While food is the staff of life for some individuals, for others it is a problem. Some people may want too little or too much of it. They may overindulge in particular food preferences or ingest unnatural substances. Some people eat too little. They may fear food will fatten them beyond a standard of beauty. For others, food is a substitute for parental attention and affection. Food is not only central to biological life; it is essential to psychological life as well (Banfield and Mccabe 373). Each person has a self-image that relates closely to eating habits. When an individual has a healthy outlook on life, food usually is taken for granted and is part of an orderly life routine.
On the other hand, when an individual has an unhealthy outlook on life, food may become excessively important and the resultant behavior disorderly. For example, many people overeat when they are unhappy. Eating disorders among adolescents are some of the most pressing health concerns (Claude-Pierre 43) Common eating disorders among this group include anorexia nervosa, bulimia nervosa, and obesity. Anorexia is a disorder characterized by extreme weight loss caused by a refusal to eat; bulimia is characterized as a combination of gorging and purging food, and obesity involves chronic overeating and extreme weight gain (assuming there is no organic problem over which the individual has no control).
Anorexia nervosa is primarily an adolescent phenomenon. Relatively rare, it has an estimated incidence ranging from 0.5 percent among females aged 12 to 18 years to 1 percent among girls between the ages of 16 and 18 (Shelley 32). Even at the U.S. Naval Academy, anorexia has become an issue, and the Academy has had to face this “quiet problem”; two female midshipmen have been hospitalized for anorexia. Anorexia is probably increasing in frequency, though moderate and severe forms remain uncommon (Shelley 33). Bulimia and obesity are more common than anorexia. Bulimia is more common in adults, but 5 to 18 percent of the 12- to 18-year-old female population are afflicted with it (Treasure 12). An estimated 15 percent of adolescents show obesity. All three of these eating disorders are serious. Anorexia and bulimia may, in a relatively short period, result in severe health problems and even death. About 5 percent of anorexics who do not recover develop bulimia. Anorexia, according to some experts, is one of the few psychiatric disorders that can follow an unremitting course resulting in death. Obesity, on the other hand, is not associated with extreme health problems in the short run, but it may result in serious health problems in the long run (Treasure 15). Except for morbid obesity, early death caused by complications associated with obesity, there are no known adverse medical consequences of adolescent obesity. The likelihood of continuation into adulthood, however, makes obesity a hazard to future health.
Obesity, or overweight, may be considered self-punishment for not meeting the ideal image. The most common form of adolescent obesity may result from chronic overeating among depressed, passive individuals with low self-esteem, further aggravated by stress. Obesity can result from stressors such as the death of parents or siblings, birth of a sibling, parental separation, personal failures, and illness. The incident at the Naval Academy may have been caused by a military atmosphere that places a strong emphasis on physical fitness and dismisses students if they do not meet weight qualifications, as well as the fact that prestigious colleges attract at-risk students who are driven to perfection and indulge in rigid self-discipline (Treasure 29). The increase in eating disorders among youths may be caused by modern stressors such as fragmented families, violence, and pressure for high academic grades and achievement scores (Treasure 43).
The demographics of eating disorders involve socioeconomics, gender, age, country of origin, affiliation, and racial group. Eating disorders appear to be related to higher socioeconomic status. Eating disorders are virtually limited to patients of white racial origin. This has been confirmed by U.S. and British clinicians. In terms of country of origin, eating disorders are extremely rare in developing countries. Anorexia nervosa is known worldwide, it is found primarily in Europe, Australia, and North America (Treasure 8). It seems to be related to social circumstances where the availability of food is not a problem.
The incidence is increasing in the United Kingdom, particularly among the private school population. As for gender, eating disorders are primarily a disorder of females. The ratio of females to males is about 10: 1. Finally, affiliation appears to be an important demographic consideration. Within the countries where eating disorders are found, it is common in groups that are selected for thinness. Ballet dancers and models, for example, are ripe for anorexia nervosa (Polivy and Herman 187). Those who believe that eating disorders are a modern phenomenon point to a pervasive obsession with personal appearance, shape, and thinness. It may be extreme to use one small group to define a cultural phenomenon, but the phenomenon is nonetheless real. while Obesity is found in children of young age, anorexia nervosa appears to be largely a disorder of adolescence and young adulthood; most cases occur between the ages of 16 and 20. Only 8 percent of the cases showed onset before 10 years. According to the American Anorexia/Bulimia Association, 1 percent of teenage girls suffer from Nervosa appears, and as many as 20 percent of college women have bulimia symptoms (2008).
