Anorexia Nervosa

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This literature review shall examine the health issue of anorexia nervosa within the life stage of adolescence. As human development is a process of interactions between all aspects of life: biological, psychological and social factors will be analysed to provide an adequate understanding of the eating disorder within this framework. An assessment of sociocultural and cognitive behavioral theory will then be undertaken to identify the influences that lead to anorexia, and contribute to an understanding of its prevention and treatment. Lastly, the response will discuss how factors of diversity such as gender and sexuality provide varied experiences of the health issue. Overall, anorexia nervosa is not a transient issue for youth

but results from a complex interaction of the aforementioned points, with serious implications upon mental and physical health.
Question 1
This response adopts a general definition of adolescence as a period of growth from childhood to adulthood, as there are a number of ambiguities that surround the term’s numerical range and cross-cultural application. Adolescence is a period of pubertal growth and significant emotional, physical and cognitive development. For example, one of the noticeable physical changes in adolescence is the growth spurt. Over a three-year period in early adolescence (11-14 years), youth gain an average of 50% of their body weight and a height gain of 17% (Hoffnung et al. 2013, p. 367). Marked differences in body shape emerge between the sexes during the growth spurt, as boys encounter an increase in shoulder width and girls experience a widening of their hips (Chen & Jenson 2012, p. 197). Although adolescence is commonly termed as ranging between 12-18 years, inconsistencies surround the definitive, numerical range of this term (Nicholls & Viner 2005, p. 950) For example; the World Health Organisation outlines the span as between 10 to 19 years (WHO 2014). These dissimilarities may be attributed to the varied perceptions of growth by institutions and the differing rates by which people progress, as some children reach puberty much earlier than others (Chen & Jenson 2012, p. 198).
Additionally, it is imperative to recognise that views of human development vary cross-culturally. For example, Western societies perceive the role change into adulthood as a gradual process over adolescence (Kalb 2003, p. 15). Different ages mark semi-adult status in the legal age for behaviours such as: driving, smoking, consuming alcohol and leaving school (Kalb 2003, p. 16). Comparatively, this transition is more abrupt in remote Australian Aboriginal communities where after puberty; male youth undergo a series of imitation processes (Hoffnung et al. 2013, p. 52). Following such ceremonies, their social roles and expectations change drastically as they are treated like adults within society (Hoffnung et al. 2013, p. 364). Although a general picture of adolescence has been constructed through research, it is crucial to recognise that behaviour emerges from a unique interaction of one’s social surroundings, biological disposition and psychological factors.

Anorexia nervosa is an eating disorder that is increasing in incidence to a wider age range of adolescents (Eisenberg et al.

2013, p. 1011). The illness is characterised by: immoderate food restriction, a distorted body image, an obsession with thinness and an intense fear of gaining weight (Nicholls & Viner 2005, p. 950). The major symptom of the eating disorder is extreme weight loss of between 25 to 50% of original body weight through self-imposed starvation and strenuous exercise (Eisenberg et al. 2013, p. 1011). The weight loss and nutritional imbalance caused by this disease can lead to serious health complications such as: amenorrhea in females, osteoporosis, slowed growth and even death (Hood & Corsica 2011, p. 1001). Despite these physical symptoms that the eating disorder is most commonly associated with, it is imperative to identify anorexia nervosa as a mental illness (Nicholls & Vine 2005, p.

