Anorexia Nervosa (AN)

1. Anorexia Nervosa (AN) Symptoms & Cause AQA A: Specifications states: cover only one eating disorder “Dieting to be beautiful can go disastrously wrong”

2. Clinical Characteristics of Anorexia Nervosa (AN): DSM IV tr • Nervous loss of appetite. • Display an ‘abnormal’ attitude towards food. (Eating Attitudes Test: E.A.T.*) • Primarily a female disorder, usually occurring during adolescence. • There is a refusal to maintain normal body weight. • Individuals need to weigh less than 85% of their normal body weight to be diagnosed as anorexic (Body Mass Index or BMI: check online) • The distorted body image is not evident to anorexics themselves (Body Dismorphia Disorder or BDD) *Online: http://psychcentral.com/quizzes/eat.htm

3. Secondary symptoms: Anorexia causes a general physical decline including… • Cessation of menstruation (amenorrhoea) • Low blood pressure • Dry and cracking skin • Constipation • Insufficient sleep • Depression and low self-esteem Up to 20% cases of Clinical AN are fatal (1-5) A BMI of below 18.5 is an indicator & 15 is clinical

4. When does it change from ‘Diet’ into an autonomous* ‘Disorder’ (DSM IVr)? When the BMI (Body Mass Index) is equal to or less than 15 (below 85% expected weight by height and frame) However the BMI is only an indicator, it must be accompanied by a distorted body image, an abnormal relationship with food, a morbid fear of gaining weight, cessation of periods (3 months) and denial that there is a problem *What does autonomous mean?

5. Why is 15% such an important figure: • At puberty a 15% increase in body fat (‘puppy fat’) is required to trigger the release of hormones necessary for the development of secondary sexual characteristics. (Wider hips, breasts, periods, etc)

6. What happens if you drop below 15 BMI: • Secondary sexual characteristic hormones are no longer produced and the body returns to pre-pubic child-like ‘asexuality’. (Narrowing of hips, cessation of periods, breasts shrink, testicular atrophy (males) and these can be permanent!) NB. The physiological effects of hormones are temporary and to maintain effect continuous production is necessary

7. Combined Causal Factors of AN: (AO2) • The aetiology (cause & progression) of AN is probably not singular, but more likely a combination of factors including: • Biological • Psychological • Familial • Socio-cultural Eg. The diathesis model Genetic Predisposition + Environmental Trigger = Disorder

8. AN: Biological explanations (1) Genetic origin: Familial studies have shown that first-degree relatives of AN have an increased risk (MZ: 56% concordance) of developing an eating disorder (Holland et al. 1988) … At age 11 there were no genetic influences on disordered eating. However, by age 17 the heritability of disordered eating was more than 50 percent. The recent findings implicate puberty in the dramatic increase in genetic effects across time. (Meta-analysis from the ‘Minnesota Twin Study’ Klump 2007) So AO3 evaluate MZ Twin Studies and what does it suggest (eating behaviour is partially [50%] inherited/biologically determined).

9. (2) “Set Weight or Point” Theory:The set-point theory argues that an individual's metabolism (metabolic hormones and fat cell enzymes.) will adjust homeostatically to maintain a weight at which the body is comfortable… AO2 So our weight/appearance is biologically controlled ∴ inherited/biologically determined

10. (3) Hypothalamic dysfunction: • An “on” and “off” command for eating • The lateral zone function as “hunger centre” • The ventromedial zone operates as “satiety centre” AO2 So our eating (hunger> full-up) is biologically controlled ∴ inherited/biologically determined

11. Biological explanations cont... • (4) Imbalance of serotonin neurotransmitters • Increased Serotonergic activity: Acts to suppress appetite There is considerable evidence that increased serotonin activity in the brain is associated with appetite suppression. In fact, drugs which act on serotonin pathways in the brain are commonly used for the short-term management of obesity (AO2) Therefore, inherited naturally high Serotonergic sensitivity would suppress eating and be a potential causal factor in the development and maintenance of AN Link: Increase in serotonin makes you happy and suppresses hunger Biological explanations of AN

12. Biological explanations summary... (AO2) If anorexia can be shown to be genetic, then it must be inherited and we have little choice (Genetic Determinism). This then raises the question, what physical abnormality is passed on? • Hypothalamic abnormality? • Serotonergic abnormality? But don’t forget to be critical of twin studies: Studies are MZ and not MZa (reared apart), therefore they would share identical family environments (eg. shared learning from an anorectic mother?) This coupled with small sample size brings the strength of evidence for genetic predisposition into question. There must be other explanations (eg. psychological or ‘triggers’)

13. Some AO3 points to consider… • In all research, the researcher is trying to ‘operationalise’ (IV’s) a factor and claim it is the cause (DV)… is this ok? • Most research was performed in the Industrialised West…. Is this ok? • Are twin studies reliable? • Are biological explanations the only ones available (isolationism)? • Does the question of reductionism/determinism arise?

