Therapy is focused on normalizing eating behavior and identifying environmental triggers and irrational thoughts or feeling states that precipitate bingeing or purging. Patients are taught to challenge irrational beliefs about weight and self-esteem. Several medications have also been shown to be effective in decreasing bingeing and purging behaviors in bulimia. Eating disorders are behavioral problems and the most successful modalities of treatment all focus on normalizing eating and weight control behaviors whilst managing uncomfortable thoughts and feelings.
Increasingly, we understand eating disorders as not just psychological problems but as disorders of learning and habit. Changing established habits can feel challenging, however practice of healthy eating behavior under expert therapeutic guidance helps develop skills needed to manage anxieties regarding food, weight and shape -- all of which fade over time with the gradual achievement of mastery over recovery.
If you think you have an eating disorder, if your symptoms have persisted or worsened despite attempts at outpatient treatment, or if you feel constantly preoccupied by thoughts of food and weight, then a good place to start is with a comprehensive evaluation in our Consultation Clinic.
To safely provide the best possible care during the COVID pandemic, we have expanded our outpatient telemedicine services to include remote clinical consultation and outpatient visits with our eating disorders doctors by videolink across multiple states. Video visits allow patients to connect face-to-face in real time without leaving their home by using their smartphone, tablet or computer. You will be seen by a psychiatrist who will perform a thorough review of your history and symptoms, medical tests and past treatment.
We recommend you forward any past treatment records ahead of your appointment for the doctor to review. Whenever possible we ask that you attend the consultation with a close family member or significant other, since we believe family support and involvement is very important when you are struggling with an eating disorder. The doctor will also be interested in any medical or psychiatric problems you may have besides the eating disorder.
Common co-occuring psychiatric conditions include depression, anxiety, substance abuse and obsessive-compulsive disorder. Begin typing your search term above and press enter to search. Press ESC to cancel. Skip to content Home Arts What is the difference between anorexia nervosa and bulimia quizlet?
Ben Davis March 8, What is the difference between anorexia nervosa and bulimia quizlet? Which of the following individuals is most likely to develop bulimia nervosa? That being said, it is not uncommon for those with anorexia nervosa to also take appetite suppressants or other harmful supplements to manage hunger.
This comes with additional potential complications, as these supplements are generally not approved by the U. Food and Drug Administration FDA and can be particularly dangerous when combined with the other physical effects of starvation.
Over time, feelings of hunger often dissipate entirely. Many people struggling with anorexia nervosa no longer feel hunger or fullness since they are so disconnected from their bodies and their physical needs. People struggling with eating disorders typically engage in disordered eating to cope with unwanted thoughts or feelings. The psychological effects of self-starvation magnify these unwanted thoughts or feelings, leading to a vicious cycle of maladaptive coping. Ignoring the physical side effects of restriction on the body can become second nature to someone struggling with anorexia nervosa.
The general lack of self-reporting symptoms or seeking help for disordered eating highlights the strong need for competence in eating disorder treatment within the greater medical community [2]. Often, outpatient medical practitioners do not receive extensive training in the field of eating disorders, leading to lack of awareness and misdiagnosis. By raising awareness for eating disorders and busting prevalent myths, the medical community, school systems, and loved ones can intervene early when they see an individual is struggling with disordered eating.
In recovery, individuals who have struggled with anorexia nervosa often have trouble getting back in touch with their natural hunger and fullness since they have been ignoring these functions for so long.
This is why meal plans are typically an integral part of the weight restoration process. Eventually, many people in recovery are able to listen to their bodies and practice intuitive eating. In Richard Morton provided one of the first known descriptions of anorexia. These names have remained unchanged, as has the idea that the condition is a mental illness, and no somatic cause has been found for the condition although genetic factors have been identified as correlated to higher susceptibility to anorexia—Wang et al.
Dealing with anorexic patients is notoriously difficult. Anorexics are usually secretive about their dieting and are very resistant to the idea of changing and getting help: they do not want to gain weight; they skip meals and say that they have eaten already, they claim that they are full, they might wear loose clothing to hide their emaciation and implement several strategies to keep on dieting.
If they refuse help and food, they are said to be incapable of deciding, and, on this basis, they have usually been subjected to involuntary treatment notwithstanding their capacity to understand the material facts Clough Anorexia is a puzzling condition: it is scarcely understood and difficult to treat Zipfel et al.
At least since the mid s, clinicians, psychologists and sociologists have formulated various hypotheses about the possible causes of anorexia. Some consider the extreme behaviours that we see in anorexia as, quite simply, the result of a mental illness.
From these other perspectives, anorexia is not just an intra-psychic condition, a mental health problem of the sufferer, but a relational issue, a coping mechanism in highly problematic families, or a defence mechanism in stressful social contexts: whereas the sufferer might have personal and individual vulnerabilities, the causes of her conditions are to be sought in the relationships between the sufferer and the environment family and society.
