Eating Disorders: Anorexia Nervosa

Anorexia Nervosa (AN) is a complex eating disorder with roots stemming from a combination of the forces of nature and nurture. The purpose of this paper is to gain a deeper understanding of the pathogenesis of AN in order to facilitate its treatment. Four lines of evidence are analyzed: studies of neurobiology in anorectics, genetic factors, the role of culture & media, and disturbances in familial relationships. Although there are cultural influences associated with the development of AN, the results of the studies reviewed in this article side with the nature side of the debate. The paper concludes that there is no single mechanism confining the causes of AN, but rather an interplay of different factors and individual differences.
At the

epicenter of the disorder-Anorexia Nervosa- lies an extreme need to control what one eats. Cognitive behavioral theory suggests that in societies today a tendency has developed whereby individuals judge self worth in terms of shape, and weight is superimposed on this need for self-control. This paper reviews various studies in order to conclude the factors that trigger the need to control nutrition.
The classic case of Anorexia Nervosa (AN) goes unnoticed by majority of medical health care practitioners. The patient is usually a young woman, involuntarily brought to the doctor at the mandate of her parents; she has menstrual irregularities and is noticeably emaciated, but insists that she is at the brunt of becoming fat. She refutes her doctors and parents and goes to inconceivable lengths to justify her disorder as merely being an outcome of her pursuit to maintain weight. Hence, the problem lies at the medical expert’s limited cognizance on the etiology of eating disorders. It is crucial for psychologists to delve into the causes of this disorder in order to understand the interplay between the activity of the brain, social and behavioral factors as well as the elements of genetics. (Chasnovitz, 2013)
According to the Diagnostic and Statistical Manual of Mental Disorders, (4th ed, text revised Washington, DC, American Psychiatric Association, 2000), Anorexia Nervosa is subdivided into two branches; Restricting type and the other one being Binge-eating/purging type.

The predominant symptoms of this illness include; a refusal to maintain a normal body weight, a preoccupation with a perfect body image, an excruciating fear of gaining weight and amenorrhea (absence of three consecutive menstrual cycles.) It’s a fallacy that eating disorders are entirely about being thin and looking good. In fact, eating disorders are severe psychological disorders that require professional intervention. People with eating disorders may portray their lives as being picture-perfect; when, truly, they are the ones who hide all the anguish and misery in that façade. Certainly, not everyone who aims to lose weight develops an eating disorder. There are various underlying factors that contribute to the development of Anorexia nervosa.
The question of nature or nurture has long been a controversy, but recent research proves that certain neurobiological causes (nature) might be the driving force behind this illness. Many believe genetics, society and family dynamics to be the causes of Anorexia, as stated by Rachel Cantrell “Society is the gun, genetics loads the gun, and the family pulls the trigger” (2013). A likelihood of underlying neurobiological factors has been found by Walter H. Kaye,

and his colleagues, in their journal “Is Anorexia an Eating Disorder”:
They often become sick around the same time (early adolescence), show similar symptoms and behaviors, and are mostly females. They typically resist eating and engage in a powerful pursuit of weight loss, yet paradoxically are obsessed with food and eating rituals. They tend to see themselves as fat and deny being underweight. They tend to resist treatment and lack insight about the seriousness of the medical consequences of AN. (p.2)
Anorexics display abnormally low levels of female hormones and exhibit reduced brain volume in regions responsible for thoughts and emotions. These anomalies tend to revert with the restoration of weight suggesting that they are repercussions of AN rather than a cause. Moreover, the higher brain regions of anorexics are able to ignore signals sent from the lower brain regions that signal starvation and the need for food intake. (Kaye, Bailer, Klabunde & Brown, p.2) This suggests that anorexia might as well be a brain disorder. This is further backed up by evidence in a study by Wagner A, et.al, showing the brain scans of anorexics during a sweet perception task. The results showed a marked difference in the brain activity levels between anorexics and control subjects. The brain images of normal subjects showed more activity in their insula, striatum, and ACC as they enjoyed the sugar. Whereas, brain images of recovered anorexics showed blunted response when given the same test. (2008, p.513-23)
Genetic factors, such as personality traits, play a major role in shaping anorexia nervosa and eating disorders in general.

As pointed out in the article “Anorexia and the brain” by Rachel Cantrell, anorexics tend to display anxiety; attention seeking behaviors, obsessiveness, perfectionism, and a drive for thinness from a very young age and it continues to persist even after recovery (2013). In a study by Cloninger C, Przybeck T, Svrakic D, Wetzel R, anorexics are termed as rule abiding, rigid and anxious adolescents who are high in harm avoidance; an inclination to criticize past behaviors and constantly worry about the future (1994.) Studies have confirmed the presence of these traits in the family members of anorexic patients regardless of their weight. These traits persist into and after recovery, which confirms the fact that these are underlying traits rather than an offshoot of the illness (Bulik C, et al.

2007)
On the other hand, the nurture side of the debate argues that anorexia is a product of social and environmental factors. The image of women portrayed in today’s media is getting thinner by the day, which goes against the body structure of the average woman. It is assumed that women who consume less food and have slender body types are more feminine. This belief leads to the development of correlated mental illnesses, such as body dysmorphic disorder, due to dissatisfaction and comparison of oneself with that of the ‘ideal image’ portrayed by the media. In more specific terms, media learning is acquired through classical and operant conditioning, which involves learning a response by merely watching a model and then reinforcing it.
Various family issues can also trigger the occurrence of eating disorders. The influence of an over-dominant and assertive family can become a cause of anorexia as the adolescent tries to gather attention, care and love. Buck Runyan, program director at Remuda Programs' Adolescent Facility, says:
There’s a shared emotional characteristic between girls who develop eating disorders. They are oversensitive and receptive to emotional content at home. In case of any emotive turbulence in the family, these individuals are inclined to personalize them. These feelings of guilt and pain are then eschewed by the victim and stored in two places, the stomach and head (Eberly & Harken, 2000).
Psycho dynamically, these troubled individuals then acquire eating disorders, like anorexia, in an attempt to gain control over their lives. Anorexics usually become perfectionists as they set up exceedingly high standards for themselves and avoid food altogether, in an attempt to punish themselves and their parents.
In short, there’s no single factor that helps shape the etiology of AN. Rather, it seems likely that this grisly disease stems from the interplay of genetic, biological, psychological, and sociological factors. It wouldn’t be fair to completely deny the existence of environmental and societal factors, even though an increasing amount of research and hardcore evidence favor the nature side of the debate.