Describe and evaluate two models of abnormality as explanations and treatment tools for anorexia.

by skidadle (student)

Anorexia Nervosa is an eating disorder and a mental health condition. Literally translated it means ‘nervous lack of appetite’. A person suffering from anorexia has an intense fear of becoming overweight and thus employs strict controls over their intake of food. (Flanagan, 2000) There are guidelines of symptoms outlined in the Diagnostic and Statistical Manual of mental disorders (DSM) that enable a diagnosis to be made on an individual suspected of suffering from anorexia. The DSM-iv classification of this disorder lists the following as symptoms of anorexia: The patient refuses to maintain a minimum body weight (e.g. 85% of expected weight for their age and height); the patient intensely fears becoming overweight despite being emaciated; self-perception of the body is abnormal i.e. the patient believes themselves to be overweight or denies the seriousness of their low weight; due to weight loss, a female patient has missed at least 3 consecutive periods, or periods occur only when she is given hormones. (Disorder Information Sheet, 2003) There are several psychological approaches that endeavour to explain the causes of eating disorders and offer appropriate treatment, such as the psychoanalytical model which states that the cause lies in childhood development and can be treated with family therapy. There is also the cognitive model, developed by Beck in 1976 (Scott, 1988) which assumes that emotional problems stem from distorted thought patterns. Cognitive therapy strives to change the way the way a person thinks and develop a better coping response. This essay will focus on the causes and treatment for Anorexia Nervosa as outlined by the biological and behavioural models.

Biological explanations of anorexia can be categorised as either genetically inherited or due to a biochemical dysfunction of the brain’s neurotransmitters. Evidence for genetic links to anorexia comes in the form of twin studies. Identical twins or monozygotic (MZ) twins have the same genetic makeup, whereas non identical or dizygotic (DZ) twins share around 50% of the same genes. In 1988 Holland et al (Cardwell & Flanagan, 2003) performed a study of genetic vulnerability in anorexics. The aim of the study was to investigate whether there was a higher concordance rate of anorexia for MZ twins than DZ twins. A sample of 34 pairs of twins and one set of triplets were selected because one of them had been diagnosed with anorexia. They found that there was a much higher concordance rate of anorexia for MZ (56%) than DZ(7%) twins which does suggest a genetic basis for anorexia although the fact that the percentage for MZ twins was not 100% shows that genes are not wholly responsible and only provide a predisposition to the disorder rather than a trigger. This study has been criticised as it does not take into account the influence of environment and nurture, MZ twins may be treated in a more similar way as they look and behave more alike. It also fails to consider cultural factors as it was carried out in western society where there is an emphasis on being thin.

Mary Ann Marrazzi, PhD (Treating Anorexia Like Addiction, 1995) believes that eating disorders should be regarded as addictions. She treated 19 women with anorexia or bulimia with a drug called naltrexone which is used to combat heroin addiction. She states that the brain releases opioids in response to self-starvation, known to cause a ‘high’, and that anorexics become addicted to the opioid-induced adaptation to starvation. Because naltrexone blocks the receptors in the brain that respond to opioids, the drug breaks the addictive cycle. This treatment lessens starvation enough for counselling to convince the individual not diet. All but one of ...

This is a preview of the whole essay

Experiments being conducted by Professor Bryan Lask (Richards, 2009) suggest that the way the brain develops in the womb is linked with the risk of developing anorexia in later life. He and his team administered brain scans to over 200 anorexia sufferers whilst they undertook various tests. They found that, in anorexics, an area of the brain known as the insula appeared to react differently from the way it would in someone without the condition. This research could lead to the development of the first drugs for the treatment of eating disorders, in a similar way that antidepressants treat chemical imbalances in people with depression.

As depression occurs far more in those suffering from anorexia than in the general population, antidepressants are commonly used to help treat anorexia. Seretonin re-uptake inhibitors such as flouxetine have been shown to improve eating behaviour by reducing compulsions, depression and anxiety. Anti depressants however should not be used as the sole treatment of anorexia. (Wattula)

The behavioural model views anorexia as a phobia of gaining weight and behaviourists believe that the disorder is the result of conditioning. Using the principles of classical conditioning, Leitenberg et al (Eysenck, 2005) believes that people suffering from anorexia may have learned to associate eating with anxiety because eating too much makes people overweight and unattractive. Their anxiety is reduced as their weight goes down and is then viewed as respite from an unpleasant stimulus. This behaviour may then be given positive reinforcement as the individual gains attention, or as they see that other people are admired for being slim, i.e. operant conditioning.

