Eating disorders are medical conditions in which a person’s consumption habits and related thoughts and emotions are distorted. Victims of eating disorders are usually preoccupied with what they eat, their shape, and their weight. Millions of people worldwide are affected by these diseases, most of whom are women aged 13 to 35. (Fairburn et al. 509). Eating disorders are often associated with other psychological issues such as obsessive-compulsive disorder, anxiety, and substance abuse in the majority of patients. Genetic traits may also play a role in how the disorders affect people whose families have a history of complications so that anyone can be affected (Yanger 7). The psychological aspects of eating disorders are discussed in this paper. Bulimia Nervosa and the Cognitive Behavior Theory
This theory can help explain how Bulimia Nervosa (BN) develops and how it is maintained. In the context of this hypothesis, bulimia nervosa is as a result of a distorted self-worth. Whereas normal humans assess themselves according to their success various spheres of life (such as successful families, good job, sports, etc.), persons with eating disorders evaluate themselves mainly by their eating habits, appearance, and weight and how they can manage them. Ultimately, their entire life is concerned about eating, their weight, and shape. They have a peculiar interest in thinness and abhor fatness thereby make losing weight their major daily objective (Fairburn et al. 510)
Given cognitive behavior theory, Fairburn et al. attest that the continued over-assessment regarding weight and of bulimics is an underlying factor for the maintenance of BN. In effect, bulimics tend to have irregular eating habits often consuming and induce vomiting afterward (purging), or use of laxatives and they are in most of the times preoccupied about eating and their weight (510). Brewerton reiterates that core psychological characteristic of this condition is binge eating whereby the person is engulfed with episodes consumed food uncontrolled eating followed by purging (Brewerton 287). Binge eating evolves from the person’s attempt to avoid food. Instead of following the ordinary principles of diet, they strictly follow many self-imposed rules. Just after eating, they mostly react negatively for fear of breaking one or more of their self-imposed rules the result being they tend to stop their restriction for a short period. The overall outcome is a pattern of strict rules alternating with binge eating. This is then the driving psychological force for the disorder (Fairburn et al. 510).
Polivy and Herman point out that the episodes of binge eating do not occur randomly but are affected by extreme variations in moods which influence the capacity to control them. But because of the reprieve got by binge eating, the patients keep on experiencing bouts of uncontrolled consumption of food (192). Bulimics are highly self-critical. They create unnecessary high standards relating to their weight, shape, and eating habits which they endeavor to follow strictly. When they fail to maintain the set standards, they blame themselves instead of perceiving that it is the standards which are too high. The outcome is a self-re-evaluation which further aggravates the problem as they would set even stricter measures to maintain their standards (Fairburn et al. 512).
Anorexia nervosa is closely related to bulimia one for they have similar psychopathology whereby in each case, the patient is overly concerned with eating and controlling their weight and shape. Anorexics are also subject to purging and use laxatives. The critical difference between anorexia nervosa and bulimia one is the net difference between under-eating and over-eating and how they influence weight. In bulimia nervosa, the effect of under-eating and over-eating tend to neutralizes each other with the result that the person maintains a normal body weight. In the case of anorexia nervosa, the balance is shifted towards under-eating whereby the patients are underweight. In this case, binge eating is limited to remarkable levels of starvation (Fairburn et al. 519).
Eating Disorders and Trauma
Studies in eating disorders have looked at the role of childhood sexual abuse (CSA), and it has been found out that CSA is a risk factor for eating discourses as well as other psychiatric ones. The findings show that CSA has a close relationship with bulimia nervosa (Brewerton 288). Sexual abuse is a strong predictor of this. Other forms of trauma such as neglect, physical assault, emotional abuse bullying are risk factors for EDs. Consequently, any condition that is capable of producing post-traumatic stress disorder can potentially lead to the development of EDs (290).
Studies have indicated that EDs are associated with multiple occurrences and forms of trauma. Brewerton notes that bulimic women reported a higher prevalence of CSA, neglect and childhood physical assault when compared to those with no eating disorders. Women with bulimia exhibited more psychopathology than those without it, and the severity of trauma was correlated with the one of comorbid psychopathology (291). Abuse occurring in adolescence or adulthood was associated with childhood trauma (292).
Eating Disorders and Sexual Abuse
Studies have indicated that victims of sexual abuse are at a higher risk of developing EDs irrespective of gender. Root points out that those have experienced sexual abuse in the past try to suppress intrusive memories and episodes related to the unpleasant situation. These can be viewed as coping strategies which manifest themselves in abuse of food. By finding solace in food, victims can temporarily forget the traumatizing experience by shifting their attention to snack (97). Another reason is that victims of sexual abuse EDs use food to acquire some sense of security to prevent an occurrence of the trauma in future. By altering their shape and weight, victims of abuse aimed at making themselves less desirable to the perpetrators of this (8). Thirdly, by abuse food, the survivors of sexual trauma unconsciously want to punish themselves for they feel that they could have taken part in the sexual episode. In essence, the victims of violence have the illusion that they once more can be able to control their body, after having felt powerless in the hands of the attacker (98).