120).
The eating disorder is a relevant health issue to adolescents, as unhealthy weight control behaviours are the third most prevalent chronic illness in the age group (Aime et al. 2008, p. 690). Anorexia is often perceived in society to be an issue that primarily affects young women (Field et al. 2007, p. 462). Although this assumption is incorrect, female youth comprise the most vulnerable group to the condition, with the bimodal risk ages of onset determined to be 14 and 18 years of age (Field et al. 2007, p. 457). During puberty, dramatic changes such as the growth spurt occur in bodies, and a concomitant rise in focus on physical appearance cause unhealthy weight behaviour to become more prevalent (Hoffnung et al. 2013, p. 367). Furthermore, research indicates that adolescents endorsing unhealthy weight control behaviours are 6 times more likely to continue such behaviours into young adulthood, across ages and sexes (Aime et al. 2008, p. 690). The prevalence of disordered eating behaviours in adolescence and continuity into adulthood reveals the necessity for prevention and intervention programs that curtail the disease in a timely way.
Question 2
Socio-cultural influences have a significant role in the development of anorexia nervosa in adolescence, as one’s social background may trigger or provide the blueprint for the illness. Urban society in the Western world is characterised by tremendous concerns related to diet and physical appearance (Szabo 1998, p. 118). Images communicated through mass media create a culturally perceived ideal that female beauty is equated with thinness and a muscular physique for males (Hood & Corsica 2011, p. 1002). As adolescents grapple with their evolving bodies against this social context, their bodies may become vehicles for the expression of intra-physic conflict in the form of an eating disorder. Research supports this proposition, as Hood & Corsica’s’ study (2011, p. 1002) found that adolescent girls who frequently read articles about issues related to weight loss were 7 times more likely to practice unhealthy weight control behaviours that those who didn’t (Hood & Corsica 2011, p. 1002). Pro-anorexia websites that reinforce restrictive eating and exercise behaviours present another source of concern. Young people who viewed these websites even once reported a decrease in self-esteem, with an increased likelihood of future engagement in negative behaviours related to food, exercise and weight (Aime et al 2008, p. 691). However, in discussion of these social influences, it is important to recognise that there is not enough evidence to ground one’s environment as causal to eating disorders. Rather, advances in neuroscience point to a complex and interdependent interaction of genetic and environmental factors (Fernandez et al 2007, p. 477).
There are also biological structures that predispose some individuals to be vulnerable to developing anorexia nervosa. Research suggests that susceptibility to the eating disorder may be genetic, with estimated inheritance rates ranging from 56% to 84% (Aime et al. 2008, p. 693). Furthermore, if the adolescent has a family member with anorexia, they are 10 to 20 times more likely than the general population to develop the condition (Fernandez et al. 2007, p. 479). Brain chemistry is also a significant biological factor to consider regarding the susceptibility of certain individuals to the illness. Those with the eating disorder have been found to have high levels of cortisol; the hormone related to stress, and decreased levels of serotonin; which is associated with depression (Aime et al. 2008, p. 691). For this reason, individuals with mental conditions associated to these hormones such as obsessive-compulsive disorder are at a greater risk of developing the disease. Overall, the connections between biological factors and anorexia nervosa requires further research as the majority of studies are conducted during the acute or recovery phase of an eating disorder condition (Fernandez et al. 2007, p. 485). Therefore, a major limitation surrounding the biological factors of adolescents with anorexia is the need for further research on the ordeal of anorexia.
Although the psychological processes that increase an adolescent’s susceptibility to anorexia nervosa are complex, research has identified a number of characteristics that are present before, during and after the recovery of the illness. The primary personality traits include: perfectionism, harm avoidance, low self-esteem and perseverance (Nicholls & Viner 2005, p. 952). Perfectionism is particularly linked with a severe prognosis, as youth with anorexia are often the overachievers or “good” children who excel in their activities. During adolescence, the idea of self-concept becomes more internalized and based upon abstract principles (Hoffnung et al 2013, p. 405). Cognitive changes involved in formal operational thought provide adolescents a new ability to critically consider their existence as a unique individual and their relations to society. Although this skill is essential to developing a sense of selfhood, some individuals might become self-conscious in social situations and hypersensitive to criticism (Hoffnung et al 2013, p. 406). For example, a warning characteristic of anorexia is how sufferers are in denial of their condition, perceiving others to be overreacting to their caloric restriction or weight. The major criticism surrounding these connections between anorexia and psychological processes is how prolonged starvation induces changes induce change in cognitive, social and interpersonal characteristics (Chen & Jensen 2012, p. 199). Therefore, it can be difficult to discern the mental causes from the psychological effects of eating disorders.
Question 3
Vygotsky’s sociocultural theory proposes that children develop mental functions through social interactions with older representatives of their culture, such as parents or teachers (Hoffnung et al.2013, p. 53). Since the development of this theory, there has been significant evidence the family environment may operate as a model for specific eating behaviours. Patients with anorexia often report unfavorable eating patterns early in life, where an excessive importance is subjected onto food. Parental behaviours that been recognised as particularly damaging to adolescents include: being overly controlling, putting an emphasis on appearance and diet, and overt criticism. Comparatively, young sufferers with a brief duration of illness, a supportive family and a clear-cut precipitant have a much better prognosis. Contrary to Vygotsky, Lerner extends the contextual approach to emphasise the interactive relationship between an individual’s changing, wider context and their development (Hoffnung et al.2013, p. 53). Incidents such as divorce or conflict may substitute the individual’s need for attachment and develop into an eating disorder. The clinical implications of this theory imply that rather than the traditional method of focusing upon food preoccupation, treatment should promote self-autonomy and external security.

