Although the topic of this article concerns the causes of anorexia, it also gives a definition of it, describes its symptoms, identifies risk factors, describes behavior linked to it, offers a prognosis, and reviews ways in which it can be treated. Most of the reference material I used is relatively recent; however, I did include an article published in 2002 from Psychiatry Online that covers an extensive survey that addresses whether the outcome of anorexia changed over the second half of the 20th century. One of these sources is from the United Kingdom and offers similar observations and conclusions as those from the United States.
As to what anorexia is, the Mayo Clinic states, “Anorexia nervosa is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of weight.” (Mayo Clinic Staff, 2018, para. 1) Individuals with anorexia place such a high value on controlling their weight and shape that their efforts in doing so cause major disruptions in their lives. Anorexia is not ultimately about food but rather it is a very unhealthy way to deal with emotional problems and it can be life-threatening.
For the anorexic, thinness is equated with self-worth. Their desire to lose weight becomes the most important aspect of their lives to the point of obsession. They can become very malnourished and thin and still think of themselves as overweight. Some of them have to be hospitalized and it can even be fatal.
Naturally, people and professionals would want to know the cause of this disease; however, the exact cause is unknown. The cause is most likely made up of some combination of biological, psychological, and environmental elements. Regarding biology aspects, it is possible there are genetic changes that put some people at higher risk for having anorexia.
Those persons with a genetic tendency toward sensitivity, perfectionism, overachieving, and perseverance may have a predisposition to possibly developing anorexia. Psychologically, there are those with anorexia who may have obsessive-compulsive personality traits that make them more easily adhere to strict diets and avoid food even if they are hungry. They might also experience high anxiety and use reduced eating to combat it. As to the environment, many Western cultures place a high priority on being thin.
In fact, one’s value and success are even linked to being thin. The Western media and entertainment culture contribute greatly to this, especially as it concerns young girls (Mayo Clinic Staff, 2018). Other causes can include family environment, low self-esteem, and traumatic experiences suffered in the past (Smith & Segal, 2018).
The Literature Review
The literature on anorexia tends to focus more on risk factors than on causes because they are easier to identify. According to D. Jade in her article “Why People Get Eating Disorders”, some of the risk factors include one’s genes; parents with issues surrounding food; being teased for being fat; abuse, neglect, trauma, abandonment, or loss in childhood; early puberty in girls; childhood obesity; family conflicts; physical or sexual abuse; having a friend with an eating disorder; and a person’s character and core personality. The study notes that persons who became anorexic were very often good kids. These were the children who were conscientious, hard-working, good students, and eager to please.
Some health professionals think that anorexic symptoms can represent a symbolic language for those who lack the capacity for expressing emotions verbally. These persons become stressed when confronted with new situations and have a low tolerance for change. Some of them may fear taking on adult responsibilities and use dieting obsessions to avoid new life stages, living away from home, or issues involving sex (“Who is at Risk for Developing an Eating Disorder, n.d.).
Some physical symptoms for anorexia include extreme weight loss and thin appearance, fatigue, insomnia, dizziness or fainting, bluish discoloration of the fingers, swelling of arms and legs, dehydration, irregular heart rhythms, hair that thins, breaks or falls out, soft downy hair covering the body, constipation or abdominal pain, absence of menstruation, dry or yellowish skin, intolerance of cold, and eroded teeth and calluses on the knuckles from induced vomiting. Some persons who experience anorexia binge and purge while others diet or fast, exercise constantly, or may use medical aids to rid themselves of food. For persons in contact with those with anorexia, it is important to note the behavioral signs of the disease.
These can include cooking avoiding food; obsession with calories, fat grams, and nutrition; denial of hunger or making excuses for not eating; eating safe foods low in calories and fat; refusing to eat around others or in public places; taking on odd eating rituals such as cutting food to precision or spitting out food after chewing; poor body image; reduced interest in sex; irritability; social withdrawal; flat mood; and complaining about being fat (Mayo Clinic Staff, 2018).
