Mental Health and Eating Disorders: An Insight into a Complex Issue
Simone de Beauvoir, the French author and philosopher, once said: “To lose confidence in one’s body is to lose confidence in oneself,” (“Quotes About Eating Disorders (155 quotes)”, 2016), which is now applicable to people especially the young women and consequently they end up developing eating disorders. With changing time and change in fashion trends people now admire thinness more than ever before, which makes some worried about their weight and body shape, but people with eating disorders take it to the extreme, regardless of their threatening consequences to one’s overall health. “Eating disorders refer to a group of conditions characterized by abnormal eating habits. They involve either insufficient or excessive food intake that is detrimental to an individual’s physical and emotional health”. (Akhtar Amin Memon, 2012).
According to Sigmund Freud personality development begins soon after the birth of child, and according to him the matter of sexuality is infantile and it gives birth to the erotic wishes and each erotic wish has a particular body part, called erogenous zone to be gratified. According to first stage of psychosexual development i.e. oral stage a child seeks pleasure through the sucking or swallowing, hence mother’s breast becomes the erogenous zone and if due to any reason this urge is not gratified or the child is overfed, the child becomes fixated to this stage in adulthood and develops eating disorders. (Philip, 2016).
In adolescence the most common disorders found are anorexia nervosa, bulimia nervosa and binge eating. People with anorexia nervosa see themselves as fat and overweight even though they are underweight. Anorexia is highly associated with the feelings of fear and distorted cognitions about the weight gain, body-shape and a drive for being thin. (Gorwood et al., 2016).
In contrast people with bulimia nervosa eat loads of food including fats and then omit them out by using laxatives, enemas, diuretics, and vomiting and exercising.(“Eating disorders”, 2016). People with bulimia nervosa have normal weight, very few are overweight but like anorexic, bulimic patients fear to gain weight and hence the behaviour of purging is followed by eating lot of food in short time. Similarly people with binge eating disorder have no control over their eating but unlike bulimia nervosa, they do not vomit or attempt to throw it out and subsequently people with binge eating disorder put on weight and become obese.
Numerous research studies have been conducted on this subject. A random number of sample was selected of postgraduate students from Lahore, Pakistan. Findings showed that 59% of normal-weight and 21% of underweight females considered themselves to be over-weight. (Zaib-u-Nisa, 2016).
Due to the impact of media especially excessive exposure to western culture makes women prone to eating disorders more than men. In addition to influence of media and peer pressure there are many other factors which lead to eating disorders. People with obsessive-compulsive personality type and sensitive-avoidant personality type are more likely to have eating disorders. People are twelve times more at risk of developing disorder with mother or sister who has had anorexia. (“ANRED: What causes eating disorders?” 2016).
A new research suggests that there is a biological connection between stress and overeating. This connection can be explained in terms of behavioural change and hormonal change when the body is exposed to stress. When exposed to stress a person craves foods that are rich in sugar, fats and calories. These foods are also known as comfort food.
In addition people with competitive life styles are more prone to stress and in response the hormones produced increase the formation of fat cells. People with eating disorders are perfectionist. Despite their countless achievements they still feel worthless for they have unrealistic expectation of themselves. (“ANRED: What causes eating disorders?” 2016).
According to Cognitive Behavioral model people are psychologically concerned about their body weight and shape they have a persistent feeling of getting fat as a result they develop anxiety and other mental disorders such as depression until that feeling goes away. (“What causes bulimia nervosa?” 2016). Despite the distinctive features of each eating disorder, a distorted self-concept is believed to be pivotal factor in all. Theorists believe that a person’s attitude, belief and thoughts regarding self are the key factors of developing eating disorders and weight related symptomology. (Stein, 1996). Eating disorders such as anorexia nervosa and bulimia nervosa are due to the subjective feeling of being too fat or verbalization of few body parts larger than they actually are.
