Eating disorders are something that I have always heard about, but have never had any personal encounters with. They are a topic that has been widely discussed in psychology and health courses that I have had the opportunity to take throughout both high school, and college. It is for this reason that I have chosen anorexia nervosa as the topic for this diagnostic paper. In this paper we will discuss the diagnosis, risk factors, cultural considerations, and my thoughts on the diagnosis of anorexia nervosa.
Anorexia nervosa is the lack of nutritional intake, fear of weight gain, and lack of positive self perception (American Psychiatric Association, 2013). There are three criteria for anorexia nervosa, the first one being described as the lack of nutritional intake that causes a low body weight that does not meet the expectation of ones age and gender signaling bad physical health (American Psychiatric Association, 2013). There are a number of ways for low body weight to be recognized, one of those ways being a low body mass index (American Psychiatric Association, 2013).The fear of weight gain is described as the fear of gaining both weight and/or fat, regardless of the low weight that is bring presented (American Psychiatric Association, 2013). Regardless of an individual progressively losing weight, or being consistently underweight, they still harvest the fear of being fat or gaining weight (American Psychiatric Association, 2013). The final criteria is the disturbance of the self-perception of body shape and weight, and/or lack of ability to recognize the low body weight and its negative effects (American Psychiatric Association, 2013). Individuals expressing this criteria might still feel as though they are overweight, or may feel that certain areas of their body aren’t meeting the standard (American Psychiatric Association, 2013). These individuals may obsess over their size and weight, and likely fail to realize the health implications that come along with the their poor physical health (American Psychiatric Association, 2013).
According to the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, anorexia nervosa may occur with a subtype, but states that only present symptoms should be used in the description of the disorder (2013).The subtypes of anorexia nervosa are restriction, and binge-eating/ purging. The restriction subtype is when the individual has not partaken in binge eating nor purging; but induces weight loss by dieting, fasting, and excessive exercise (American Psychiatric Association, 2013). Binge-eating/ purging subtype is when the individuals have irregular eating patterns caused by binge-eating and/ or purging (American Psychiatric Association, 2013). Binge eating is the excessive intake of food, which is generally followed by purging which is the ridding of the food that has been binge eaten in a forced manner. With anorexia nervosa binge-eating and purging are not always seen together, sometimes purging occurs alone and is followed by any intake of food (American Psychiatric Association, 2013). Along with that the BSM-5 states that both subtypes may occur interchangeably (American Psychiatric Association, 2013).
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Anorexia nervosa is more prevalent among females as opposed to their counterpart with an occurrence ratio of 1 male to 10 females (American Psychiatric Association, 2013). According to one study done only 46% of people who have been diagnosed with anorexia nervosa fully recover, and 20% remain chronically ill (Arcelus, Mitchell, &Wales, 2011). The morality rates among those diagnosed with anorexia nervosa is about 5.1 deaths per 1000 individuals diagnosed (Arcelus, Mitchell, &Wales, 2011). This same study also concluded that 1 in 5 deaths that occur in people with anorexia nervosa were caused by suicide (Arcelus, Mitchell, &Wales, 2011). Anorexia nervosa has the highest death rates among the eating disorders, and mostly seen in post-industrialized countries without too much outlook on unindustrialized countries(American Psychiatric Association, 2013). Although the prevalence of anorexia nervosa is seen at lower rates among Latinos, African Americans, and Asians in the United States the DSM-5 states that professionals need to be aware of the examination biases seen among these populations(2013). Anorexia nervosa generally occurs in adolescence in to young adulthood though it may occur at other times in a person life, and usually presents itself after a traumatizing period (American Psychiatric Association, 2013). The DSM-5 also states that those diagnosed with anorexia nervosa sometimes recover after a single episode, but other generally relapse after 5 years (2013).
There are many risks that come along with anorexia nervosa both physical and health related. Individuals may begin to get a low bone mineral density which unfortunately is irreversible (American Psychiatric Association, 2013). Females may experience amenorrhea or the absence of an menstrual cycle, constipation, abdominal pain, lethargy, cold intolerance, and excess energy (American Psychiatric Association, 2013). A more obvious symptom of anorexia nervosa is emaciation or to be excessively thin (American Psychiatric Association, 2013). Some of the other most common physical signs of anorexia nervosa are low blood pressure, low heart rate, and hypothermia (American Psychiatric Association, 2013). Those who purge through vomiting may experience hypertrophy of their saliva glands and enamel erosion which is a symptom that I have discussed with both anorexia and bulimia (American Psychiatric Association, 2013). The list of physical signs and symptoms that come along with anorexia nervosa is extensive but these seem to be the most relevant of those mentioned in the DSM-5 (2013).