It is well worth taking a look at an actual study regarding anorexia. In 2002, H.C. Steinhausen wrote an article for The American Journal of Psychiatry which examined whether anorexia nervosa changed over the second half of the twentieth century. Over a hundred study series covering 5,590 patients suffering from the disease were published in English and German literature as it related to global outcome, mortality, and other psychiatric disorders. The results were sobering. Mortality rates were high and of the surviving patients, “less than one-half recovered on average, whereas one-third improved, and 20 percent remained chronically ill” (Steinhausen, 2002, para.1)
Basically, no evidence states that the outcome of the anorexia improved over the second half of the previous century. Associated features of anorexia such as vomiting, purgative abuse, bulimia, obsessive-compulsive personality symptoms, and the chronic nature of the illness contributed to a poor prognosis for the patient. What is interesting to note is that the treatment of anorexia nervosa evolved from a purely medical approach in the 1950s and 1960s to a focus on individual psychotherapy to behavioral interventions, to the addition of family therapy since the 1970s. One outcome of the studies was that one-quarter of the anorexia patients had anxiety disorders and one-quarter had affective or mood disorders. While the onset of the disorder during adolescence was linked with a lower mortality rate, the onset of it before puberty had a significantly poor outcome (Steinhausen, 2002).
Although the statistics in the Steinhausen article appear grim, in another article from Helpline.org written sixteen years later by Melinda Smith and Jeanne Segal, there are some helpful tips for dealing with the disease of anorexia nervosa. It begins with the sufferer admitting that they have the problem and deciding to get help.
Three general things to consider are to find a good listener to talk to, to stay away from people and activities that prompt your obsession with being thin, and to consider seeking professional help. In more serious cases such as extreme malnourishment or loss of the will to live, hospitalization may be necessary. Getting more specific, the person needs to comprehend that their condition is not really about food or weight.
The behavior is really about something deeper such as insecurity, needing to be perfect, or depression. For some, anorexia can be a distraction from confronting unpleasant emotions.
Another tip is learning to tolerate one’s feelings and that includes the negative ones. Try to be honest and identify what feelings you are having without being too harsh on yourself. Also, remember that one’s feelings do not define a person as feelings can eventually pass. One advice is to confront negative mindsets. This is a form of cognitive therapy.
One example of a damaging mindset is all-or-nothing thinking such as “I am a loser” or “there is no hope in my life.” Another is the musts, must-nots, and have-tos such as “I have to make the dean’s list” or “I must not gain any weight this week.” Yet another example of this is catastrophizing or always taking up the worst-case scenario.
Another good idea is to develop a healthier relationship with food. Begin to eat more food and do not be so restrictive as to types of food. Do not let your weight become the measure of your self-worth. As for dealing with someone else with anorexia, it is advisable to voice your concerns in a gentle way and resist judgment. Do not resort to threats, expressions of anger, put-downs or try to scare them. Be a role model for them and consider obtaining advice from a health professional even if the anorexic will not. Finally, do not take on the role of the food policeman, always monitoring what the person eats (Smith & Segal, 2018).
Returning to the original question “why do people get anorexia”, the research has found that there is no one definitive cause. Instead, there are probable causes or probable combinations of causes. There are, however, several identifiable risk factors associated with the disease.
There are also many physical and mental symptoms of anorexia. The studies mentioned in Steinhausen’s paper are very useful even though the data ends at the finish of the 20th century. Particularly interesting to me in the study were attributes which contributed to either a good or a bad prognosis and the way the treatment for anorexia nervosa evolved over the decades. A good article to finish on was the one with all of the helpful tips for combatting anorexia as that is the ultimate goal of dealing with the disease. I believe each source made its contribution to this paper and there were none that I disagreed with. I do feel that more research needs to be done on this subject as society has changed from the previous century.
Goldberg, J. (2017). Understanding anorexia—the basics. WebMD. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/understanding-anorexia-basics
Jade, D. (2010). Why people get eating disorders. National Centre for Eating Disorders.Retrieved from https://eating-disorders.org.uk/information/why-people-get-eating-disorders/
Mayo Clinic Staff. (2018). Anorexia nervosa. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/anorexia/symptoms-causes/syc-20353591
Smith, M. & Segal, J. (2018). Anorexia nervosa: signs, symptoms, causes, and treatment. Helpguide.org. Retrieved from https://www.helpguide.org/articles/eating-disorders/anorexia-nervosa.htm
Steinhausen, H. C. (2002). The outcome of anorexia nervosa in the 20th century. The American Journal of Psychiatry. 159 (8). Retrieved fromhttps://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.159.8.1284
Who is at risk for developing an eating disorder? (n.d.) Anred. Retrieved from https://www.anred.com/who.html
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