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Anorexia and bulimia among adolescent girls i Anorexia and Bulimia Among Adolescent Girls Jennifer Gavrilko CSU, Monterey Bay CHHS 302- Professional Writing for Health and Human Services April 2, 2012 Anorexia and bulimia among adolescent girls ii Table of Contents Table of Contents.......................................................................................................ii A Growing Problem.................................................................................................. 3 Factors Influencing Anorexia and Bulimia............................................................... 3 Effects of Anorexia and Bulimia............................................................................... 5 Treatments and Solutions......................................................................................... 7 Conclusion............................................................................................................... 8 References............................................................................................................. 10 Appendix.................................................................................................................11 Anorexia and bulimia among adolescent girls 3 A Growing Problem Living in our society, it’s not surprising that young girls feel pressure to look a certain way in order to feel beautiful. Our society’s emphasis on appearance and idealization of thinness promotes dangerous dieting behaviors. The things adolescent girls are doing to keep up with their idea of beauty are slowly killing them and parents need to be more aware. Counting calories and skipping meals in order to lose a few pounds can quickly spiral out of control and turn into an eating disorder, such as anorexia or bulimia. “Over one-half of teenage girls... use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives” ("Teens health," 2011). Eating disorders are so much more than skipping a couple meals to lose a few unwanted pounds. Anorexia and bulimia are extremes in dieting behavior- the diet that never ends or gets severely more restrictive over time, for example. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) says individuals with anorexia keep their body weight below a minimal normal level by exercise, control of food intake, and other means. Individuals with bulimia control their body weight in spite of binge overeating by purging (self-induced vomiting) or use of laxatives, diet pills or other means (American Psychiatric Association, 2000). These disorders take over the lives of adolescent girls. As a result, every thought ends up centered around the disorder. Their lives become focused on their eating, shape and weight, dietary control, thinness and weight loss; ‘fatness’ and weight gain are constantly avoided. Anorexia and bulimia are not new in our society. They have been around for years and are most prevalent in adolescent girls. Without early detection and treatment, anorexia and bulimia can become life-threatening, and yet so many of these girls are going without professional treatment. Only 13 percent of those struggling with an eating disorder receive professional services (Caldwell, 2004). Given the persistence of eating disorders (anorexia and bulimia) in adolescent girls, it is imperative that we do a better job of educating parents about the importance of identifying and seeking professional treatment for eating disorders, as well as informing parents of the treatments that are most effective. Factors Influencing Anorexia and Bulimia There is no single known cause of any eating disorder, but it is known that they exist mainly in prosperous cultures where there is plenty of food. Why voluntary behaviors, such as eating smaller or larger amounts of food than usual, morph into an eating disorder for some people is unknown. According to Derenne and Beresin (2006), many clinicians now believe that eating disorders, previously thought to be caused by dysfunctional family dynamics, are multifactorial in origin. People with anorexia have a real fear of weight gain and a distorted view of their body size and shape. As a result, they are unable to maintain a normal body weight. Many adolescents with anorexia restrict their food intake by dieting or fasting. Bulimia is similar to anorexia. Someone with bulimia might binge eat and then, in order to compensate, they will force vomiting or exercise excessively to prevent weight gain. They may also use laxatives or excessive exercise. Adolescent girls with bulimia typically feel powerless to stop the eating and can only stop once they're too full to eat any more. Over time, these steps can be dangerous — both physically and emotionally. Eating disorders can be difficult to Anorexia and bulimia among adolescent girls 4 overcome due to the social stigma surrounding the affected individuals. This stigma prevents open discussion, acknowledgement, and treatment of the disorders Family Factors Family members are a huge influence in an adolescent girl’s life. They are the people these girls are spending the majority of their time with, which means that these are the