Eating disorders are not simply a behavioral disorder; it is a complex disorder that represents behavioral and emotional concerns as well as medical complications. It has been categorized by some professionals as a psychophysiological, or psychosomatic, disorder, a physical condition in which psychological factors are known or presumed to play a causal or at least contributory role. A distinct feature of this psychosomatic disorder is that there is actual damage to the body (Polivy and Herman 187). The first criterion relates to the refusal to maintain body weight at or above minimally normal weight for one’s age and height. Most studies of anorexia nervosa cite a criterion of at least 25 percent loss of original body weight. By this standard, the statistically normal female, who is 5’5″ tall at age 16, should weigh 110 pounds and would meet this criterion if her weight fell to 82 pounds or less (Treasure 33; Eating Disorders Association 2008).
One of the key attributes of eating disorders is the feeling that others are responsible for one’s emotions and actions. For example, when trauma occurs, one reaction is to feel victimized by someone or something that had control. Strict dieting, in this view, is one way to control an otherwise uncontrollable life. The anorexic’s control, furthermore, is rigid, fueled by a perceptual disturbance (Nielsen 479). Not only are physical dimensions distorted; sensations of hunger and satisfaction are misperceived. Essentially, the anorexic substitutes external signals for internal ones. In other words, rather than eating when hunger is felt, the anorexic may sit down with the family but eat strictly controlled amounts. Perception, not bodily sensations of hunger, controls eating behavior. Consequently, anorexics become defensive. Because they deny their bodily sensations and refuse to eat adequately, they must develop explanations and excuses. They become impervious to others’ opinions and influence. Only their perceptions matter to them. The anorexic tries to impose order and control by disorderly means, going to great lengths to self-delude and cover up a serious problem. Eventually, the disorder causes the anorexic to try to control everything related to food intake. Because food is so basic an issue, eating becomes a major bone of contention (Izevbigie 152).
Some professionals contend that anorexia nervosa and bulimia are an outcome of a modern cultural obsession with thinness. Others maintain that anorexia nervosa has been with us for a very long time. Both views are based upon fact. Eating disorders, particularly anorexia nervosa, have been evident since early times. Various accounts of asceticism, starvation, and emaciation in young women have come to us from the Middle Ages. The first published account of classical anorexia nervosa, with the symptoms that are recognized in the modern era, is a 1694 paper written by Richard Morton. This paper described an 18-year-old girl and a 16-year-old boy who developed a condition (Shelley 98).
The premodern and modern eras are replete with examples of faddish attitudes about weight. For example, sixteenth-century Frenchwomen swallowed sand to ruin their stomachs and acquire a pale complexion ). At the beginning of the twentieth century, a buxom woman was the ideal. In the 1920s flat chests and lean, angular looks were the ideals (Claude-Pierre 17). Then, by the 1940s, a well-fed look matched the post-World War II rationing era and became the sign of attractiveness. When Twiggy was the rage of the 1960s, at 5’7″ and 92 pounds, she represented yet another body ideal in a chain of twentieth-century ideas. Co-existing cultures provide a perspective on eating disorders throughout history. Concurrent with Western modern industrialized and technologically advanced societies are agrarian cultures that extol obesity. Overfed women in some cultures represent the indolent, well-to-do class. The 1990s in the United States have been notable for a fitness movement and a drive to be thin. There is evidence that the prevalence of anorexia nervosa has been increasing (Claude-Pierre 76).
The anorexic’s early development has been described as relatively trouble-free. Parents often describe their anorexic daughters as having been even-tempered, docile, and affectionate in their early years. There may have been food fads, excessive tidiness, or difficulty in forming friendships, but nothing dramatic or alarming. Against this background, anorexia nervosa may appear quite suddenly. One day the girl appears to be thinner. Amenorrhea may be the first symptom to precede weight loss (Holt and Espelage 346). There are four theories about the psychological progression of anorexia. These theories relate to life changes that may contribute to the development of this disorder. Contextual factors are multiple and have received the most attention in the evaluation of eating disorders. These theories involve family dynamics, sexual peculiarities, stress, and psychodynamics.
