A proper diet is essential to good health, both physical, mental and emotional. It is important therefore that we learn and understand various issues that can affect our personal health and well-being. An eating disorder, like Anorexia Nervosa, is a good example and it is by this article that I hope that we can not only develop an understanding of this disease and its sufferers but also learn to be responsible for our own bodies. Christina Tan
Anorexia Nervosa is a serious mental condition which affects primarily adolescent girls with 90% of all cases reported being female. This disorder has been around for many centuries and its name was first used by physiologist William Gull in the early 1870s. The term "anorexia nervosa' means 'nervous loss of appetite'. This term is often misleading as an anorexic is not only interested in food but often may actually be extremely hungry. Often this disorder is linked to various factors and these can be internal factors like low self-esteem as well as external factors, for instance, society's preference for thin women. Anorexia usually begins with an attempt at dieting to lose excess weight. This dieting, however, can become an obsession and, as time goes by, the anorexic becomes abnormally sensitive with his/her weight and appearance, claiming that he/she is too fat despite people saying otherwise. Eventually, the disorder becomes a disease when psychopathology becomes physiopathology - that is, when problems of the mind create problems for the body (Levenkron, cited in Sondon-Hagopian, 1992, pp1).
Anorexic people are usually perfectionists with high expectations. They are usually compliant, approval seeking, dependent and socially anxious. According to researchers Bruch (1978) and Muuss (1985) (cited in Sondon-Hagopian, 1992, pp5), their studies have shown that, as children, some anorexics were well-behaved, conscientious, cooperative, overachievers in school and quiet, but, with a fear of not receiving the respect and admiration of others. These children are also in tune with adult expectations for them and are often described as children who do everything right. Other characteristics also include perfectionistic tendencies with a fear of making the wrong decisions, unrealistic goal-setting, intense desire to be respected, self-confident and successful, problems in identity formation and compulsive bevariors such as excessive orderliness and overly conscientious study habits.
There are various signs and symptoms which may tell us if a person is anorexic, the most striking of which is thinness. An anorexic is extremely thin with a loss of 15% or more of his/her ideal body weight. In fact, the anorexic does not just look thin but skeletal. Although, he/she may wear clothes which can mask their appearance, their faces are usually gaunt with hollow cheeks and sunken eyes. An anorexic also has a fine downy hair called lanugo hair which develops on the arms and can even cover the face. It is also likely that the anorexic's skin will be rough and dry and that his/her nails too may show ridges across them and be cracked and broken. Among female sufferers, a loss of menstrual periods or amenorrhoea often occure when the body weight has fallen to below 85% at least of the female average weight (taking into account her age and height). The pulse rates in anorexics are also slow with a range of 40-60 beats a minute, increasing if the individual had recently eaten. This is so due to a reduced metabolic rate and the body conserving its energy. In addition, he/she may also feel nauseated or bloated after eating normal amounts of food and may also weight him/herself frequently. Other warning signs include a reduction in food intake, ritualistic eating habits such as cutting up meat into extremely small bites or chewing every bite excessively, excessive exercising and weakness due to the wasting away of muscles.
Anorexics, particularly women, use food as an outlet for relieving highly charged emotions such as anger, frustration, anxiety and depression. This form of relieving their emotions is similar to how men vent their feelings on drinking, gambling, sports or sex. Victims of Anorexia Nervosa frequently suffer from guilt, shame, fear of rejection and inadequacy and self disgust. According to Strober (cited in Sondon-Hagopian, 1993, pp5), anorexics are dependent, have low self-esteem, lack assertiveness and are insecure. All these will, in turn, affect the victim's ability to cope with any role which requires him/her to be assertive and independent. "Many anorexics also feel constantly, like the alcoholic, that they are just one temptation away from disaster. If they once start eating they will never be able to stop." (Crisp, 1980, pp81) Anorexics usually also feel isolated and friendless and think they are unacceptable people. However, this problem only forms a vicious circle as sufferers often shun others whether it be at home or in public for fear of exposing their real self and their problems. Most anorexics prefer to dine alone either in their bedrooms or at times others than family mealtimes. Usually sufferers will also reject offers of help and cannot tolerate any disruption of their daily routine which includes exercise, eating and purging times. It is therefore often that words such as secretive, hostile, stubborn, withdrawn and sad are commonly used to describe their behavior by others around them.
