Anorexia Nervosa, often called anorexia, is classified as an eating disorder categorized by weight loss or an abnormally low body weight. An individual with Anorexia has a very intense fear of gaining weight, which is often due to not getting enough calories. There are times where the fear is not shown, but their tenacious behavior will still restrict their weight gain. While suffering from Anorexia Nervosa, the individual will place great significance on controlling their weight, which will interfere severely with one’s life. When an individual has Anorexia, usually they have a hard time recognizing the significance of the issue. They are often very contingent on their body weight and are unable to see how thin or underweight they are.
Because of the hidden nature of this disorder, it is difficult to get accurate statistics of Anorexia Nervosa. Anorexia can affect people of any demographic characteristics including, but not limited to race, age, gender, ethnicity, sexual orientation, and socioeconomic status. While this is true, only about 10% of all subjects are male. Statistics show that Anorexia mostly affects young women and 1-5% of all female young women suffer from Anorexia. While it is rare, children under the age of 10 have been known to have the condition, but the average age of onset for this disorder is 17. Older women may have it as well, but it is usually diagnosed in adolescent years (mirror-mirror.org, 2018). According to The National Association of Anorexia Nervosa and Associated Disorders, 0.9% of women suffer from Anorexia Nervosa in their lifetime. While 50-80% of the risk for Anorexia is genetic, environmental factors and personality traits can also pose a high risk for developing this disorder. About half of individuals diagnosed with Anorexia also have a comorbid anxiety disorder, which can include but is not restricted to obsessive-compulsive disorder and social phobia (The National Association of Anorexia Nervosa and Associated Disorders, 2018).
It is important to treat an individual with Anorexia Nervosa, as it can be fatal. There could be serious consequences to one’s health if this disorder goes untreated. If an individual with anorexia becomes severely malnourished, organs in the body can be seriously damaged and this impairment may not be entirely reversible. Some of the complications of Anorexia include, anemia, heart problems, bone loss, and electrolyte abnormalities.
Diagnostic Assessment:
According to the DSM-5 criteria, to be diagnosed as having Anorexia Nervosa a person must display a number of items. These include, “the persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health), either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight), and disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight” (eatingdisorders.org, 2018).
To diagnose or evaluate this problem, the first step would be to find out the referral question depending on the situation. To be as specific as possible, it would involve who wants to know, what they want to know, and why they want to know this. This will help provide guidance about what to focus on. To rule the diagnoses and match the client to the best therapy approach, it is necessary to comprehend the disorder with regard to fundamental dimensions. For better reliability, usually multiple methods of assessment are used. While observing the client, it is necessary to make note if the problem relates to disruptions in five systems. According to Wildes & Marcus’s (2015) Current Psychiatry Reports, 17, 1-10, in the negative valence systems, one with Anorexia may show hyperresponsivity in fear circuits to food and body image cues, while the positive valence systems will show a diminished reward valuation. Relating to cognition, one who suffers from anorexia will also have less cognitive flexibility and more perseveration. In addition to this, systems for social processes will report lower levels of facial communication with some difficulty understanding the mental states of other individuals. In arousal regulatory systems, there is not much, but there may be a brainstem disturbance, with emphasis on the hypothalamus due to the regulation of energy intake. (Lecture: Week 6, 2018).
To start off the first initial assessment, a standardized questionnaire will be given to the client. This questionnaire will be validated to pick up on the symptoms of an eating disorder with an objective measure to compare it to. Next, one of the general tools that could evaluate the problem would be a clinical interview with the client. Throughout this interview it is important to ask the client questions and directly observe the client during the interview. It is also very important to place prominence on predicting future behavior in regard to dangerousness to self and others. To start of the interview, the intake is used to assess the client to diagnose and plan the treatment. The interview will start off with general questions about what makes the client them and what their life has been like up to this point. Following those general questions, the questions focus will be rotated to more specific questions about the eating disorder, like what antecedent caused this behavior to start. To figure this out, it is important to focus around the time period where these symptoms were identified and create a picture of what this time looked like. This could include any peer conflict, major changes, trauma, life stressors, etc. The goal of the initial interview includes, addressing the referral question, establishing rapport, and encouraging engagement in future treatment. Some examples of these interview questions can include, “how much more or less do you feel you worry about your weight and body shape than other people your age?” or “compared to other things in your life, how important is your weight to you?” (nationaleatingdisorders.org, 2018). Additionally, the clinician will need to keep an eye out for any binging and purging going on, which will help inform treatment and diagnosis.
Based on using a clinical interview, using high structured questions will result in high reliability, but it is important to be aware of becoming protocol bound. If a psychologist is too faithful to protocol, they may miss some important information, which will affect the validity. Rapport can also affect the reliability and validity of the clinical interview. It is very important to have a good client-clinician relationship, so that the client is aware of the clinical environment and expectations. The interview should also be age, language, and culturally important. Because of this, it is critical to assess the cultural background and inform oneself of the differences in the client’s culture. All of these factors will affect engagement and whether or not the client will return to continue treatment. Furthermore, clinicians are human and they are prone to common cognitive error, so it is important to be willing to keep open minds and seek feedback (Lecture: Week 6, 2018).
General Conceptualization:
While the exact reason for the development of Anorexia Nervosa is unknown, there are a lot of biological, psychological, and environmental factors that come into play.