The medical model however, has different implications for treatment. Since the medical model advances a biological cause for disorders, it follows that therapies based on this approach will be biologically based. There are several types of such therapy, one of them being drugs. Drug therapy is by far the most common biological therapy and involves the use of four main classes of drugs. These classes comprise anti-psychotic drugs for the treatment of disorders as schizophrenia; anti-depressants to treat depression; anti-anxiety drugs to treat disorders that involve extreme anxiety such as obsessive-compulsive disorder and anti-manic drugs for disorders such as bipolar depression. Another therapy used is electroconvulsive therapy. This involves passing an electric current strong enough to produce a strong convulsion from one side of the head to the other. This type of treatment remains controversial since it used to be done without the muscle relaxants that are now used, and was therefore frightening and dangerous. Another source of controversy is the uncertainty as to why this therapy works. Some people argue that this treatment can produce serious money loss and other serious side effects, and that it should never be used. It is usually a treatment of last resort for patients who do not respond to other treatment and are suicidal. Psychosurgery is a therapy, which involves destroying minute areas of the brain, and, as it is obviously permanent, it is only used with fully informed consent on parents who have resisted all other forms of treatment and request this one.
(c) ‘The rapid increase in the incidence of anorexia nervosa is a direct result of the social pressures on young girls to be thin’
In the light of the above quotation, critically evaluate explanations for the causes of anorexia nervosa.
Biological explanations of eating disorders fall into two categories, genetic inheritance, and biochemical dysfunction of neurotransmitters in the brain.
Genetic science has been unable to identify genes for specific behaviours, such as those associated with eating disorders. Research is based, therefore, on examining whether a particular disorder runs in families. The American Psychiatric Association reports that there is an increased risk of eating disorders among first-degree biological relatives of those diagnosed, with a number of studies showing a much higher prevalence rate than in the general population. However, since relatives usually share the same environment, this does not necessarily support a genetic cause, as the behaviour may have been learned from other family members. Twin studies provide more reliable evidence. The nature of this research is to compare monozygotic twins with dizgotic twins. MZ twins have identical genes, whereas DZ twins are no more alike genetically than any other siblings. Therefore, environmental factors could be largely eliminated if a significantly higher concordance rate were found among MZ twins compared with DZ twins.
The study of anorexia nervosa on 34 pairs of twins and one set of triplets took place in 1984, by Holland et al. its aim was to investigate whether there is a genetic basis for anorexia by studying identical and non-identical twins where at least one twin in each pair suffered from anorexia. Participants involved 30 female twin pairs, four male twin pairs, and one set of male triplets. The twins and triplets were selected because of one of the twins had been diagnosed as suffering from anorexia nervosa. Data was collected on the other twin and triplets to check for concordance. High concordance rates were found for monozygotic female twins, in which 55% compared to 7% for dizygotic female pairs. Five of the non-anorexic female co-twins had either other psychiatric illnesses or minor eating disorders. None of the male co-twins had anorexia. Results support the view that there is some genetic basis for anorexia among females, since identical twins had 55% concordance, while DZ twins showed only 7% concordance.
The higher concordance rates among identical twins may be caused by the similar ways in which they were treated by family and friends rather than by their genetic similarity. Holland and colleagues acknowledge that if genes do contribute to anorexia, their role is small. The sample size is very small and so is probably unrepresentative; other studies have not supported a genetic basis. Another example was Wades study in 1998, where he studied both genetic and environmental risk factors in 325 female twins. They found a significant environmental influence in shaping women’s attitudes towards weight, shape, eating and food, but little evidence of a genetic component.
There are behavioural explanations for the rise of anorexia nervosa. They believe it is down to advertising companies, and teenage magazines. The general message promoted by such magazines and advertising promotes the message that ‘slim is beautiful’. It is not surprising therefore, that so may people turn to diets with such frequency. This has led to the layperson’s view of anorexia as ‘slimming that got out of hand’.
Classical conditioning agrees with this view, it incorporates that of layperson’s view, suggesting that sliming becomes a habit, just like any other habit, through stimulus-response mechanisms. The person first goes on a diet and after a while receives admiration from others, either for their endeavour or their new, slimmer appearance. In other words, they learn to associate being slim with feeling good about themselves.
The learning theory view holds that social cultural pressures placed on females in Western society provides an alternative explanation for the origin of eating disorders. The evidence that social cultural norms have an important influence on eating disorders supports behavioural view of anorexia. From an extremely early age children, especially girls are bombarded with messages from the media that to be fat is to be an attraction and fulfilment. Thus agreeing with classical conditioning that thin is associated with positive reinforcement and being of normal weight or more is associated with negative feelings of unattractiveness and lack of self control. The pressures of models and famous women who are classed as ‘slim’ have important influence on young girls. This can be seen in the differential rates of eating disorders amongst certain cultures and professions. Anorexia nervosa is very prevalent among models and dancers, especially ballet dancers.
Not only are there pressures from the culture but from certain families. Several studies indicate that anorexia is common in the daughters of parents who, from a time when the children are young, put great emphasise on thinness, physical appearance and dieting.
The learning theory view also holds that it is not just social pressures on young girls that cause anorexia nervosa. The theory holds that anorexia is a phobia, which had arisen as all phobias do – as a result of learning. The specific phobia in this case is the fear of being fat and the fear of being out of control of your life. Anorexics are typically desperately fearful of eating in case they loose control and eat more than they should.
To conclude, we can see how social pressures can be the cause of girls developing anorexia nervosa, but we can also see other factors that contribute, so it cannot be defined as the sole cause.
