Neurology of Eating Disorder
They find “sizeable reductions” in three important brain measurements, including cortical thickness, subcortical volumes, and cortical surface area, in individuals with eating disorders (Gorrell et al., 2019). The loss of brain cells or the connections between them is assumed to be implied by reductions in brain size, which is why they are significant. This indicates that compared to those with illnesses like depression, ADHD, or OCD, those with anorexia showed reductions in brain size and shape that were two to four times bigger (Gorrell et al., 2019). Reduced body mass indexes throughout the population could be the cause of the reported changes in brain volume for eating disorders (BMI). By regulating one’s internal reward response and changing the food intake control circuitry, behavioral features, particularly food intake behavior, support the maintenance and progression of eating disorders.
Facts about Eating Disorder that are Surprising
Unexpectedly, I discovered that eating disordersâ€”typical of anorexia in particularâ€”are extremely prevalent. According to research, atypical anorexia nervosa and anorexia nervosa share the same psychological and physiological traits. The person’s initial weight is the only distinction (Frank et al., 2019). I also discovered that picky eating could be classified as an eating disorder in its most extreme form (US Preventive Services Task Force, 2022). This syndrome, also known as avoidant restricted food intake disorder (AFRID), has just recently been classified by the DSM as a legitimate eating disorder. Naturally, selective eating in kids is usual, but with ARFID, the rigidity is strong and gets in the way of social interaction or regular, healthy growth and development.
Classifying Eating Disorder
As clinicians we must remain objective when classifying eating disorder. It is important to remain vigilant in the data collection and history taking. Taking into consideration the clientâ€™s culture and family background is part of the theoretical assessment t identify potential contributing factors for the development of eating disorder. We cannot deduce the diagnosis of eating disorder to a lifestyle change or a matter of willpower (Frank et al., 2019). As clinicians, we mut look into the various aspect of the theoretical orientation of the client as well as the clientâ€™s background and manifestations. We cannot conclude that client with an eating disorder is restricting his or her weight because of lifestyle, we must look deeper into the problem so we can properly address it.
Cultural Implications of Classifying an Eating Disorder
Negative family dynamics have historically been linked to the onset and maintenance of eating disorders, with the focus initially being on anorexia nervosa. The systemic approach, to put it more specifically, holds that the emergence and persistence of issues in children are directly tied to specific types of family organizations. In particular, in examining the subject of family dysfunctions that can cause the emergence of an eating disorder. According to a study, parents and children relationships are frequently tight but strained in young people who acquire eating problems.
Even if this is typical during the teen years, someone who is more susceptible to having an eating disorder will go overboard with worries about issues with the parents’ relationship. The youngster can be trying to manage an unspoken conflict or lack of harmony within the family, or he or she might be fearful of disappointing his or her parents. In a poll of teenagers in South Africa, many of those who had performed well on the Eat Attitudes Test (EAT) stated that their obsession with food was not caused by an eating disorder but rather was a result of hunger, poverty, and a lack of access to food (US Preventive Services Task Force, 2022).
All of this is very significant because it demonstrates the various ways in which a person’s cultural experiences and upbringing may influence their attitudes about their body, their food, and themselves. Given that AN is a widespread occurrence in Japan without fat-phobia, treating a Japanese person with AN by normalizing obesity may not be appropriate. There are a plethora of questions that can be raised regarding a person’s cultural background, how it affects their relationship with their bodies, and how food and culture both play significant roles in shaping this image (Gorrell et al., 2019).
Supporting the Family
Families tend to be in denial about the reality of eating disorder. Most family members do not have factual and helpful information and resources that can provide them with the right mindset about eating disorder and the reality of this diagnosis. AS clinicians, it is important to dispel myths and misconceptions that a family may have about eating disorder and provide them with credible and factual data about the diagnosis (Hoeken et al., 2020). Also, presenting simple case studies involving real life scenarios about eating disorders is important to present a mental picture of the reality of the diagnosis. We must not be prejudiced in approaching these families because their current perception about eating disorder may be culturally based. Education is best approach to dispel myths and preconceived notions (US Preventive Services Task Force, 2022).
It’s difficult to witness a loved one struggle with an eating issue. The parents or other members of the family may feel worn out, lonely, helpless, or even despairing. They could also be denying the existence of an eating disorder. We will be there for you and your entire family every step of the way, even if coping with these emotions is difficult and the recovery process is not always straightforward (Hoeken et al., 2020). Family members and other close friends play a role in the recovery process for an eating disorder sufferer. The client will be treated as a vital component of their family’s treatment team because eating disorders thrive in isolation. Growing awareness of eating disorders is crucial since they frequently co-occur with other diseases including anxiety and despair. Suicidality can occasionally accompany depression and raise the mortality risk for those with eating disorders.
