Anorexia nervosa is associated with high rates of mortality and morbidity in young people Drawing on
Abstract Anorexia nervosa is most prevalent in younger populations and is associated with significant morbidity and mortality. This essay aims to consider the issues associated with working psychologically with this population. The treatment of anorexia nervosa can be challenging, protracted, often unsuccessful, and raises various issues of controversy. ... A range of aetiological theories and treatment approaches exist, each with their own associated issues. ... Epidemiology Anorexia nervosa was first described in the medical literature as a nervous disorder associated with young women (Lasegue, 1873). ... Although most frequently associated with adolescent females, it is also known to occur in older populations, males, and children as young as 8 years old. ... There is less consistency in the prevalence rates reported for younger children due to disputes regarding appropriateness of using adult diagnostic tools with pre-pubescent children (Bryant-Waugh & Lask, 1999). ... Medical Complications Anorexia nervosa frequently runs a chronic course, causes significant psychological and emotional distress, and is associated with serious physical morbidity. With an estimated mortality rate of 20% over 20 years (Theander, 1985), it ranks above any other functional psychiatric illness and comparatively high among most chronic medical illnesses. A wide variety of physical complications are associated with anorexia nervosa. ... Early onset anorexia has the additional complications of delaying puberty and in some cases permanently interfering with growth in stature and breast development (Russell, 1985). ... The medical complications of anorexia nervosa are not only serious and complex, but have features unique to the illness. ... Multidisciplinary working The multifaceted nature of anorexia nervosa means that working psychologically with this group frequently requires close interdisciplinary liaison. ... This section aims to provide a brief overview of each of the aetiological perspectives, and consider the treatment implications and issues associated with each. Genetic theories argue the existence of a genetically based biological predisposition that leaves individuals vulnerable to developing anorexia nervosa in certain environmental circumstances. ... Starvation theories argue that eating disorders are maintained by psychological changes arising from the neuroendocrine abnormalities associated with starvation. ... They noted the following range of behavioural, emotional, social, and cognitive symptoms, many of which have noted as characteristic aspects of anorexia nervosa. ... Prior to re-feeding and the reduction of the psychopathology associated with malnutrition, psychotherapy is often considered inappropriate (Danzinger, 1989). ... Higher prevalence rates also exist dancers and athletes where there is an even greater pressure to achieve a slim ideal. ... A social constructionist perspective also highlights the negative impact that labelling anorexia nervosa as a disorder can have on our ability to understand it. ... Simply characterising anorexia nervosa as a cultural ‘slimmer’s disease’ does not appear to adequately explain its associations with low self-esteem, and a lack of a sense of self, of independent autonomy, and control (Malson, 1998). ... The meaning of this cultural context should therefore be considered when trying to treat anorexia nervosa. ... Crisp (1983) hypothesises that anorexia nervosa may develop as an avoidance strategy in individuals struggling to deal with the physical and emotional changes associated with the transition into adolescence. ... The peak age for the onset of anorexia nervosa is mid-adolescence (Szmukler & Patton, 1995); a period associated with the transitions of sibling departure from the home, loss of grand-parents, and puberty. ... This perspective promotes the use of supportive intervention to help assist families in managing the stresses associated with the role transitions of the family lifecycle. ... The psychological deficits and physiological risks associated with the effects of starvation means that abnormal nutrition must be improved, but without depriving the patient a sense of autonomy. ... The extent to which these are exacerbated or even caused by the cognitive deficits and obsessive tendencies associated with malnutrition remains unclear, although treatment approaches which focus upon weight restoration alone have been strongly criticised (Bruch, 1974). ... Family based theories of anorexia focus on a range of organisational aspects to the family system that may constitute predisposing or maintaining factors. ... There does not appear to be one single dysfunctional family constellation that causes anorexia, rather a variety of different patterns of family organisation that may be associated with eating disorders (Eisler, 1995). ... Ethical and Legal Issues in Treatment There is a range of potential approaches to treating anorexia nervosa, however the anorectic’s prime fear of gaining weight will frequently result in problem denial and a reluctance to agree to treatment. Alongside this, treatment refusal has been associated with the following psychological aspects of the anorectic; a fear of giving up control, a lack of trust in interpersonal relationships, the need to counteract a strong sense of ineffectiveness, passive aggression, perfectionism, cognitive distortions, and mood disturbance. ... Treatment refusal in anorexia nervosa has evoked considerable discussion regarding the use of compulsory treatment. ... The addition of health concerns related to anorexia nervosa have been identified to contribute considerably to the responsibility and burden experienced by professionals involved with their care (Rubel, 1986), with therapists at times describing the physical health of their patients as holding them ‘hostage’ (Lackstrom & Woodside, 1998). Patients with anorexia nervosa have been reported to generate more anger, stress, and helplessness in medics than diabetics or obese patients (Brotman, Stern & Herzog, 1994). ... Conclusion Working psychologically with young anorexic populations evokes a range of issues.