Social learning theory assumes that anorexic behaviour is learned from observing role models and imitating their behaviour. The media perpetuates the image that ‘thin is good’ and it is well documented that eating disorders are much more common in Western than in non-Western societies. (Eysenck, 2005) In 1999, Becker (Cardwell & Flanagan, 2003) published a study documenting the introduction of television to the island of Fiji and the effects that it had on the attitudes towards eating and incidences of anorexia amongst adolescent girls. In 1995, 63 girls were questioned about their attitudes towards eating and their TV viewing habits, with only 3% reporting that they vomited to control their weight and 13% whose answers indicated risk of an eating disorder. Just three years later these had risen from 3% to 15% and from 13% to 29%. These findings signify a strong link between the changing attitude to eating and the exposure to Western ideals of thinness. However, it cannot be assumed that Western TV causes eating disorders or even that TV alone has caused the change in attitudes, as if this were the case everyone would develop an eating disorder. Another study conducted by the University of Zululand in South Africa and the Northumbria University in England, found that many young Zulu women appeared to be depressed about their weight and want to look more like western girls. Professor Christopher Szabo, a psychologist at the eating disorders clinic at the Tara Hospital, Johannesburg stated "I don't think that it is just media images, I think that there have been significant societal changes in South Africa such as urbanisation and there has been significant change with the emancipation of black females and increasing role choice." (BBC News, 2002)

When treating anorexia, behaviour therapy employs classical conditioning, systematic desensitisation and aversion therapy. An example case of a young anorexic woman, who was rewarded with social interaction whilst eating, learned to associate this desirable activity with food. This was continued and repeated and resulted in changing her behaviour. This therapy was based on similar findings of Bachrach et al in 1965 (Gross & Mcllveen, 1998)

The biological model goes a long way in explaining why an individual may be predisposed to developing an eating disorder. However in the case of the twin study and similar follow up studies, it is evident that it is difficult to separate the effects of a shared environment from a shared genetic makeup and if the condition was solely genetically based, then the concordance rate for MZ twins would be 100%. While studies have demonstrated that there are biochemical changes in people suffering from anorexia, it is difficult to determine whether this is a cause of the condition or a consequence. Barlow and Durand stated “The consensus is that some neurobiological and endocrinological abnormalities do exist in eating disorders but they are a result of semi-starvation... rather than a cause” (Eysenck, 2005, p. 214)

The behavioural model is useful in accounting for the increased rates of anorexia as society increasingly focuses on thin as desirable and behavioural therapies have been successful in treating anorexia. It also helps to explain cultural differences but fails to elucidate why some women develop the disorder while others do not, as we are all exposed to the same media imagery. Conditioning theory can explain how the disorder is maintained through reinforcement but falls short on addressing the underlying causes of the condition. Fedoroff and McFarlane stated “...culture is only one of many factors that contribute to the development of eating disorders... cultural factors can only be understood as they interact with the psychology and biology of the vulnerable individual... a culture cannot cause a disorder” (Gross, 2009, p. 800)

In conclusion, it is apparent that no one model can fully explain the reasons an individual may develop an eating disorder or provide comprehensive and effective treatment for the condition. Anorexia is a multi determined disorder in that it is a combination of biological predisposition, family life and media influence, therefore a multi dimensional approach must be taken. Treatments are stronger and more effective when they are used together for example, a combination of behavioural and cognitive therapies address distorted thought patterns whilst shaping behaviours and responses. The most successful and effective treatments of Anorexia Nervosa are this style of combined therapies tailored to suit the individual sufferer.

Bibliography

Cardwell, M. & Flanagan, C., 2003. Psychology AS The Complete Companion. Cheltenham: Nelson Thornes Ltd.

Disorder Information Sheet, 2003, August 21. Retrieved January 7, 2010, from Psychnet-uk: http://www.psychnet-uk.com/dsm_iv/anorexia.htm

Eysenck, M. W., 2005. Psychology for AS level. 3rd ed. East Sussex: Psychology Press ltd.

Flanagan, C., 2000. Revise AS Psychology. London: Letts Educational.

Gross., 2009. Psychology - The Science of Mind and Behaviour. 5th ed. London: Hodder Arnold.

Gross, R. & Mcllveen, R., 1998. Psychology - A new introduction. London: Hodder & Stoughton Educational.

BBC World Service's Outlook programme. 2002, November 4 . BBC News. Retrieved January 20, 2010, from BBC: http://news.bbc.co.uk/1/hi/world/africa/2381161.stm

Inside Out London - The Secrets of Anorexia. BBC One. 2009. November 30, 19:30

Scott, D., 1988. Anorexia and bulimia nervosa: practical approaches. London: Croom Helm Ltd.

Psychology Today Staff, 1995, March 1. Treating Anorexia Like Addiction. Retrieved January 21, 2010, from Psychology Today: http://www.psychologytoday.com/articles/199503/treating-anorexia-addiction

Wattula, A. L., Anorexia Nervosa: Pharmacologic Treatments . Retrieved January 22, 2010, from Vanderbilt University: http://www.vanderbilt.edu/ans/psychology/health_psychology/anorexia_drugs.htm