Among the theories of psychogenesis are psychodynamic explanations, which focus on unconscious wishes and fears. There also may be an unconscious desire to avoid threatening sexual conflicts (Claude-Pierre 112). Sexual conflict often precedes the onset of eating disorders. Other psychodynamics refers to a morbid fear of fatness or a history of obesity associated with taunting and social failure. Some, too, ascribe a symbolic search for personal mastery along with a fear of failure and need for empowerment. Another psychological explanation is that anorexia nervosa is a form of hysteria that develops when there is an inconsistency between action or desire and word. For example, when a youngster is exposed to religious sermons that emphasize damnation for engaging in sexual behavior, there may be a conflict with a strong desire to be sexually active (Claude-Pierre 123).
Learning theories focus on the acquisition of behaviors to explain eating disorders. These theories (e.g., Gold et al. 1980 cited Claude-Pierre 66) emphasize environmental factors that maintain the behavior, specifically events that reinforce the dieting and related behavior. For example, an anorexic mother may encourage and be a role model for her daughter’s spindly frame and fashionable thinness. There may also be secondary gains from attention and sympathy. Despite the persuasiveness of psychogenesis or learning as explanations for the disorder, professionals cannot avoid citing organic issues because of the effect of food refusal on the body and because the body is its venue; organic theories address issues of effect or effect, and both. Biologically oriented theorists (e.g., Gold et al. 1980) emphasize such possibilities as hypothalamic dysfunction (Claude-Pierre 69).
Biochemistry may play a role in the genesis of eating disorders. Researchers at the National Institute of Mental Health (NIMH) found that young women suffering from eating disorders had elevated levels of the hormone vasopressin. They concluded that a behavioral problem may change to a biochemical problem when the anorexic’s weight drops below a critical level, which triggers a biological reaction (Treasure 87). Among 16 anorexics in one study, the vasopressin levels were above normal, which led to an imbalance in fluids. When women experience a considerable weight loss, levels of hormonal secretions also may be suppressed. The most obvious manifestation of such a fall in hormone level is amenorrhea and impaired fertility. Most endocrine and metabolic changes probably are secondary to starvation, but there is evidence for primary neurochemical abnormality. Hormones, then, may play an important part in the genesis of eating disorders. Some critics admit a biological predisposition to eating disorders, especially bulimia and obesity (Treasure 23, Holt and Espelage 346).
Eating disorders are culture-bound. Severe eating disorders, especially anorexia and bulimia, are related to societal affluence. In countries where food is scarce, most people do not have the luxury of overeating or gaining attention by refusing to eat. In India, for example, there is a scarcity of food and a commensurately low incidence of anorexia (Harrison 162). Affluent countries, such as the United States, show a high incidence of both obesity and anorexia. Eating disorders are also strongly related to gender. Most individuals with eating disorders are female, although bulimia is distributed somewhat more equally between males and females (Holt and Espelage 346).
For individuals with eating disorders, educational strategies must be varied to deal with misperceptions, need for control, rigidity, inattentiveness, inconsistent performance, careless work habits, inability to take risks, tenuous relationships, and social isolation (Harrison 119). A comprehensive approach is needed also to deal with low self-esteem, nonassertiveness, absenteeism, distrustfulness, inability to take criticism, difficulty with changes, and inability to accept responsibility for their behaviors. These problems point to needs for acceptance/approval, internal control, appropriate engagement, encouragement, consistency/routine, and attention (Harrison 162). To encourage the individuals, ensure that the assigned tasks are appropriate and at the student’s ability level. To promote socialization, pair the student with another student or with a peer tutor.
Move later to larger groupings when the individual is comfortable with one peer. Provide frequent positive feedback. Provide feedback that indicates the student is successful, competent, important, and valuable. Provide constructive criticism. In feedback, combine strengths and weaknesses; focus on what was done well as well as what needs improvement (Shelley 98). Rational-emotive therapy has been effective in cases of social discomfort (Treasure 29). This therapy premise is that faulty thinking produces negative emotions and that focusing on commonly held irrational beliefs (exaggerating negative consequences, unrealistic demands, and blaming statements) can enhance self-awareness of faulty thinking. Rational thinking can be taught through lectures, discussions, and practice. The emphasis is on developing attitudes of self-acceptance, risk-taking, accepting uncertainty, and tolerating imperfection, all needed by individuals with eating disorders (Treasure 30). For example, individuals can be taught that it is irrational to exaggerate negative consequences.
In sum, eating disorders is complex social and medical problems influenced by biological and psychological conditions and modern cultural values. The task of parents, educators, and medical professionals is to recognize early signs of this disease and find appropriate methods of treatment. Anorexia is uncommon among males; females represent 90 to 95 percent of all cases. Because adolescent depression is also more likely to occur among girls than boys, obesity (often linked to depression) is more likely to be found among female adolescents.
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