Anorexia nervosa, or simply referred to as anorexia, is a potentially fatal eating disorder characterized by a severe fear of being fat or gaining weight as well as a dangerous lack of food consumption (Schacter, Gilbert & Wegner, 2011, p.330). Also associated with anorexia is the obsessive thought of being overweight, although their physical appearance is reflective of severe emancipation and characterized as “skin and bones.” Anorexia dates back to ancient times with fasting rituals and it has now developed into one of the most common disorders found in the present day. This disorder is not only present in the United States, but it can also be found in many places across the globe like China, Nigeria, Japan, India and the Middle East (Watters, 2011, p.24). Many studies have been conducted to cover every aspect of anorexia from its rate of occurrence to developing treatments to the genetics behind it. Overall, anorexia nervosa is an eating disorder caused by many physiological, psychological, social and neurological factors. This disorder should not be taken lightly as it is a very complex and highly studied disorder.
There are two subtypes of anorexia: Anorexia Nervosa Binge/Purge Type and Restrictive Anorexia Nervosa. The Binge/Purge Type consists of binge eating or eating excessive amounts of food, only to purge or get rid of the consumed food. Individuals suffering from this type of anorexia nervosa typically feel an overwhelming feeling of guilt due to the excessive intake of food and will compensate for these feelings by vomiting, abusing laxatives or extreme exercising. The other type of anorexia nervosa consists of an extreme restriction of food intake, which is also characterized as self-starvation or fasting. (Anorexia nervosa, n.d.). These types of anorexia have been present throughout the history of the disorder with the restriction type being more common since fasting has been thought of as the early cases of anorexia nervosa.
The history of anorexia nervosa begins in the ancient times in the form of fasting. Fasting was seen “as a means of penance or purification as individuals denied themselves the pleasure of eating” (Martin, 1998, p.3). Fasting has also been present in biblical stories with Moses fasting for 40 days before he received the Ten Commandments. Also, there have been reports that European women within the thirteenth to seventeenth century time period take part in a religious holy fasting or self-starvation (Martin, 1998, p.3). Up until this point in history, anorexia nervosa wasn’t considered a medical condition, but rather a symptom of physical and emotional disorders. Also, anorexia nervosa was also mistaken for tuberculosis and psychotic disorders such as “hysteria, mania, and melancholy” (Fairburn & Brownell, 2002, p.151). It wasn’t until the end of the 17th century when a physician named Richard Morton created the first medical description of anorexia nervosa or “nervous consumption” (Martin, 1998, p.3-4). His work in differentiating anorexia and tuberculosis did not become popular until the late nineteenth century, when anorexia nervosa was finally classified as a medical condition. Anorexia was once a rare condition, but in the present day, it has become a very common disorder that affects mostly women who are between 15 and 19 years of age (Schacter et al., 2011, p.330). Anorexia nervosa has many causes and symptoms that have been gathered throughout history.
Back in the early times during the thirteenth century, the causes for this disorder were though to be due to supernatural powers and demonic influences (Fairburn & Brownell, 2002, p.151). Then in the sixteenth century during the Reformation time period, self-starving individuals were considered to be practicing witchcraft, possessed by the devil or severely mentally ill (Martin, 1998, p.3). Nowadays, the common causes of anorexia are thought to derive from various combinations of physical, emotional, sociological and family factors as well as genetics. Some patients that suffer from this disorder have said that cause for their “food refusal [was due] to painful digestion… an impassable lump in the throat… [Or] the inability to chew [their food]” (Watters, 2011, p.27). Other causes of anorexia nervosa include: “social media and its outrageous stereotype for women figures, careers that promote thinness, childhood traumas, peer pressure and biological factors such as genetics” (Anorexia nervosa, n.d.).
Although there are many causes for this eating disorder, culture plays a key role in not only the United States, but also around the world. Western culture specifically has played a role in places around the world like China. Ethan Watters writes, “Western culture [was] influencing the way women around the world viewed their bodies; as Western movie stars and models became the world standard for glamour and attractiveness, it appeared eating disorders followed” (Watters, 2011, p.24-25). Many of the celebrities that are plastered across billboards, social media and magazines are all considered “perfect” for their extremely skinny figures, but what people do not realize is that these models are some of the most common individuals to develop anorexia. This obsession with models and celebrities in social media has spurred what Watters called the “Me-Too” anorexics. This term means that because people see how models and celebrities look, they strive to become like them and will take whatever measure, including self-starvation, to achieve that look. Culture, along with the other main causes of anorexia, has played a key role in the rise of anorexia across the globe.
As for symptoms, there is a set of criteria, called the DSM-IV, which a person meets in order to be considered as anorexic. The DSM-IV consisted of four main criteria points: “refusal to maintain body weight at or above a minimally normal weight for age and height… intense fear of gaining weight or becoming fat, even though underweight… disturbance in the way in which one’s body weight or shape is experienced… [And] amenorrhea or the absence of at least three consecutive menstrual cycles” (Fairburn & Brownell, 2002, p.155). Other symptoms of anorexia nervosa include: “obsession with calorie counting, hair thinning, fixation with food recipes and cooking and engaging in ritualistic eating patterns” (Anorexia nervosa, n.d.). Although this disease seems extremely difficult to recover from, there are many treatments that can help and save individuals with anorexia.