A general criticism of sociocultural theory is its simplistic interpretation of development, that there is predictability in human growth and behaviour (Goelman & Guhn 2011, p. 213). Goleman and Guhn (2011) note that although contextual and relational factors can be highly influential, it is imperative to acknowledge that adolescents are capable of initiating their own constructions in life.

Slade’s cognitive behavioral model proposes that anorexic symptoms are maintained by an extreme need for control and a set of overvalued ideals about body shape and weight (Slade, 1982, p. 173). An important term within the theory is the ‘functional analysis’, which refers to how a need for control is central throughout the course of human development (Slade, 1982, p. 174). Anorexic adolescents have a tendency to judge self worth in terms of body weight and shape, leading to disordered eating beliefs and behaviour. Therefore, the functional analysis is reinforced positively through feelings of success from weight loss, and negatively through fear of weight gain ( lade, 1982, p. 173). The fact that the disorder typically starts in adolescence supports the theory, as controlling eating provides a means of arresting the uncertainty associated with the physical and psychosocial changes of puberty. (Woodruff et al 208, p. 406) The cognitive behavioral theory advises that the principal focus of treatment for anorexic adolescents should be the development of alternative ways of thinking and behaving under psychological distress (Woodruff et al 208, p. 406).
The primary limitation of cognitive behavioral theory is that the model of human development is too narrow, where control is elevated as the preeminent to human functioning (Woodruff et al 208, p. 408). There is a necessity to recognise the broader issues and intricacies of the experience of growth in adolescence. Further clarification is also required whether faulty cognitions are a cause or consequence of such cognitive processes.
Question 4
Research evidences that anorexia nervosa affects people of every: ethnicity, age, socio-economic status and gender identity (Kalb 2003, p. 39).
Gender is a significant influence in producing disparate experiences of anorexia in adolescence.

Although anorexia occurs primarily in women, 5-20% of people with eating disorders are men (Field et al. 2007, p. 456). Contrary to common perception, these statistics indicate that male adolescents are engaging in destructive dietary practices as their female counterparts. In contrast to a general desire of adolescent girls to lose weight, adolescent males strive to increase their muscle mass (Szabo 1998, p. 119). DiDomenico and Andersen found that magazines targeted primarily to women included more content on weight reduction such as articles about diet and calories; whilst content targeted at men contained more shape articles about weight lifting, fitness or muscle toning. Anorexia nervosa in males may even be more prevalent than the reported estimates, as eating pathologies that conceive anorexia as deviant from the social norm cause many male anorectics to go unnoticed (Field et al. 2007, p.

456).

Sexuality is another factor of diversity that affects the susceptibility of certain individuals to anorexia. A disproportionate number of men with eating disorders are gay and bisexual, as 14-21% of non-heterosexual men are affected compared to 3% of the general male population. The sociocultural perspective provides a prominent explanation for this high prevalence, as cultural values esteem an ideal body image that is near unobtainable for gay and sexuality men. Comparatively, there were no differences in eating disorder prevalence between lesbian and bisexual women and heterosexual women, or across racial groups. In wider application of sexuality, individuals experiencing conflict over sexual orientation are more at risk to anorexia. Burns and Crisp found that adolescents with anorexia in their study admitted “obvious relief” at the diminution of their sexual drive during the acute phase of their disease.
Conclusion
As adolescence is a time of immense and rapid development, anorexia poses a significant health threat upon physical and mental health. Although a general picture of adolescence has been constructed through research, it is crucial to recognise that behaviour emerges from a unique interaction of one’s: social surroundings, biological disposition and psychological factors.