people the girls are learning from. Negative influences within the family may play a major role in triggering and perpetuating eating disorders. Parents who put an emphasis on looks and dieting or criticize their children's bodies are more likely to have a child who ends up struggling with an eating disorder. If children perceive that they are failing to live up to family expectations, they may turn to something that seems more easily controlled and at which they may be more successful, such as food restriction or weight loss. Caldwell & Kirkpatrick (2004) suggest that people with bulimia may be more likely than average to have an obese parent or to have been overweight themselves during childhood. Marital discord, domestic violence and divorce are also not uncommon family issues for those suffering with an eating disorder. In addition, some people turn to an eating disorder after they've experienced a family trauma such as sexual or physical abuse, or neglect. Cultural Factors Culture is thought to play a significant role. Today’s culture is unique in that the media (including television, internet, movies, and print) is a far more powerful presence than ever before. Women, especially, are conditioned at a young age to think they have to be skinny in order to be beautiful (Ebneter, 2011). They are pressured to fit a model of beauty that is defined by body weight. This bombardment of images of thinness from magazines and television produces a feeling of dissatisfaction with ourselves and our bodies. There is a significant dichotomy between society’s idealized rail-thin figure and the more typical American body (Watson, 2011). Vulnerable young girls do not see the horrors that anorexia and bulimia can bring. Instead, they are impressed that someone can “eat all she wants” and still lose weight just by sticking her finger down her throat and vomiting. The media also tends to glorify eating disorders. Talk show hosts present guests with eating disorders to create a sensation. The presentation of an emaciated girl with anorexia, hanging onto life by a thread, creates a powerful image. But instead of educating the public about the negative aspect of eating disorders, this image has the opposite effect. It teaches onlookers how to lose weight dramatically (Derenne, 2006). Although it is tempting to blame today’s media for perpetuating and glorifying unrealistic standards of physical beauty, the truth is far more complicated and there are a number of other factors that contribute to the development of an eating disorder. Biological Factors Biology may also be a factor. Caldwell and Kirkpatrick (2004) say anorexia is eight times more common in people who have relatives with the disorder, and some doctors believe that genetic factors are the root cause of many cases of eating disorders. Appetite control and the regulation of food intake is very complex, with many hormones in the brain and the body contributing to signals of hunger and fullness Anorexia and bulimia among adolescent girls 5 ("Teens health," 2011). According to Soyka, Grinspoon, Levitsky, Herzog, & Klibansky (1999), research suggests that people with anorexia have increased activity in the brain's dopamine receptors. This overactivity may explain why people with anorexia do not experience a sense of pleasure from food and other typical comforts. Other circumstances factor in, too. Eating disorders can be triggered by stress, social difficulty, loneliness, depression or dieting itself. Dietary restriction can lead to a repetitive pattern of self-deprivation, which can result in binging, weight gain, and worsening self-image. Effects of Anorexia and Bulimia Eating disorders are serious medical problems. Anorexia nervosa, bulimia nervosa are types of eating disorders that can be potentially deadly. Eating disorders most often develop during adolescence or early adulthood, but can occur during childhood or later in adulthood. Females are more likely than males to develop an eating disorder. Symptoms of anorexia may include: ● refusal to maintain body weight at or above a minimally normal weight for age and height ● intense fear of gaining weight or becoming fat ● extreme influence of body weight or shape on self-evaluation ● infrequent or absent menstrual periods ● use of either food restriction or excessive exercising to limit body weight ● feeling cold or lethargic, caused by drop in body temperature as weight loss advances ● growth of hair all over the body ● dry, yellowish skin ● severe constipation (Caldwell, 2004) Symptoms of bulimia may include: ● recurrent episodes of binge-eating, characterized by consuming an amount of food larger than most people could eat in a short amount of time ● the feeling that one cannot stop eating or control how much is being eaten while binging ● behavior to prevent weight gain; purging is most common, laxatives and excessive exercise may be used ● extreme influence of body weight or shape on self-evaluation ● chronically inflamed sore throat ● swollen glands in the neck or jaw ● dehydration due to purging of fluids ● kidney problems from diuretic abuse (Caldwell, 2004) Medical care, including hospitalization to treat malnutrition or