For the anorexic, society and fashion's preference for thin women is probably one of the most significant factors in contributing to their disorder. The message that is being expressed is that thinness and beauty equals to social, sexual, interpersonal and professional success. The work of Garner, Garfinkel, Schwartz and Thompson (cited by Sondon-Hagopian, 1992, pp2) revealed the role of sociocultural pressure in anorexia nervosa in the last 20 years. Their inestigation of 'Playboy' magazine centerfolds, and contestants and winners of the Miss America Pageant (from 1959 to 1978) show that there has been a gradual but definite change in the preferred shape for women toward a more angular and thinner physique. During that same period, they also found an increase in the number of diet articles in six popular women's magazines. This indicates a parallel increase in the culture's interest in and attention to dieting, thinness and appearance in women. It is this sociocultural pressure that has an enormous impact on the women and this, together with family expectations and individual characteristics determine the causes of this disease.
The treatment of Anorexia Nervosa is three fold: medical assessment and stabilization, weight restoration and psychological recovery. Sufferers of Anorexia Nervosa firstly need to acknowledge that they have a serious problem and that they need to take up the courage to seek help and treatment. Ultimately, their own feeling of selfworth must be reaffirmed. It is with this frame of mind that they can be motivated and helped by professionals. Sometimes, the anorexic may be hospitalized to enable the doctors to monitor his/her nutrition. This is usually so in extreme cases where the anorexic's body weight has reached a dangerously low level and needs immediate attention. When the anorexic's diet gradually turns to an adequate diet, the physical symptoms of starvation will also gradually disappear. Other various forms of treatment such as counselling, self help groups, medical and non-medical practices are also available and it is best that one consults his/her nearest clinic for an assessment and referral before commencing any treatment.
ADELAIDE Anorexia Bulimia Nervosa Association (Inc) ABNA 1st Floor, Woodards House 47-49, Waymouth St Adelaide SA 5000 Tel: 08 8212 1644 Fax: 08 8212 7991 Office hours: Mon to Fri, 10 am to 4 pm
BRISBANE Eating Disorders Association Inc (Qld) PO Box 138 Wilston QLD 4051
Eating Disorders Association Inc Resource Centre Open 9 am to 5 pm 102 Kedron Brook Road Wilston, Qld 4051 Tel: 07 3352 6900 Fax: 07 3352 7700
CANBERRA ACT Anorexia & Bulimia Nervosa Support Group PO Box 773 Woden ACT 2606 Tel: 07 286 3941
HOBART Dr Elaine Hart - Cambell House Tel: 03 6234 3802
Jane Dunsford - Women's Health Centre 326 Elizabeth St Nth Hobart, TAS 7000 Tel: 03 6231 3212
Kaylene Allan - Community Nutritionist Tel: 03 6228 8323
Organished "Why Weight?" Body Image and Eating Disorder Awareness Schools Kit available from: Community Nutrition Unit PO Box 96 MOONAH TAS 7009
MELBOURNE Anorexia & Bulimia Nervosa Foundation of Victoria 1513 High St Glen Iris, VIC 3146 Tel: 03 9885 0318
PERTH Eating Disorders Awareness Group (EDAG) Chris Harris PO Box 523 Claremont, WA 6010 Tel: 09 371 0752
SYDNEY Eating Disorders Association (Inc.) PO Box 81 Castle Hill, NSW 2154 Tel: 02 9655 1511 or 02 9634 7642 (Support for families and friends)
Eating Disorders Support Network PO Box 53 Willoughby, NSW 2068 Tel: 02 9412 4499 (Support for sufferers and families)
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Clark, Kristine L., Parr, Richard B. & Castelli, William P. (1988). Evaluation and management of eating disorders. Champaign, Illinois: Life Enhancement Publications
Crisp, A. H. (1980). Anorexia nervosa: Let me be. London: Academic Press Inc. (London)
Largen, Velda L. (1981). Guide to nutrition. South Holland, Illinois: The Goodheart-Willcox Company, Inc.
Lester, Ian H. (1994). Australia's food & nutrition. Canberra: Australian Government Publishing Service
Saxelby, Catherine (1987). Nutrition for life. New South Wales: Reed Books Pty Ltd
Slade, Roger (1984). The anorexia nervosa reference book. London: Harper & Row, Publishers
Way, Karen (1993). Anorexia nervosa and recovery. New York: Harrington Park Press
Anorexia Bulimia Nervosa Association
A Clinical Perspective
Definition of Anorexia Nervosa
The Connection Between Anorexia Nervosa And Achievement In Modern Society - A Review
The National Agricultural Library
Reference Guide for Vitamins
Reference Guide for Minerals
Advances in Nutrition
Healthlink
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