simone. (1972). La faim et le corps: une étude psychanalytique de l'anorexie mentale. Paris: Presses Universitaires de France.
Venisse, Jean-Luc (Ed.). (1991). Les nouvelles addictions. Paris: Masson.
Aronson, Joyce K. (ed.) (1993). Insights in the dynamic psychotherapy of anorexia and bulimia: An introduction to the literature. Northvale, NJ: Jason Aronson.
Freedman, Norbert, et. al. (2002). Desymbolization: concept & observations on anorexia & bulimia. Psychoanalysis and Contemporary Thought, 25,165-200.
Sours, John. (1980). Starving to death in a sea of objects: the anorexia nervosa syndrome. New York: Jason Aronson.
Thoma, Helmut. (1967). Anorexia nervosa. New York: International Universities Press.
Wilson, Charles, Hogan, C., and Mintz, Ira. (1985). Fear of being fat: the treatment of anorexia and bulimia (2nd ed). Northvale, NJ: Aronson.
Young-Bruehl, Elisabeth. (1993). Feminism and psychoanalysis: in the case of anorexia nervosa. Psychoanalytical Psychology, 10, 317-330.