Root attempts to show the correlation between sexual trauma and eating disorders and asserts that EDs is not the real issue but a distorted mechanism of copping the post-traumatic stress one. If the sexual abuse history of the victim is not known, it may be more difficult to treat patients with eating disorders and if this issue is not well addressed the ED patients with a history of sexual trauma may not fully recover.
Persons with binge disorders are not able to control their eating and as such consume too much and often. As opposed to bulimia nervosa, binge eating is not accompanied by compensatory actions like purging, use of laxatives, and exercising. It, therefore, follows that victims of binge eating are always overweight and obese (Spitzer et al. 192).
Psychological Aspects of Obese People
Obese people may face several psychological pressures. The stigma for such individuals is remarkably high in the society, and it starts at childhood. Kids as young as six years characterize obese people as ugly, dirty, lazy, and stupid. Unfortunately, such individuals themselves portray the same stigma as the non-obese people (Stunkard and Wadden 525S). Stunkard and Wadden further report that obese persons are likely to be denied admission to prestigious colleges and jobs as compared to non-obese counterparts. Reports show that overweight people who suffer from binge eating go through more psychological problems than the obese people who do not experience binge eating. Furthermore, during treatment, obese binge eaters are likely to relapse (526S).
Treatment of Treatments of Eating Disorders
Psychological interventions aim at making the patient (i) comprehend and collaborate with physical and nutritional rehabilitation and (ii) comprehended and change distorted attitudes concerning eating habits. Further, the interventions (iii) improve the social dimensions of their lives and (iv) address the psychological turbulences and comorbid psychopathology that support the eating disorder behaviors (Fairburn 521).
Acute Anorexia Nervosa
When the patient is being induced to eat more and has shown some progress in weight gain, individualized psychotherapeutic attention that aims at giving understanding, praise for efforts, explanations, encouragements, and any other positive behavior are found to be successful. It is not recommended to apply formal psychotherapy with persons who are underweight and suffering from obsession and cognitively challenged as this gives little positive results. For adolescents and children, family support and intervention produces the most effective results (Yanger et al. 16). In most rehabilitation institutions the available programs provide an environment which addresses the emotional needs and actions that combine bed rest, exercise, and task that target weight, positive behavior, and good feedback concerning weight gain (Fairburn 522).
After normal weight has been achieved, gaining weight should be the next target. Psychotherapy should aim at addressing some areas. The patient should be induced to interact with their problem, mental distortions and how they have led to the development of the problem. Also, the patient should understand how their problems affect their families and society. They should also comprehend the coping skills required to regulate emotions and how to prevent re-occurrence of symptoms (Yanger et al. 17). Evidence indicates that after the initial successes in addressing nutrition, the patients show remarkable levels of thought processing capacity whereby improved mood and better cognitive acumen are noticed. Preventing relapse of EDs in adolescents and adults requires use cognitive-behavioral therapies coupled with interpersonal psychotherapy. It is critical for medical practitioners to put into consideration cultural attitudes, patient concerns about the sex of the therapist, issues relating to potential abuse or other developmental trauma (18).
Chronic Anorexia Nervosa
Patients with chronic anorexia nervosa normally do not respond to normal psychotherapy. However, after undertaking therapy for a substantial period, people tend to show some response. More extensive innervations are required to induce and motivate patients. For those clients who refuse to talk about their problems, non-verbal approach such as movement therapy and creative arts can be of help. Because anorexia nervosa is quite persistent, therapy is recommended for more than one year (Fairburn 523).
Psychological Interventions of Bulimia Nervosa
In choosing the appropriate psychosocial interventions for bulimics, the therapist should put many factors into consideration. Some factors include the patient’s cognitive development, comorbid psychopathology, psychodynamic issues, patients’ age and the patient’s family background. For adults, studies indicate that cognitive behavior therapy is the most effective. Some patients respond better when cognitive behavior therapy is combined with Interpersonal Therapy (Yanger et al. 20).
Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) in treating bulimics involves focusing on cognitive disillusions and behavioral malfunctions of the victims. In general, CBT aims to minimize observable characteristics of binging and purging and reprogram the distorted attitudes about food, body shape, and weight (Trompeter 101). The therapy is carried out in three stages. The first step is the awareness phase where the victim is made to understand the functioning of the disorder and attempt to discourage restraint in eating for healthy eating patterns. The second stage addresses the cognitive aspects of the problem how the mental distortions towards weight and shape lead to the manifestations of the problem. The third phase aims at maintaining healthy behaviors and enhances relapse prevention mechanisms. Throughout the therapy stages, progress is noted through continuous evaluation such as the victim’s self-evaluation journals and Eating Disorder Examinations (102). For patients with comorbid trauma, it is vital that therapists address the trauma to achieve full recovery (Yanger et al. 21).
The major EDs are anorexia nervosa and bulimia nervosa. EDs victims are typically preoccupied with what they eat, their shape and weight. In most of the patients, eating disorders are accompanied by other psychological disorders such as obsessive-compulsive disorder, anxiety, and substance abuse. Victims of bulimia nervosa are of average and even overweight whereas people suffering from anorexia nervosa are often underweight and suffering from effects of starvation. A childhood trauma such as sexual abuse, neglect, and physical assault can be a risk factor for eating disorders. In addressing these disorders appropriate Psychological and psychosocial interventions in conjunction with other methods can bring reprieve to the patients.
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