Both anorexia and bulimia have subjective overestimation of the body size, which is identified as one of the four defining feature of disorder in DSM-IV.
The body weight schema reflects the cognition of person regarding his body shape and size and like other schemas it is socially constructed by self-evaluation and categorization or the evaluation and categorization made by other people. The body weight self-schema is a frame work used to determine the occurrence of eating disorder in a person. For example a women who considers herself heavier than she objectively is, is due to the activation of the already made schema from the working memory when she was over-weighed, hence exercise, purging and other weight losing behaviors are stored in the schema as procedural knowledge each time the schema is activated. (Stein, 1996).
People with eating disorders show severe manifestations which are threatening to their both physical and emotional health and should be immediately reported and treated. These include: dry skin, hypercarotenemia, lanugo (soft body hair), acrocyanosis, atrophy of the breasts, swelling of the parotid and submandibular glands, peripheral edema and thinning hair. (“Anorexia Nervosa: Practice Essentials, Background, Pathophysiology”, 2016).
Interpersonal psychotherapy for eating disorders is considered as an effective therapy. Late adolescence and early adulthood is a critical period of forming relationships and as a result of interpersonal relation disputes one may end up developing eating disorders, social withdrawal is the most common indicator of eating disorder when a person has low self-esteem because of his poor body image therefore one seek for treatment. Interpersonal psychotherapy is used to help client address their interpersonal difficulties and assist recovery from eating disorders. (Murphy, Straebler, Basden, Cooper, & Fairburn, 2012).
Another therapy used to treat eating disorder is The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA). MANTRA is a cognitive interpersonal treatment of anorexia for adult patients. MANTRA is based on neuroimaging, neuropsychological, social cognitive and personality trait in anorexic thus aim to formulate strategies to address both inter and intra personal factors. It consist of twenty to forty sessions depending upon the severity of illness and up to five follow up sessions.
The treatment phase of MANTRA includes nine modules; Module 1: Getting started, Module 2: Working with support, Module 3: Nutrition, Module 4: My anorexia: why, what, and how? Module 5: Goals and experiments, Module 6: Exploring thinking styles, Module 7: The emotional and social mind, Module 8: Identity and Module 9: Moving forward. The therapy ends with follow up meetings. (Schmidt, Wade, & Treasure, 2014).
Enhanced cognitive behavioural therapy is used to achieve both behavioural and cognitive changes, but enhanced cognitive behavioural therapy unlike CBT changes behaviors to modify thinking it does not focus on direct restructuring of the cognition. CBT-E is done in four stages. (Murphy, Straebler, Cooper, & Fairburn, 2010).
Another approach to treat eating disorders is the nutrition counselling which is done by dieticians and nutritionists with knowledge of eating disorders. The counselor can help identify healthy eating habits and counter harmful habits, by building focus on healthy foods, the mechanism of body using vitamins and their importance to one’s health, co-relation of eating habits and emotions, and effective diet planning. (“Nutritional Counselling”, 2016).
In conclusion eating disorders are the most common disorders among adolescence which is due to the influence of media, distorted thoughts about self, low self-esteem and disturbed interpersonal relationships. Nomi Wolf in one of her books ‘The Beauty Myth’, describes the use of beauty images against women. In this book she explains that the women are coerced to meet the social standards of physical beauty. To deal with patients with eating disorders a nurse should have knowledge and understanding regarding the problem and its severity.
For a nurse to provide holistic care, she must first be non-judgmental. Other than physical care which includes regular monitoring of weight and vitals, a nurse should also support patient psychologically. Additionally a nurse should be confident too besides being skilled.
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- Akhtar Amin Memon, K. (2012). Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study. BMC Research Notes, 5, 84. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395848/
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- Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. (2010). Cognitive Behavioral Therapy for Eating Disorders. Psychiatric Clinics Of North America, 33(3), 611-627. http://dx.doi.org/10.1016/j.psc.2010.04.004
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