14. Psychological explanations of anorexia nervosa Research into cause

15. Psychological explanations of AN Psychological explanations of AN Behaviourist Explanations (AN as a ‘Learned’ behaviour) Classical conditioning (Learning by association) • Eating can be associated with anxiety since it can make people overweight • Losing weight ensures that the individual reduces these feelings of anxiety ∴ Feel fat/ugly so diet and associate happiness with weight loss and unhappiness with weight gain

16. Operant conditioning (Learning as a consequence of action) • The individual avoids food to gain a reward such as feeling positive about themselves • In early stages – individuals can be admired or congratulated for losing weight and looking slim and healthy (positive regard) • Gain reward or satisfaction as a consequence of their actions (control of their food intake) ∴ they associate their ACTION with happiness and failure (eating something) with unhappiness

17. SLT: People imitate people they admire (Media/Peers etc)– vicarious reinforcement (later reward for gaining the look) They adjust behaviour to achieve the looks of others and gain the rewards

18. Consider some simple questions ….. Q) Why do you like to look good when you go out? Q) How do you know if you look good? Q) What influences you when you go clothes shopping? Q) Why are females more anxious about visiting a hair dresser than a dentist? “Jeggins”

19. Psychological explanations of AN (AO2) 19 Psychological explanations of AN • Behaviourist Explanations – studies... • A review of 25 studies showed that a slender beauty ideal causes body dissatisfaction and contributes to E.D. (Groesz et al, 2001) • The effect was most marked in girls under 19 • The slim ideal becomes equated with success and health whereas average weight or overweight becomes synonymous with failure, and this slowly becomes the dominant belief in society (Harrison, 2001)

20. Psychological explanations of AN 20 Behaviourist Explanations – studies... Women feel undue pressure on their appearance and reported that 27% of girls felt that media pressure them to strive to have a perfect body (Forehand, 2001) Increase in eating disorders in Fiji with the introduction of American television programmes, which emphasise a westernised idealised body shape (Fearn, 1999)

21. Psychodynamic explanations (Freud) • Stages of Psychosexual development • Eating as manifest representation of sex (ego-defence) 21 • Adolescents don’t want to grow up and separate from their parents • They become fixated at the oral stage*1; when they were completely dependent on their parents • Anorectics lose weight, lose secondary sexual characteristics, become childlike again (asexual) and return to the safety of being a ‘little girl’ again (AO2: Gender Bias) • In Freudian terms, eating and sex are symbolically related*2 • A refusal to eat (the only control, they feel they have) represents a refusal of sexuality

22. Cognitive: Williamson et al (1993): Distorted Body Image • Two groups of participants • High risk AN (diagnosed) • Low risk AN (healthy + No near relatives with AN) • Task: Put ‘stretched’ photographs of ‘self’ back to correct size:

23. Findings….. • High Risk Group: significantly over-estimated real size • Low Risk Group: significantly under-estimated real size (flattered) Conclusion: Anorectics cognitively misrepresent their own body image (Body Dismorphic false belief system: BDD). Therefore no matter how much weight they lose, they still feel ‘fat’. Anorectics can never reach their goal!

24. ED as an addiction: Smoking… Drinking… Dieting… ‘Reversal Autonomy*’ (*See article: McCarthy, 2009) So the dieting behaviour is learned, reinforced and gains AUTONOMY and then the dieting controls the person.

25. Some AO2/3 points to consider…. • The Behaviourist Approach suggests that AN is a ‘learned’, reinforced product of ‘involuntary associations’ (classical) or as a ‘consequence of actions’ (operant)… be critical (+/-) of this approach. • SLT suggests we learn ‘vicariously’ and model our behaviour on the consequences of observation… be critical (+/-) of this approach. • Psychodynamics (based on Freudian principles) suggests a dysfunction during the ‘oral stage’ of psychosexual development… be critical (+/-) of this approach. In all cases consider : the approach, research methods (inc culture), isolationism and the ‘reductionism/determinism debate. NB: The cognitive example supports one factor. Addiction is an alternative way of looking at ED’s and 1 & 2 above are nowadays combined as ‘Social Cognitive Theory’.

26. Assignment... 26 Psychological explanations of AN Outline symptoms of AN, then describe/evaluate two psychological and two biological explanations. ( 25 marks) Instructions: The essay style answer should have an Introduction (introduce/define). Then AO1 (9 marks) and AO2/3 (16 marks) as sub-headed sections followed by a short conclusion (summary). You WILL need to focus on AO2/3 (check ‘commentary’ and chapter summary pp 94-95 textbook: Cardwell & Flanagan). Ideally word processed (1 to 1.5 A4 or 500/600 words).