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Comm 1312: Writing and Research Section # 202, Dr. Runna Alghazo Name: ID: Major: Finance Assignment #3: Literature Review Topic: Anorexia Nervosa Introduction: Anorexia Nervosa, a disease that is caused by the obsession of losing weight, is increasing at a high rate day by day. Anorexia was not yet known as a disease until it increased and became more well-known to physicians in the later part of the nineteenth century and throughout the twentieth century. Anorexia was first discovered by a London doctor called Sir William Gull in 1874. According to Lucas (2004), a professional researcher in the field of eating disorders, anorexia was found to be the third most common chronic illness among teenage girls (Lucas 2004). However, anorexia is also common among adult women and men. Many people die from anorexia nervosa, either from suicides caused from the depression that anorexia leads to or due to the medical problems it causes. Curtis (1999) states in his book: "Anorexia nervosa originally indicates a ‘loss of appetite through nervous causes’" (Curtis 1999). Anorexia Nervosa is considered to be partly genetic but mostly a psychological disorder. It comes along with a range of changes in behavior, emotions, thinking, perceptions, and social interactions. Anorexia is believed to be just another sign of destroying oneself like cutting one's wrist. Since anorexia is a major disease worldwide, it is important to consider its causes, negative effects, symptoms, how is it diagnosed, who is more prone to anorexia, and its treatments. Causes: There are many causes that are suggested by different doctors for anorexia since the significant cause is still uncertain till now. A couple of the most probable causes are the pressure from the media and the society, and from a particular failure often seen in families of anorexic patients. Passer et al. (2005) and Stoppler (2007), professional psychologists, state that the cause of anorexia usually lies in a combination of environmental, psychological, and biological factors. Many women who immigrate to Western countries from non-western countries usually end up with anorexia since there are variations in the beauty standards among different cultural groups. Anorexics are perfectionists since they strive to live up to superior self-standards. Therefore, since they think that being thin makes people seem attractive, they try to be even thinner than normal people which causes them to be anorexic. This is caused by the pressure from the media and the society. Therefore, the poor self image that they have starts the problem of anorexia and losing weight for them becomes like a battle for success and control. (Passer et al, 2005; Stoppler, 2007) Passer et al. (2005) and Stoppler (2007) also state that biologically, anorexia can also be passed on genetically when the neurotransmitter levels in the brain are imbalanced. In addition, families also play an important role in causing their children to become anorexic. When the family is overprotective and rigid having high parental expectations, poor communications skills, and frequent problems, the children usually end up becoming anorexic (Passer et al., 2005; Stoppler, 2007). Brunch (2001) indicated that observant parents should offer food to their children even if they do not want to and take care of their children. The families should talk to their children and they should not leave them alone. The parents should try to help their children as much as possible to boost their self esteem. Therefore, when their self esteem increases, they would be happy with the way they look keeping them away from being anorexic (Brunch, 2001). Passer et al. (2005) also points out that in children, especially girls, part of this malfunction includes a fear of growing up and the desire to be perfect to impress their family. Treating anorexia, like all the other eating disorders, is difficult and may take years since they have to change the way they eat, think, and act. (Passer et al, 2005) Symptoms of anorexia: According to Strober and Scheider (2005), there are three stages that a person goes through before being anorexic. These three stages are called the slippery slope. The first stage is the innocent but rigid dieter where the person thinks that he or she needs to lose a little weight; therefore, he or she picks a diet and sticks to it. The person also starts exercising every day. The second stage is the exhilarated dieter where the person starts receiving many complements about losing weight; therefore, she or he starts studying carbohydrate and calorie charts. The last stage is the obsessed and preoccupied dieter where the person starts thinking all the time that he or she is really fat. At this time the person get tired so he or she start sitting on their own all the time because they think no one is understanding the. The symptoms of anorexia start to appear. (Strober & Schneider 2005) According to the EhealthMD organization (2004), some of the warning signs or symptoms of anorexia are the denial of hunger, isolation, obsession in losing weight, menstruation stops, repeatedly weighing oneself, excessive exercising, guilt after eating, mood swings, depression, skipping meals, use of diet pills, body dissatisfaction, low self esteem, eating low fat foods, vomiting, sleep difficulties, fatigue and changes in relationships with families and friends (EhealthMD, 2004). Another symptom is when the person starts to claim to feel fat when obviously not over-weight and wearing baggy clothes to hide their body. Anorexics are usually sad, angry, stubborn, aggressive, and secretive. They like to be isolated from everyone even their family and friends. Individuals are hard to be diagnosed as anorexics since they deny the fact that they are losing weight so fast. Negative effects Physical Changes: EhealthMD organization (2004) states that many physical changes can occur to an anorexic person. Some of these physical changes are a pale face color, teeth cavities, swollen ankles, dryness of hair, and reduced sleep hours. Another physical change is the growth of lanugo hairs on the back, arms, and face. Lanugo hairs are the fine, silky hairs found on the fetus. It also grows on grown people as a sign of starvation since the body tries to protect itself when too much weight is lost (EhealthMD, 2004). Medical Problems: In addition, there are a lot of medical problems that are caused by anorexia such as osteoporosis which is the loss of bone density, low breathing rate, low body temperature, fainting, weakness, swollen salivary glands and constipation. Michel (2003), an expert on the study of anorexia, states that the anorexics' blood pressure, heart rate lower due to the fact that the body responds to starvation by slowing down to preserve calories. Anxiety disorders become more common as the studies show that 60 to 83 percent of the anorexics had an anxiety disorder at some point