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Anorexia nervosa is an eating disorder that consists of self-regulated
food restriction in which the person strives for thinness and also involves
distortion of the way the person sees his or her own body. An anorexic
person weighs less than 85% of their ideal body weight. The prevalence
of eating disorders is between .5-1% of women aged 15-40 and about 1/20
of this number occurs in men. Anorexia affects all aspects of an affected
person's life including emotional health, physical health, and relationships
with others (Shekter-Wolfson et al 5-6). A study completed in 1996 showed
that anorexics also tend to possess traits that are obsessive in nature
and carry heavy emotional reliance on other people (Herpertz-Dahlmann et
al 461). Dependency, self-directed hostility, and assertiveness did not
correlate highly with anorexia nervosa as assumed (Rogers and Petrie 138).
In addition, anorexics tend to require constant hospitalization which incur
personal and systematic costs (Shekter-Wolfson et al 6-7).
In order for a person to be diagnosed with anorexia nervosa, they must
possess the two essential psychological symptoms of the drive for thinness
and the body image distortion problem. According to the DSM-IV, anorexics
are categorized into two categories, restricting and binge-eating/purging
types. Another assessment device is the Eating Attitudes Test and the Eating
Disorders Inventory. The evaluation of an affected person should be multidimensional
and comprehensive because of the severity of this problem (Shekter-Wolfson
et al 10).
After this has taken place, a formal interview with the client is conducted.
This interview consists of many components. The history of the client's
weight is assessed as well as the extent to which he or she is immersed
with the ideas of body weight and shape. If the counselor possesses a firm,
understanding perspective, the client will more likely open up and share
issues with the advisor. As long as the interviewer knows that the symptoms
expressed by the client are due to the eating disorder itself (in this
case starvation), the counselor can grasp the problem in a tight manner.
Other issues discussed between the interviewer and the client include past
history of emotional disturbance, past medical history, family history,
current family situation, family eating patterns, family attitudes about
weight, and other personal history. Another important criterion that must
be addressed is the presence or absence of past or present physical or
sexual abuse because this is a significant determinant of a person possessing
an eating disorder (Shekter-Wolfson et al 13).
The first step in the treatment of anorexia is to aid the client
in adapting a more standardized eating pattern. A dietitian may intervene
at this point to assist the affected person to adopt more healthy eating
behaviors. The counselor's role is to gradually help the client begin to
adopt a more normal eating style (Shekter-Wolfson et al 13). In all cases,
however, there are six goals of any treatment process:
1) To treat the medical complications
2) To revive a normal state of eating
3) To provide guidance on nutrition and exercise
4) To alter distorted views through CBT
5) To optimize support by educating the family
6) To enhance self-esteem with or without medication (Anonymous 101)
The most common form of outpatient individual therapy is cognitive
behavioral therapy (CBT). This type of therapy focuses on the thoughts
that envelop food and eating and presents a challenge to the dysfunctional
beliefs on the part of the anorexic. One of the main goals of CBT is for
the affected person to acquire a more self-focused and self-observant approach,
so the person is asked to keep a diary of food intake and a journal of
thought processes during the treatment period. There is still much more
work to be done to assess whether CBT is as or more effective than other
treatments of anorexia nervosa (Shekter-Wolfson et al 15).
Interpersonal therapy is an broadened form of psychotherapy in which
the focus is upon the patient's relationships with others and with the
therapist (Shekter-Wolfson et al 15). Many psychologists believe that many
anorexic people also face shortages in psychosocial functioning may also
be a factor in the lengthiness of an anorexic's condition. More research
is needed to assess whether new and improved elements should be added to
the treatment agenda, but the sense is that programs on sexuality or an
interpersonal approach should be added to the CBT method (Herpertz-Dahlmann
et al 454).
Almost every type of psychotherapy has been used on anorexic patients
and all have been proven to be effective (Yager 156). However, more structured
and organized forms of psychotherapies, including behavioral therapy, tend
to work more effectively early on in the treatment process while more psychodynamic
treatments like behavioral or family therapy are used more gradually for
a period of one to two years. A longitudinal study was conducted with 24
anorexic patients who were continuously receiving inpatient treatment.
A comprehensive behavior therapy process lead to a significant improvement
in body weight, eating habits, and body image and these results remained
for 7 years when the follow-up was conducted. At the 7 year point, most
of the patients had improved more so than at the one year point (Yager
In cognitive behavior therapy for anorexia, the disorder is treated
as if anorexia is nothing more than a fight for freedom, intelligence,
self-respect, and self-discipline. Another goal of CBT is to correct the
unhealthy cognitive processes that are causing the distorted beliefs. Even
though most of these techniques are not used during periods of emaciation
where the main goal is for the patient to regain weight, many people consider
psychodynamic psychotherapies and cognitive treatment to be the most advantageous
interventions for aiding the patients in keeping the weight on their bodies
as well as to ease psychological maturation and improvement. There are
six cognitive approaches that are widely used in CBT:
1) education about the disorder
2) providing informational answers to questions in regard to weight, calorie intake, and changing health status
3) showing the patient to recognize and focus upon negative thoughts and other emotions linked to the distorted beliefs and fixations associated with weight, body shape, nutrition, exercise, and other aspects of the disorder.
4) teaching the patient to come up with and replace alternative, more productive and positive thoughts for the negative ones
5) problem-solving discussions
6) teaching alternative coping strategies (Yager 160-161)
As a result of a study conducted by Russell et al in 1987, family therapy was shown to be highly effective and necessary in most cases, especially in cases where the patient is still living at home. The reason is because anorexia creates high emotional stress that echoes among all family members. Families in which there is a lot of 'expressed emotion' (families that express large amounts of negative and critical attitudes) adversely affect the progress of an anorexic patient. Families undergoing a large amount of stressors may benefit from behavioral therapy techniques in which the patient and the family together learn communication and problem-solving skills. In severe cases where there is dysfunctional interactions occurring, 'constructive separations of family members are implemented. Also, family support groups with more than one family discussing problems together can help families face realistic goals about their individual cases (Yager 163). One study conducted on family therapy showed a more effective outcome for younger clients as opposed to individual therapy (Shekter-Wolfson et al 18). At any rate, family therapy will differ in nature and content depending on the family situation at hand (White 94).
I think that CBT is the most effective form of treatment for anorexia. My reasons are that if the patient can alter his/her thoughts permanently, true changes in cognitions could take place. I have many friends who have this terrible eating problem and I have strongly recommended this form of treatment to them after doing the research for this paper.
Anonymous (1995). Treatment Options for Eating Disorders.
Patient Care. 29: 101-105.
Herpertz-Dahlmann, B., Wewetzer, C., Hennighausen, K., and Remschmidt,
H. (1996). Outcome, Psychosocial Functioning, and Prognostic Factors
in Adolescent Anorexia Nervosa as Determined by Prospective Follow-up Assessment.
Journal of Youth and Adolescence. 25: 455-465.
Rogers, Rebecca L., and Petrie, Trent A. (1996). Personality Correlates
of Anorexic Symptomatology in Female Undergraduates. Journal of
Counseling and Development. 75: 138-141.
Shekter-Wolfson, Lorie F., Woodside, D. Blake, and Lackstrom, Jan
D. (1997). Social Work Treatment of Anorexia and Bulimia: Guidelines
for Practice. Research on Social Work Practice. 7: 5-20.
White, Mark B. (1997). How Good is Family Therapy? A Reassessment.
Journal of Marital and Family Therapy. 23: 93-94.
Yager, Joel (1994). Psychosocial Treatments for Eating Disorders.
Psychiatry. 57: 153-168.
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