Changes in Personality
Individuals with eating disorder might be extremely secretive. They will not display this behavior does not talk about it. They also display avoidant behavior. They usually dress in normal or baggy clothes to conceal their weight and their body. Also, they manifest a faÃ§ade where they enjoy eating dinner or socializing. Majority of individuals with eating disorder have depressive thoughts as well as compulsive thoughts to exercise and to restrict eating.
Personality wise, individuals with eating disorder manifest high expectations and standards of oneself to the point of having unrealistic standards of oneself or with beaty ad body type. They are impulsive, use harm avoidance, are reward dependent and sensation seeking (Wu et al., 2019). Also, majority of patients with eating disorder have low-self-directness and not are assertive.
As a clinician, to assess for this manifestation, a careful history taking is important. A health assessment also should reveal a thin state, signs of electrolyte imbalance or reduced nutrition, reduced BMI, amenorrhea. Patients who purge may display enamel problems during an oral examination. The clinician can use the EDDS or the Eating Disorder Diagnostic Scale or the Eating Disorder Examination Questionnaire to collect important diagnostic data that can support the diagnosis (Wu et al., 2019).
Complications and Consequences of Eating Disorder
If an eating disorder is not adequately treated early in its development, it can have serious long-term repercussions. People with eating problems frequently experience major long-term physical health consequences. Osteoporosis, heart disease, abnormal heartbeats (arrhythmia), cardiomyopathy (weakening of the heart), electrolyte and hormone imbalances, dental decay, problems during pregnancy, and cognitive impairments can all fall under this category.
FBT, often known as family-based treatment, is a psychosocial approach to treating eating disorders. It is provided by therapists who have received the necessary training and adhere to the FBT treatment manuals (Hay, 2020). A form of family therapy called FBT involves the patient and family going to the therapist together. In contrast to the majority of family treatment strategies for eating disorders, FBT (Brockmeyer et al., 2017):
Â· FBT does not search for underlying problems or reasons and is “agnostic” concerning the origin of eating disorders.
Â· During the initial phase of treatment, parents are required to make all meal decisions. Siblings are also included.
Â· Food is medicine. There is a “family lunch” session early in treatment where patients are pushed to resist, and parents are educated in how to overcome resistance. Therapists coach parents in discovering their own solutions to obstacles during treatment (LeGrange et al., 2020).
Parental power is mobilized as needed in response to the health crisis that the eating disorder creates, even if this process is collaborative in character. The autonomy of the adolescent is maintained in other areas (friendships, school), at a level appropriate for the patient’s developmental stage. After the acute symptoms have subsided and a regular pattern of consuming a range of meals has been established, the adolescent is given back control over their eating during the second phase of treatment (LeGrange et al., 2020). The third stage of treatment deals with difficulties related to family structure, termination, and typical teenage development. FBT corrects misconceptions of blame aimed at the parents and the unwell teenager and regards the parents of adolescents with bulimia nervosa as a resource for treating the problem. Siblings are shielded from the parental duties and play a supporting role in the therapeutic process. FBT concentrates on how to treat this severe condition rather than what led to the bulimia nervosa.
Brockmeyer, T., Friederich, H. C., & Schmidt, U. (2017). Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychological Medicine, 48(8), 1228â€“1256. https://doi.org/10.1017/s0033291717002604
Frank, G. K. W., Shott, M. E., & DeGuzman, M. C. (2019). The Neurobiology of Eating Disorders. Child and Adolescent Psychiatric Clinics of North America, 28(4), 629â€“640. https://doi.org/10.1016/j.chc.2019.05.007
Gorrell, S., Loeb, K. L., & Le Grange, D. (2019). Family-based Treatment of Eating Disorders. Psychiatric Clinics of North America, 42(2), 193â€“204. https://doi.org/10.1016/j.psc.2019.01.004
Hay, P. (2020). Current approach to eating disorders: a clinical update. Internal Medicine Journal, 50(1), 24â€“29. https://doi.org/10.1111/imj.14691
Le Grange, D., Gorrell, S., Hughes, E. K., Accurso, E. C., Yeo, M., Pradel, M., & Sawyer, S. M. (2020). Delivery of Family-Based Treatment for Adolescent Anorexia Nervosa in a Public Health Care Setting: Research Versus Non-Research Specialty Care. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.01001
van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, 33(6), 521â€“527. https://doi.org/10.1097/yco.0000000000000641
Wu, X. Y., Yin, W. Q., Sun, H. W., Yang, S. X., Li, X. Y., & Liu, H. Q. (2019). The association between disordered eating and health-related quality of life among children and adolescents: A systematic review of population-based studies. PLOS ONE, 14(10), e0222777. https://doi.org/10.1371/journal.pone.0222777
US Preventive Services Task Force. (2022). Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(11):1061â€“1067. doi:10.1001/jama.2022.1806