create weight gain, is sometimes necessary in anorexia. Eating disorders can lead to serious physical health problems, such as heart conditions or kidney failure. Someone whose body Anorexia and bulimia among adolescent girls 6 weight is at least 15% less than the average weight for that person's height may not have enough body fat to keep organs and other body parts healthy (Soyka, 1999). In an article written by Soyka, Grinspoon, Levitsky, Herzog & Klibansky (1999), it is stated, A severe degree of decreased bone mass has been reported even in young adolescents with a brief duration of illness. Adolescence represents a critical time in bone metabolism, as most bone mineral is accumulated during the teenage years, and deficits incurred during this time may be permanent. In severe cases, eating disorders can lead to severe malnutrition and even death. For females between the ages of 15 and 24 who struggle with anorexia, the mortality rate for their illness is 12 times that of all other causes of death (Lock, 2011). Chart 1 Note: Chart 1 is an illustration describing the effects anorexia has on the entire body. Retrieved from http://www.womenshealthzone.net/eating-disorders/anorexia-nervosa/effects/ With anorexia, the body goes into starvation mode. Without proper nutrition, the body can react with an inability to concentrate, anemia, drop in blood pressure, pulse and breathing rate, light headedness. Slow heart rate and low blood pressure means that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower. With bulimia, vomiting and lack of nutrients can cause constant stomach pain, damage to the stomach and kidneys, tooth decay (from exposure to stomach acids) Anorexia and bulimia among adolescent girls 7 (Caldwell, 2005). "Chipmunk cheeks," happen when the salivary glands permanently expand from throwing up so often and loss of potassium. Electrolyte imbalance is caused by dehydration and loss of potassium, sodium and chloride from the body as a result of purging behaviors. Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Cardiac complications are found in 80% of patients with an eating disorder and studies have demonstrated that approximately 30% of deaths in patients with AN are due to cardiac complications (Stiles-Shields, 2011). Treatments and Solutions Psychotherapy Psychotherapy is an essential part of any treatment plan for eating disorders. It is the most effective and longest lasting treatment. Individual, group, and family therapy sessions focus on different aspects of these complicated conditions. Psychotherapy, coupled with attention to medical and nutritional needs, should be tailored to the specific individual depending on the severity of the disorder. Psychological counseling should focus on both the disordered eating symptoms and the underlying issues that contributed to the disorder. Simply changing patients’ thoughts and behaviors is not enough, however. To ensure lasting improvement, patients and psychologists must work together to explore the psychological issues underlying the eating disorder. Psychotherapy may need to focus on improving patients’ personal relationships. Antidepressants, to improve mood and reduce obsessiveness, may be prescribed for those with eating disorders (Stiles-Shields, 2011). Cognitive behavioral therapy (CBT) Cognitive behavioral therapy (CBT) is an active type of counseling and is known to be an effective treatment for eating disorders. Sessions usually are held once a week for as long as you need to master new skills. Individual sessions typically last one hour, and group sessions may be longer. During cognitive-behavioral therapy for anorexia, patients will learn about the illness, its symptoms, and how to predict when symptoms will most likely recur. They are encouraged to keep a diary of eating episodes, binge eating, purging, and the events that may have triggered these episodes. They learn to eat more regularly, with meals or snacks spaced no more than 3 or 4 hours apart. Patients learn how to change the way they think about their symptoms, reducing the power the symptoms have over them. Cognitive-behavioral therapy is used to treat the mental and emotional elements of an eating disorder. This type of therapy is done to change how one thinks and feels about food, eating, and body image. It is also done to help correct poor eating habits and prevent relapse (Fairburn, 2003). Many people turn to 30-day inpatient treatment after finding little success with outpatient psychotherapy. When a person is "inpatient" it means that they will be living at the facility for a certain period of time. This can range from a couple of weeks to several months. The facility usually has medical doctors, registered nurses, therapists, dietitians and volunteers on staff to work with the people in recovery on a daily basis. It is intended to provide a safe environment in which to recovery from an eating disorder. Depending on the facility, the routine can vary, but it may include the following: group sessions, one-on-one therapy, medical evaluations, weigh-ins, nutritional counseling, art Anorexia and bulimia among adolescent girls 8 therapy, medication administration, spiritual exploration