However, even those are somehow incomplete. This is not to be intended as a negative criticism: it is a feature of the most promising hypotheses that they raise further interesting questions.
In the next section I summarise the main findings of these studies, and then discuss the outstanding questions that they leave unanswered. Since the earliest studies, it has been recognised that family dynamics are determinant in the genesis of anorexia. Anorexia is considered, under this perspective, as a coping mechanism Selvini Palazzoli ; MacSween , ch. One of the first systematic studies of the eating-disordered family was provided by Salvador Minuchin. This family is typically characterised by rigidity, enmeshment, overinvolvement, and conflict avoidance.
Although not being the sole causes for the disorder, such dynamics are, he believed, an essential element in the development of eating disorders Minuchin ; Eisler et al. Hilde Bruch, one of the pioneers of eating disorders studies and therapy, similarly argued that anorexia is a cluster of symptoms that emerge in response to dysfunctional family dynamics Bruch , pp.
Today it is believed that eating disorders are likely to be caused by both biological and psychosocial factors multifactorial Treasure et al. Families with an anorexic member are normally described as highly problematic, manipulative and incapable of deep and stable affective bonds Lackstrom and Woodside , pp. In some instances our colleagues see the individual with the eating disorder as a victim of her disturbed family or at the opposite extreme as a scheming manipulator who is purposefully destroying her long suffering family in her search for attention Beaumont and Vandereycken , pp.
In a landmark study of anorexia nervosa, Mara Selvini Palazzoli, while discussing the family of the anorexic, wrote:. To the superficial observer, this may look like quite an ideal family. Generally, parents are completely dedicated to their work or to the house, they have a high sense of duty and of social and conventional norms Even in cases in which the father, thanks to his intolerant and dictatorial behaviour, seems to be the dominant figure , the mother wins The daughter easily becomes the victim of the mother A few years later, Hilde Bruch in her seminal work Eating Disorders: obesity, anorexia nervosa, and the person within Bruch , reported a number of cases that appeared remarkably similar to those described by Selvini Palazzoli.
Up until the s, eating disorders were nearly exclusively found in Western countries Gordon or westernized societies such as South Africa and Santiago Chile Beaumont and Vandereyken or countries that are becoming economically emancipated, such as China Beaumont and Vandereyken ; Selvini Palazzoli et al.
Although the prevalence in low-income countries seems to be on the rise, eating disorders still seem to be more prevalent in high-income Western countries Erskine et al. There seems to be growing evidence that eating disorders affect people across the socio-economic spectrum Mulders-Jones et al. One of the factors that explain the upsurge of anorexia in economically emancipated societies, according to a number of researchers, is the change in the social role of women.
Basically, nowadays the woman is asked to be beautiful, elegant and well-kept, and to spend time on her looks; this however, should not prevent her from competing intellectually with men and other women, having a career, and also romantically falling in love with a man, being tender and sweet to him, marrying him and representing the ideal type of lover-wife and oblational mother, ready to give up her degrees…to deal with nappies and domestic stuff.
It seems evident that the conflict among the many demands…represents a difficult challenge for adolescents, especially the most sensitive… Selvini Palazzoli , p. Susie Orbach also noted that in economically emancipated societies women are typically subjected to contradictory expectations: on the one hand autonomy and independence and, on the other, femininity, nurturance, deference and dependency Orbach These roles are incompatible and the crisis generated by this conflict is faced by refusing food, which is, under this perspective, a defence mechanism that enables the sufferer to remaining in a limbo between childhood and adulthood.
What happens within families thus often naturally mirrors social changes and values, which families, consciously or not, internalise and by which they begin to shape family dynamics. MacSween similarly argued that the crisis of the anorexic is not due to her own disorders: it is rather the social world that is lacerated by conflicting expectations about the behaviour of adult women MacSween , chs. According to Crisp, faced with impossible demands, the anorexic refuses food, unconsciously refusing in this way to become a woman.
She opts for a small body, where smallness is symbolic of a rejection of adulthood, with the conflicting demands it carries with itself Crisp Food refusal allows the person to exercise some control over her life and over others Lawrence , p.
MacSween conducted a number of interviews with anorexic patients. She asked them why they believed they had become anorexic, and the most common answer was that they felt powerless in their environment and they needed to exercise control over at least one portion of their life; the girls were not only blaming parents; they said they were sensitive to the expectations of peers and even of their own expectations of themselves MacSween Psychological control is still today considered as one of the main causal factors of anorexia Surgenor et al.
These accounts are illuminating but, as I anticipated earlier, they leave some questions unanswered. One of these is why we suffer, if others or society at large have unrealistic expectations of us. Answering this question requires an analysis of the moral values that underpin the relationships in these cases. In the analyses of anorexia summarised earlier, anorexia is presented as a defence mechanism against the high and contradictory demands that come either from within the family, or from society at large.