Anorexia nervosa may also occur during or after another disorder diagnosis, or even be falsely diagnosed if it is not closely evaluated. Weight loss can sometimes occur from medical conditions becoming something that the individual begins to expect, so sometimes these conditions lead to anorexia nervosa (American Psychiatric Association, 2013). Anorexia nervosa can also occur with other disorders some of which we have had the opportunity to study in this class. It may accompany both schizophrenia and substance abuse, but both of these things would need a careful diagnosis as weight loss could only be occurring due to odd eating habits (American Psychiatric Association, 2013). Three disorders it is commonly seen with are bipolar disorder, depression, and anxiety all of which are generally recognized prior to a diagnosis of anorexia nervosa (American Psychiatric Association, 2013). Individuals with anorexia nervosa may also experience obsessive compulsive features that are associated with the lack of nutrition, such as hoarding their food, though an actual OCD diagnosis shouldn’t be made unless obsessions occur with things other than food (American Psychiatric Association, 2013). I have watched a show that followed someone with anorexia nervosa, and this is a behavior that the female had expressed as she used to shove food under her bed and leave it there.
There are always going to be multicultural considerations to make as counselors when diagnosing any disorders. Earlier in the semester we went over Chapter 11 in our textbook which discusses just that. I think for anorexia nervosa there are a few things that may need to be considered. The DSM-5 had talked about anorexia nervosa being less prominent in the Latino, African America, and Asian populations but it’s believed that it may be due to past biases (American Psychiatric Association, 2013). I think that for counselor who is working with a patient expressing the criteria of anorexia nervosa the background of where the client is coming from is super important, by this I mean they need to look at the culture of which the client was raised under. This is super important because there may be some type of beauty standard that the client may have been expected to meet while growing up. For instance the DSM-5 references Asia as having a ‘fat phobia” due to health issues that may occur in their culture (American Psychiatric Association, 2013). This would be good incentive for someone in the Asian culture to be more wary of their weight which could eventually lead to them expressing criteria B of anorexia nervosa, but it not actually enough incentive in and of itself to diagnose anorexia nervosa (American Psychiatric Association, 2013). Another culture that is mentioned in the DSM-5 is that of the Latina culture where a fear of weight gain is expressed more often which is something that I have experienced myself being raised in a Mexican/Hispanic household (2013). My aunts always make it a point to let you know that you’re gaining weight which may cause someone in the culture to want to maintain a lower body weight.
My friends mother used to have anorexia nervosa but luckily hasn’t relapsed since her initial diagnosis at a young age. Her mother used to tell her and her siblings that they have to stay smaller than the size of a tiny belt that her mother used compare their hips and waist too. All of the children were very small because if they didn’t meet this standard they would get in trouble, and their mother would watch their diets more closely and make them workout. I think this is a great example of looking in to the cultural background of a patient because it really gives you an understanding of where the client truly came from, and what has formed their psyche. In this particular case of my friends mother she would encase all of the criteria, along with they subtype of restriction when herself or her mother felt that her weight was above the belt. Currently, my friends mother would be considered full remission as she hasn’t expressed those criteria in many years. This example really was great for me to think about because it allowed me to apply what I have learned from the DSM-5 to her mother which really helped further my understanding of the diagnosis. She expressed unawareness of her disorder through the initial stages as it was conditioned to her that she must be a certain size which may have caused an onset of issues such as anxiety (Erford, 2018).
This was quite an interesting paper to write as it made me go through the DSM-5 for a specified disorder. This paper has really helped me gain a better understanding of the development of psychotherapy, and the huge role that it plays in an individuals life. The development of anorexia nervosa is something that generally seems to occur after an event in an individuals life which they may find traumatizing causing a change in their eating and health behaviors. In the case of my friends mom it’s something that seemed to have arisen through conditioning done by her family, and their personal cultural influences. Anorexia nervosa seems like it can be a little tricky to diagnose especially when symptoms from other disorders may seem to meet one or more of the criteria for anorexia nervosa. Overall this was very informative, and I thoroughly enjoyed learning more about the infamous disorder that I always seem to hear about.