and prayer, meal times, and social or leisure activities. Integrative Medicine Integrative medicine can be defined as a healing-oriented discipline that takes into account the whole person — body, mind and spirit — including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of both conventional and alternative therapies. Complementary and alternative therapies used in integrative medicine can include acupuncture, chiropractic, herbal medicine, dietary supplements and others that give the clinician a wide array of treatments for difficult conditions. This is particularly true in the integrative medicine approach to eating disorders. The cornerstones of an integrative medicine model for eating disorders includes some components that are found in every approach to the treatment of eating disorders, but may be used in a unique manner. Prevention Prevention is always the best option when it comes to eating disorders. There are many ways to help prevent a child from developing and eating disorder. Parents can set healthy examples by eating right and exercising. Parents need to lead by example when it comes to self-image. If the general public would accept the basis of eating disorders and remove the surrounding stigma, then affected individuals will feel more comfortable seeking help within the medical community and among close friends and family rather than anonymous and potentially detrimental websites. There also needs to be more support for families of girls struggling with an eating disorder. It would be highly beneficial to have some kind of program, possibly through the schools, that educates and supports parents and students. There are several options when it comes to treatment of anorexia and bulimia. Sadly, the number of girls not receiving treatment greatly outnumbers the girls that are in treatment. Eating disorders are not easy to recognize, even by those who need help and asking for help is even more difficult. Conclusion It is important that people in the lives of young girls with anorexia or bulimia know how to recognize the signs and symptoms. Eating disorders are more than just a problem with food. Food is used to feel in control of other feelings that may seem overwhelming. Parents can help prevent kids from developing an eating disorder by building their self-esteem and encouraging healthy attitudes about nutrition and appearance. Living a healthy lifestyle where kids are taught that they don’t have to be thin to be happy and beautiful can do a great deal to prevent an eating disorder. They need to be able to get these girls the treatment they need in order to live a healthy life. It's important to remember that eating disorders can easily get out of hand and create habits that are difficult to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists. Parents and family members need to pay attention to this research because eating disorders, such Anorexia and bulimia among adolescent girls 9 as anorexia and bulimia, are most prevalent in adolescent girls and it seems that they will not be going away anytime soon. Anorexia and bulimia among adolescent girls 10 References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Caldwell, P. & Kirkpatrick, J. (2004). Eating disorders: Everything you need to know. Buffalo, NY. Firefly Books. Derenne, J. M.D., Beresin, E. M.D.; (2006). Body Image, Media, and Eating Disorders. Academic Psychiatry. May, 30(3), 257-261. Ebneter, D.S., Latner, J.D., O’Brien,K.S., (2011) Just world beliefs, causal beliefs, and acquaintance: Associations with stigma toward eating disorders and obesity. Personality and Individual Differences, 51(5), 618-622. Retreived from (http://www.sciencedirect.com/science/article/pii/S0191886911002595) Fairburn, C., Cooper, Z. Shafran, R.. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. Retrieved from (http://www.sciencedirect.com/science/article/pii/S0005796702000888) Lock, James. (2011). Family treatment for eating disorders in youth and adolescents. Psychiatric annals. 41(11), 547-551. Retrieved from http://illiad.csumb.edu/illiad/illiad.dll?Action=10&Form=75&Value=46661 Soyka, L., Grinspoon, S., Levitsky, L., Herzog, D., & Klibansky, A. (1999). The effects of anorexia nervosa on bone metabolism in female adolescents. The Journal of Clinical Teens Health. Retrieved from http://kidshealth.org/teen/food_fitness/problems/eat_disorder.html Stiles-Shields, C., Smyth, A., Glunz, C., Hoste, R. Boepple, L., & Le Grange, D. (2011). A Review of the Role of Psychiatrists and Pediatricians in Outpatient Treatment of Adolescents with Anorexia and Bulimia Nervosa. Current Psychiatry Reviews, 7, 177-188 Watson, H. J., Raykos, B. C., Street, H., Fursland, A. and Nathan, P. R. (2011). Mediators between perfectionism and eating disorder psychopathology: Shape and weight overvaluation and conditional goal-setting. International Journal of Eating Disorders, 44, 142–149. doi: 10.1002/eat.20788 Anorexia and bulimia among adolescent girls 11 Appendix Anorexia and bulimia among adolescent girls 12 Note: These criteria were accessed from the American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, D.C.: American Psychiatric Association, 1994:427-9. Copyright 1994.