Anorexia Nervosa

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  • Anorexia Nervosa (AN)
    • Clinical character-isitics
      • Anxiety and dissatisfact-ion with body weight and/or shape
      • A body weight 85% or less than normal weight for age.
      • Loss of 3 consecutive menstrual cycles (amenorroea)
      • Distorted perception of body weight.Do not see their own thinness
    • Prevalence
      • 0.9% of females
      • 0.3% of males
      • Over 90% of cases are female.
      • Most cases are in early teens to late 20's.
      • More people in their 30's, 40's and children are being diagnosed.
    • Prognosis
      • AN often develops into Bulimia Nervosa.
      • Very resistant to treatment.
      • 30-40% show no improvemnt over 5 years
      • 1/3 live with the condition all their lives and learn to manage it.
      • mortality rate: 8% (often through suicide).
    • Biologiclal explanation
      • Evolutionary explanations
        • Adapted to Flee Famine Hypothesis (AFFH). Guisinger (2003)
          • In the EEA, hunter-gatherers had to move on regularly as food supplies in the local area were exhausted
          • Key character-istics of people with AN include restlessness and high levels of activity.
          • A normal reaction to starvation/we-ight loss would be depression and inactivity.
          • High levels of activity and denial of hunger help the individual to migrate in reponse to famine.
        • AO2
          • doesnt explain why it affects women more than men.
          • Explains why AN sufferers deny their hunger and have increased activity levels.
          • Men with these characteristics get called 'sportsmen' and women get called 'anorexics'.
          • Post-hoc
          • Unscientific
          • Deterministic
          • Doesnt account for the 'westernisat-ion' of AN.
          • Treatment Implications
            • Removes the 'control' issue.
            • Aids understand-ing of the sufferer, it removes blame.
      • Genetic explanations
        • Dizygotic (DZ): share 50% of their genes. Monozygotic (MZ): share 100% of their genes.
        • Strober et al (1990)- parents of Anorexic daughters were 4X more likely than average to have the disorder themselves
        • Eating disorders (ED) tend to run in families.
          • Kaye (1999)-10% of ED patients have a reative who also sufferes from an ED.
          • depression, anxiety and OCD are more prevelant in families of ED patients.
          • AO2: difficult to seperate the effects of genes from the effects of the shared environment.
        • Holland et al (1984)- Concordance rates for anorexia.
          • 55% MZ twins.
          • 7% DZ twins.
          • Reduces confounding effect of a shared environment.
          • sugessts a genetic contribution, but not a cause.
          • AO2: small sample, findings not always replicated (e.g. Wade et al 1998).
      • Neural factors
        • Kaye et al (2005)-found a reduction in levels of the serotonin metabolite    5-HIAA in people with eating disorders.
          • AO2
            • Suggests that the serotonin pathways are underactive.
            • Done on people who are currently suffereing from AN-serotonin levels could have been affected by starvation.
            • How do we know that it is the cause?
        • PET Scans
          • Fewer serotonin receptors in the brain of AN sufferers.
            • AO2-    SSRI's arent effective for AN- other factors must be involved.
              • ok in preventing relapse.
    • Psychological explanations of AN
      • Sociocultural Influences
        • Early examples from tyhe 19th Century (Gull, 1874).
        • Hock et al (1998)-Curacao.
          • They are both affected by their culture.
          • Survey of the majority black population in Curacao in the Caribbean.
          • Black inhabitants had no AN. White population had similar eating behavior to the US.
          • Whites aspired to a western represen-tation of an ideal body weight (petite).
          • Black population had a larger ideal body shape.
          • AO2
            • Social desirability bias.
            • Relying on memory and honesty.
            • Nature VS nurture.
            • Medicines can target the population most prone to AN.
        • Becker et al (2002)-Fiji study
          • Study of 63 Fijian school girls
          • 2 samples-before TV and after TV. Were interviewd and also took a questionairre on eating behaviour.
          • Findings; disorded eating was more prevelant following exposure to TV. Stated a desire to  lose weight to model themselves on TV characters.
          • AO2
            • High ecological validity
            • Low reliability
            • Natural experiment
        • cultural pressures that glorify "thinness" and place a high value on obtaining the the 'perfect body'.
          • Narrow definitions of beauty.
        • helped by social learning theory.
          • limitation of role models.
          • Vicarious reinforce-ment-praise being put on someone because they are thin.
        • Keel & Klump (2003). Are ED's culture-bound syndromes?
          • Major review of cross-cultural and historical studies of ED.
          • Bulimia is culture-bound, AN is not.
          • AN-found in all cultures studied. even those not exposed to cultural influences.
          • Historical examples of AN are frequent (found in 12th C)
          • Cultural factors may influence AN but these are not sufficient or necessary.
          • AO2
            • Expansive study.
            • Includes quantitative and qualitative data-increases reliability and validity.
            • depriving someone of media will not prevent AN.
            • Nature VS nurture.
      • Psycho-dynamic explanations
        • Causes of anorexia: (Bruch, 1973).
          • 1. Ineffective parenting (e.g. thinking the child is hungry when they actually cold).
          • 2. Child is confused about internal needs-reliant onthe parents.
          • 3. Adolesence-want autonomy.
          • 4. Eating behaviour can be controlled-abnormal eating habits.
        • Crisp (1980)-amenorrhea is an attempt to remain a child and postpone adult reponsibility.
        • Minuchin (et al (1978)-
          • AN is used to divert attention away from other family problems (e.g relationship breakdown). Its a misguided attempt to keep the family together.
        • AO2
          • Which comes first?
          • High face validity-but dificult to test scientifically and often based on cases studies
          • Psycho-therapy and family treatment is often successful.

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