in their lives (Michel, 2003). Anorexics also take diet and diuretic pills by a higher dosage than required and more frequent times leading to dangerous outcomes. Even though anorexic people usually weigh less than 85% of the normal weight, they still view themselves as being fat. Crisp (1995) points out that there are many metabolic abnormalities due to anorexia such as levels of the lipid in the blood may be very high or very low, high levels of insulin, and low levels of glucose (Crisp 1995). Anorexia causes menstruation to stop for females; it damages the heart. It also increases the risk in death since it causes many diseases and because it causes depression and isolation; therefore, anorexics might commit suicide. (Passer et al., 2005) Who is more prone to anorexia? According to Shuriquie (1999), traditionally in numerous non-Western countries, chubbiness is considered to be attractive unlike the western countries where slenderness is considered to be attractive. An experiment was made using a sample of 420 students in Egypt to see if anorexia is a common disease in Egypt and the result was that the traditional values of Egyptian society do not value a thin body too highly; rather they join the importance of a women's fertility with being an ideal mother. Being slim and fit is preferred in Western cultures where being thin apparently represents social acceptance, self-discipline, selfcontrol, competitiveness and class. In non-Western cultures eating disorders have been considered rare and plumpness is the ideal for feminine beauty (Shuriquie, 1999). According to EhealthMD organization (2004), anorexia nervosa occurs in 1% to 5% of the population, it is most common in the white upper and middle class, and it is most common within the people whose jobs require them to stay thin such as dancers, models, and gymnasts (EhealthMD, 2004). Curtis (1999) indicated that females are twenty times more likely to develop anorexia than males; however, anorexia is occurring in males more often than before. (Curtis, 1999) Types of families that the anorexics come from and what should those families do? Strobber and Schneider (2005) state that there are three types of families that their children have a possibility of being anorexic and each family has a different way of helping their anorexic child. The three types of families are the conflict-avoidant family, the high achieving family and the chaotic family. The conflict- avoidant family is the type of family which has limited emotional breadth and is tightly controlled. They may seem peaceful in the outside but there is always a sense of resentment and isolation, unhappiness and anger. This type of family should start to be honest with each other and talking more about their problems and emotions. They should also sit together for meals. The second type of family is the high achieving family where their standards are too high. This family pressures the children to be perfect; therefore, their children can turn out to be anorexic thinking that the perfect body image is to be skinny. This family should redefine for their children what being successful is. When the parents see that their child is trying too hard to be the best, the family should tell her that it is not necessary and should not put too much pressure on him or her. The third type of family is the chaotic family. This family has many faces; they share a number of qualities. Therefore, they should be clear about their boundaries, and they should talk about the chaos instead of pretending that there isn't any. In all the cases the families can help their anorexic child to return to his or her healthy lifestyle (Strober & Schneider, 2005). Treatments: The Capital Health Eating Disorders Clinic in Canada follows the following steps for treating the people with the signs of anorexic (Capital Health Eating Disorder Clinic, 2009). The first step in the treatment of a person with signs of anorexia is the physician referral process where the family doctor has to refer the patient to the Eating Disorder Clinic at the hospital. Once the referral is sent to the hospital, the patient will be asked to complete a survey and to attend an interview to assess the person’s individual condition. The patient then attends a Stages Group which is a four-session group which helps the person to get to know the program and its services and to learn more about his or her readiness to engage in treatment. Finally, once the person is ready, a treatment will be designed specifically for them. Outpatient treatment is usually sufficient for people with mild symptoms of anorexia. They undergo group treatments only in the Eating Disorder Clinic but most of their treatment is at home where they have to follow strict eating schedules. However, those that are anorexic and develop severe symptoms are sent by the Clinic treatment team to a mental health inpatient unit close to the person’s home. These people’s condition is too serious and requires constant supervision in a hospital setting. This step becomes necessary when the person’s condition worsens even after intensive outpatient treatment or they have entered into a serious state of depression which is affecting their way of life and their self esteem. Specifically, patients with BMI (Body Mass Index) below 18 absolutely need to undergo inpatient treatment until they are stable enough to go back to outpatient group treatments. Some clinic groups under the eating disorder program include eating experiences, assertiveness, body image, and psychotherapy. (Capital Health Eating Disorders Clinic, 2009). Conclusion: In conclusion, Anorexia is a serious problem that is increasing throughout the world. Stoppler (2007) states that anorexia is among the conditions with the highest death rate, with an estimated 6% of anorexia victims dying from complications of the disease and another cause of death is suicide (Stoppler, 2007). According to Lucas (2004), there are many rumors regarding anorexia. One of the rumors is that anorexia strikes a million American women and 150000 of them die every year. Nevertheless, this is not possible since if this was true, anorexia would be the fourth most common cause of death, after heart disease, cancer, and stroke (Lucas 2004). Although research mostly blames the media for such disease since they make the people misunderstand the idea of a good body image, families should also be blamed since the parents fail to make their children feel the sense of confidence and self value. In fact, according to Schwarz (2009), some lawmakers want to forbid skinny models so that people would not be affected by them (Schwarz 2009). Anorexics should not think of losing weight as a battle for success and control. People should be satisfied with the way they look and they should not be affected by the media or the celebrities they see. They should thank God on the way they look and they should remember that being skinny is not the perfect body image.