Although there may be many treatment options for individuals to utilize, the main treatments used for individuals with this disorder include: hospitalization, various forms of therapy, social awareness, and in extreme cases, force-feeding (Martin, 1998, p.36-49). Hospitalization is common among anorexia treatments since it allows healthcare providers to monitor and create a healthy recovery for patients. Along with hospitalization, there are many forms of therapy that can help such as family therapy, pharmacotherapy, individual therapy and group therapy (Sours, 1992, p.361-377). These various forms of treatment can help the mental aspect of the disorder. Social media can play a role in the treatment of anorexia nervosa by raising awareness of the issue and help others be aware of the symptoms. If this disorder got more attention on social media around the world, many individuals who already have the disorder can see that and maybe realize that they need help. Also, it can create awareness among individuals who do not have this disorder so that these individuals can help others they think might be showing signs of anorexia. Although these treatments seem strong enough to change one’s life around, some individuals have a harder time than others, leading to an extreme form of treatment called force-feeding. This treatment consists of a naso-gastric and intravenous feeding. This treatment is used only in severe or life-threatening cases since it does come with many complications. Treatments for anorexia are always developing and changing throughout time, but despite the healthcare provider’s efforts, the long-term survival of affected patients is unpredictable.
A study on the long-term survival of patients with this disorder was conducted and researched by six individuals in Rochester, Minnesota. The objective of their research was “to estimate long-term survival of unselected patients with anorexia nervosa” (Korndorfer, Lucas, Suman, Crowson, Krahn & Melton, 2003). To begin their study, they identified two hundred eight residents that lived in this city for at least a year when they were diagnosed with anorexia between 1935 and 1989. Also, these individuals had to be monitored for up to sixty-three years in order to be included into the study. Of these two hundred eight individuals, all where white, one hundred ninety-three were women and fifteen were men all with ages ranging from ten to fifty-seven years. These cases were then defined as definite (meeting all criteria of DSM-IV), probable (meeting three criteria of DSM-IV) and possible (meeting criteria one and four). Their results showed that eighty-two patients (eighty women and two men) had definite cases, ninety-two (eight-four women and eight men) had probable cases and lastly, thirty-four (twenty-nine women and five men) had possible cases (Korndorfer et al., 2003).
After years of follow-ups and calculating the survival rates of affected patients, the researchers concluded that the survival among patients wasn’t worse than what they originally expected. They originally expected that the survival among patients suffering from anorexia nervosa would be significantly less. The researchers found that “the estimated survival thirty years after the initial diagnosis of anorexia nervosa was 93% compared with an expected 94%” as well as “only seventeen deaths occurred compared with an expected 23.7 deaths” due to this eating disorder (Korndorfer et al., 2003). To conclude, the researcher’s study was unlike what they hypothesized.
There have been many research studies conducted on the causes, outcomes and incidences of anorexia nervosa in not only the United States, but also in places around the world. For example, there was a study done on the incidence or occurrence of anorexia nervosa in Curacao, the main Caribbean island in a group of islands known as the Netherlands. This 1995-1998 study was conducted and researched by six individuals who have their M.D. and/or Ph.D. This study was done due to the false thought that this disorder only occurred in affluent societies. These researchers hypothesized that “anorexia nervosa in newly affluent societies should be approaching the incidence levels of high-income countries, such as the Netherlands and the United States” (Hoek, van Harten, Hermans, Katzman, Matroos & Susser, 2005). Also, they wanted to examine if this disorder emerged in societies that are undergoing a socioeconomic transition. The method used to conduct this research first consisted of contacting all of the hospitals, private practices and other healthcare providers and asking permission to obtain any probable cases of patients with anorexia. After sorting through the cases, there were twenty-four “probable cases.” Probable cases were those that had suggestive evidence that the case met the DSM-IV criteria.
Once these twenty-four cases were found, the written consent of twenty-two patients was obtained and a diagnostic interview took place by one of the researchers. Along with an extensive interview, weight and height measurements were taken to help make a clear diagnosis of the patient. Their results showed that of the twenty-two patients, only eleven fulfilled the DSM-IV criteria, four being the restriction type and the remaining seven being the binge/purge type. All eleven individuals were females with ages ranging from fifteen to thirty-nine years and all had amenorrhea. Of the females, two were white and the other nine had a mixed race. From their results, they were able to determine the incidence rates per 100,000 person-years (Hoek et al., 2005). To conclude, the researchers had two main findings. The first was that there was an incidence rate of 1.82 for the total population of Curacao, which was a lot lower than the high-income countries like the United States and Netherlands. This conclusion does not support their hypothesis that the incidence levels should be approaching the levels of high-income countries such as the United States and the Netherlands. The second finding was that there was no evidence to support their thought that this disorder emerged from socioeconomic transition. Overall, their study was unlike what they hypothesized.
Anorexia nervosa is a serious and potentially fatal eating disorder. Despite efforts made by healthcare givers and some awareness, the rise of this disorder seems to continue. Dating back to ancient times, anorexia nervosa affects both men and women, but more so women between the ages of fifteen and twenty-four. Many healthcare professionals and researchers have conducted studies to develop better treatments, define more causes and monitor the rise of anorexia. All in all, anorexia nervosa is a very complex and extremely dangerous disorder that needs to be handled very delicately and cautiously.