Lisa looks at herself in the mirror. She turns around and takes a good look at herself. She is thinking: “ How can everyone else be so skinny while I am so fat? “. In fact Lisa is a high school student. Lately her situation has been worsening. Not only does she feel guilty when she eats, but she also purges it up when she is finished. This can be the beginning of an eating disorder called Bulimia nervosa. Eating disorders are amongst the most common psychiatric syndromes, and leads to most treatment seeking, inpatient hospitalisation, suicide attempts and mortality (Stice 2002). This essay will point out the most significant risk factors for Bulimia nervosa and Anorexia nervosa and the most common methods for treatment and prevention of these factors.
The diagnoses for the diseases Anorexia nervosa (AN) and Bulimia nervosa (BN) are different. However, they are very similar and share many common risk factors with a few variations. Furthermore, the patients are moving frequently between the disorders (Fariburn and Harrison 2003). As a result of this, and for the simplicity and the required length for this essay. I will address them both as only eating disorders and allocate the risk factors to both AN and BN. In addition, this essay will be organised by presenting the most common risk factors followed by how they can be prevented and treated.
Fariburn and Harrison (2003) along with most researchers advocate that being a female is the most important risk factor concerning eating disorder. Among those who have eating disorder are 90% females. The next significant factor is the age adolescence and early adulthood (Fariburn and Harrison 2003). These are both very significant factors and have also led to the fact that the majority of the research reports only target the female population in adolescence. For example, Piran in his longitude research study targets ballet schools in which over 90% of the students are young females (Piran 1999). There also exist several other research reports that target female’s only, in high schools or similar institutions. This is essential to keep in mind when I will present the other risk factors that are extracted from research studies targeting females in adolescence or areas where this demographic group is in majority.
The media play an important part in creating an image of the “perfect slim body”. Adolescences are very sensitive to their own body image and easily perceive the body image media create. They can easily associate this image as a significant factor for success in dating and other general achievements in life. Furthermore, the adolescences are likely to feel unsatisfactory with their own body and therefore seek methods to live up to their ideals presented by the media. Tomori and Rus-Makovec (2000) did an interesting research including 4700 high school students. The objective of the study was to measure the level of self-esteem in high school students. The study has a more or less equal balance with 53.3% girls and 46.7% boys. The results shows surprisingly that 62.1% of the girls would like to weigh less and only 18.3% among the boys. Furthermore the research concluded that there is a correlation between low self-esteem and development of eating disorders. However, the report did not indicate any particular reasons for low self-esteem. Stice (2002) on the other hand have evaluated several studies. Stice advocate that the media is an indirect risk factor for eating disorders. The pressure to be thin increases body dissatisfaction, dieting and negative affect that all are important risk factors ( Catarin & Thompson, 1994; Field et al., 1998; Stice& Whitenton, in press; Wertheim, Koerner, & Paxton, 2001 as cited in Stice 2000).
Another risk factor that is clearly pointed out is family relationship. It shares some common feature with media but now the family takes the role as an indirect part that provokes risk factors like body dissatisfaction and lower the self-esteem. The provokers can be parents or siblings (Byely et al. 2000; Gowers & Shore 2001 cited by (Fariburn and Harrison 2003). Tensed family conditions are also shown to be a direct risk factor for development of disordered eating behaviour (Byely et al., 2000; Swarr & Richards 1996 as cited by Fariburn and Harrison 2003). A difficult childhood and strained family relationship seem to be a popular theme and these reports is highly presented in psychINFO. But few reports have revolutionary results. The most effective prevention programs are to maintain a positive family relationship. On the other hand, this scenario can easily be reversed to hypothsized what results a negative family relationship would cause. Therefore, I find this risk factor of great importance.
There exist no published study that can show a preventive result in a high risk setting for the development of eating disorders (Piran 1999). A few psychoeducational programs have been tried in high schools without success. The programs had similar settings were different methods have been tried in order to teach the students in how to deal with pressure of thinness, self-esteem enhancement and healthy diet (Littleton and Ollendick 2003). Piran (1999) launched a similar program in a ballet school. Firstly, the school staffs were instructed to not make evaluative comments to the students regarding body weight or shape. Secondly, they had also assigned staff to act as a support for students with body dissatisfaction. Finally, students had small group meetings regularly discussing issues around eating disorders. The study shows positive results with a decrease in eating disorders and healthier eating habits among the students. Contradictorily, Piran (1999) himself advocate that the study needs to be replicated in a more controlled environment before a final conclusion can be made. After searching through articles on psyINFO the factor that has the most empirical support is a positive family relationship. If parents are giving social support and staying closer to the children it greatly reduces the risk for the adolescents to adopt body dissatisfaction and eating disorder. (Byely et al., 2000;Swarr & Richards, 1996, McVey et al. 2002 as cited in Littleton and Ollendick 2003) I discovered that a positive family relationship is the most effective preventive method grounded on the research reports I found.
Treatment of eating disorder has received very little attention considering eating disorders are amongst the most common psychiatric syndromes. As mentioned in the first paragraph the adolescents are the age group that are most likely to develop an eating disorder. Luckily it is also the age that offers the greatest opportunity for effective treatment and recovery. It is important to discover the disease early because a treatment in the adolescence is significantly strengthening the outcome of the treatment (Benedetto and Lederhendler 2000). Generally all the treatment programs that concerns eating disorders can be divided in to three main phases: 1) restoring the severe weight loss; (intravenous very commonly used) 2) treating cognitive distortions (regain self-esteem and body image, resolve family conflicts) 3) long term rehabilitation (full recovery) (Benedetto and Lederhendler 2000). The treatments that seem to be the most promising approaches for adolescents are family systems (Benedetto and Lederhendler 2000). For the older population cognitive behaviour therapy is the most effective. No drug has shown to have any effect on eating disorder (Fariburn and Harrison 2003).
Mostly people with eating disorders can be placed in a clear demographic group: Female adolescences. However, most of the research done in this field is done the last 15 years. Therefore, I find it hard to find any strong conclusions or thread that distinguish apparent risk factors, preventions and treatments. The main overall risk factors are the inputs a person receives from outside environment. This input can comes from media, family or social groups. These inputs can to a great extent be the origins of what destroy a person’s own self-image and self-esteem and thereby result in disordered eating. The reason arrives from the way the people perceive themselves related to the rest of the public. They might not be satisfied and therefore tries to adopt the ideals presented. Preventing eating disorder can be conducted by affecting these input sources (i.e. teachers, family) or the receivers (especially adolescences).
Psychoeducation programs were found to have some positive results even though there were no significant empirical supports. Contradictorily, positive family relationship was proven to be the most effective prevention. The most common treatments that are shown to be most effective are a family system for adolescents and cognitive behaviour therapy for the older.
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