Anorexia Nervosa
Eating disorders are a cause for serious concern from both a psychological and a
nutritional point of view. They are often a complex expression of underlying
problems with identity and self concept. These disorders often stem from
traumatic experiences and are influenced by society\'s attitudes toward beauty
and worth (Eating Disorder Resource Center, 1997). Biological factors, family
issues, and psychological make-up may be what people who develop eating
disorders are responding to. Anyone can be affected by eating disorders,
regardless of their socioeconomic background (Eating Disorder Resource Center,

1997). Anorexia nervosa is one such disorder characterized by extreme weight
loss. It is the result of self imposed and severe restrictions of food and fluid
intake, a distorted body image, an intense fear of becoming fat, and a poor self
esteem. Besides dieting to extremes, anorexics often over exercise to lose
weight. Anorexics themselves are often the last to realize how undernourished
and underweight they are. Even after reaching a weight that is dangerously low,
they feel good initially, about losing the weight. No matter how much is lost,
anorexics continue to feel fat and desire to lose more weight. It is this denial
that makes it so hard to convince anorexics to seek help (Eating Disorder

Resource Center, 1997). This paper\'s focus is to look in more detail at the
psychological and societal factors contributing to anorexia nervosa, as well as
the nutritional and physiological complications that arise for people on such
severely restrictive diets. Psychological and Societal Contributions Anorexia

Nervosa was first described by an English physician by the name of Richard

Morton in 1689. Until 1914, it was considered a disease that arose from a morbid
mental state and a disturbed nerve force. That year, Dr. Simmonds, a
pathologist, found one woman=s refusal to eat to be the direct result of an
anterior pituitary lesion. This shifted the focus away from the emotional
aspects of the disorder to more physiological and endocrinological terms. It was
not until 1938 that anorexia nervosa was once again considered a largely
emotional disorder (Blackman, 1996). In fact, one of the criteria for the
diagnosis of anorexia nervosa according to the manual of The American Medical

Association (DSM IV) is an intense fear of gaining weight or becoming fat, even
though underweight. Another clearly psychological requirement for diagnosis, is
a disturbance in the way in which one=s body weight or shape is experienced,
undue influence of body weight or shape on self evaluation, or denial of the
seriousness of the current low body weight (Blackman, 1996). Anorexia nervosa
may be a primary disorder in which other psychiatric conditions are secondary,
such as depression. It may also be secondary itself to a disorder such as
schizophrenia or co-morbid with obsessive compulsive disorder. As well, it can
also be a component of a personality disorder (Blackman, 1996; Carlat, 1997).

The anorexic sufferer is typically female. Ninety-percent of all cases occur
among adolescent girls or young women but the number of males with the disorder
is on the rise (Blackman, 1996; Carlat, 1997; Kinzl, 1997). It is estimated that

1% of girls ages 12-18 meet the criteria for full blown anorexia and as many as

5-10% have milder forms of such eating disorders if the criteria is applied less
stringently (Blackman, 1996). Anorexics are usually high achieving youngsters
who may be heavily involved in sports (e.g. gymnastics, swimming, cheer leading,
ballet, etc.). These people are often competitive, perfectionistic, with
obsessive compulsive personality features. Fears of growing up or discomfort
toward sexuality may also be precipitating factors (Blackman, 1996). Studies
have shown that 75% of American Women are dissatisfied with their appearance and
as many as 50% are on a diet at any one time. Even more alarming is that 90% of
high school junior and senior women regularly diet, even though only between

10%-15% are over the weight recommended by the standard height-weight charts
(Council on Size and Weight Discrimination, 1996). The majority of these women
do not develop eating disorders; however, 1% of teenage girls and 5% of
college-age women do become anorexic or bulimic (Council on Size and Weight

Discrimination, 1996). Perhaps these figures represent the women who are less
able to cope with their bodily dissatisfaction and thus are the ones who take
dieting to the extreme. The disordered eating behavior usually starts out with a
pattern of dieting or particular food choices, such as avoiding certain foods
which are seen as fattening. As the disorder progresses, anorexics become
resourceful in hiding their troublesome behavior and may start to avoid eating
with their families. They may also attempt further weight loss by compulsive
exercising. The condition can