The vulnerable adolescent, overwhelmed by these demands, unable to fulfil them, opts for a small body, a body that she can control and master. One underlying assumption here is it is natural or understandable to be upset, when others set inappropriate expectations of us, and depending on what the expectations are, and who sets them, the suffering can be psychologically devastating. But not all expectations cause suffering and upset. If I expect that, once you have read this paper, you should change your mind about anorexia, my wish might well remain unfulfilled.
You have no reason to feel inadequate or bad because you are letting me down. I have no moral claim to your appreciation, and you would not let me down by disagreeing with me. The root of the suffering in these dynamics is thus not the set of expectations per se, but a moral norm: the sufferer has accepted the expectation as a legitimate one, and has accepted that disappointing those who have legitimate claims is something we should feel bad about. This might be obvious: most of us would agree that there are legitimate moral claims within close relationships, and most of us would take it as a sign of moral decency that people feel bad when they let down some significant other.
The victim feels bad or inadequate or even guilty because she lets others down; but those who set expectations let the victim down too. Many shift from one account to the other. The clinicians capture the dynamic in place in the families observed, but are somewhat absorbed in that dynamic: rather than unpacking it, they participate in it, as evidenced by their own expressions of frustration, irritation, powerlessness, accusations….
Of course relational rupture within families is unlikely to result just from a mismatch between expectations; much can lead to feelings of disappointment and inadequacy. The root of the problem is not the expectations, but the moral beliefs that are intertwined with them, the moral logic that underpins the relationships. It might be that we do have a moral obligation to meet certain expectations, particularly within close relationships; it is possible that certain moral codes have positive function in the fabric of family life or in the fabric of society.
Indeed, it might be hard to challenge the moral dynamics here because the moral values at stake are perhaps commonly accepted and might serve some important function.
In this sense, the continuity between ordinary moral values and those that are in place here makes it difficult to unpick and challenge these. However, without explicit acknowledgement of the moral dynamics at stake here, it is difficult to move beyond the frustrating tensions that are well described in the literature.
The literature suggests that anorexia enables the sufferer to retain control over the self, through control of food intake and of her body shape, and at the same time to retain control over others Surgenor et al.
But why does self-starvation enable such control? Again, this question cannot be answered without explicit acknowledgement of a certain moral background. There is a doctrine about the nature and place of minds which is so prevalent among theorists and even among laymen that it deserves to be described as the official theory.
With the doubtful exceptions of idiots and infants in arms every human being has both a body and a mind […] Human bodies are in space and are subject to the mechanical laws which govern all other bodies in space […] But […] the workings of one mind are not witnessable by other observers; its career is private […] Underlying this partly metaphorical representation of the bifurcation of a person's two lives there is a seemingly more profound and philosophical assumption.
It is assumed that there are two different kinds of existence or status. What exists or happens may have the status of physical existence, or it may have the status of mental existence Ryle , pp. It must be noted that various philosophers and philosophical schools for example non-Cartesian monism, structuralism and post-structuralism objected against this type of metaphysical dualism for example, Searle ; Ayer ; Inwagen , pp.
Despite this, the dualistic conception of the human being has been fundamental for Western thought and culture, and the association between body and baseness recurs in all eras: in the Greek thought, in Christianity, in the patristic doctrines, in Scholastic philosophy, in the different confessions of Christianity Catholicism, Protestantism, Puritanism, Calvinism ; in Humanism and Renaissance, with their flourishing of Neoplatonic and neo-Aristotelean theories, in modern philosophy and in contemporary society as well.
Christianity in particular hallowed the idea that moral perfection has to be found in the detachment from the world and ascension to God, and fasting, together with other forms of self-inflicted suffering sleeplessness, isolation and various other forms of mortification became one of the most effective ascetic techniques since at least early Christianity 3rd and 4th Century AD Murchu Max Weber discussed how this metaphysics and the corresponding ethic are not only religious but also secular, and discussed how pervasive they are in contemporary society Weber More recently Krogovoy has shown that they are still ubiquitous, and has argued that they are likely to impact on the way people perceive their physical impulses, including hunger Krugovoy Silver , p.
Fasting has been associated and is still associated with ideas of control and purity. Not only a historical search for the value of religious fasting, but a simple google search will show hundreds of health farms that advertise fasting in similar terms.
This is not to suggest that anorexics fast for religious reasons for an analysis of the phenomenological similarities and differences between anorexic starvation and other forms of starvation see Vandereycken and Van Deth , chs.
This is instead to suggest that control of hunger can become a coping mechanism because of a certain metaphysical and moral background, which is likely to be implicitly accepted in the systems in which the disorder appears.
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