Abstract
Some people think of eating disorders as a lifestyle choice or fads, but they are severe mental disorders. They affect people mentally, physically and socially and may eventually lead to threatening consequences. In the United States, these eating disorders affect an estimated population of 10 million men and 20 million women. These conditions are expressed through unusual eating habits from the influence of body shape, food, and body weight. Individuals suffering from these conditions reveal the symptoms of severe fasting, food binges abnormal purging behaviors. A study conducted on twins revealed that indeed eating disorders are hereditary. The eating habits of one twin is likely to have a 50% chance that the other will have similar habits. Other causes of eating disorders are personality traits, peer-pressure especially with adolescents, and cultural preferences. The writings in this will primarily focus on a specific life-threatening eating condition, Anorexia. Anorexia Nervosa (AN) is the most common among eating disorders. It is a condition characterized by a lack of normal weight gain and so those suffering from the disorder have low body weight. Anorexia does not have a limit of age, gender, race, and ethnicity. For many years, psychologists have identified the symptoms of anorexia in a wide array of distinct populations. A restrictive form of anorexia is associated with disciplined traits of restricting foods with high fat or sugar intake. Subsequently, this condition can also be a binge type. This is where a person diagnosed with anorexia is often purging by either vomiting or exercising excessively after taking meals. Symptoms of anorexia include dramatic weight loss, inflexible thinking, sleep problems, and limited social spontaneity. An anorexic eating disorder is caused by personality traits, environmental factors, and biological factors.
Biological Explanations
Twin and epidemiological studies have demonstrated the heritability of eating disorders. It has been revealed that liability of 40% to 60% is on additive genetic factors. The remaining liability is because of individual environmental factors which are not shared ( Sjogren, 2015) . The research on genetic factors has been done using various methods. First, a hypothesis/phenotypic driven method focusses on phenotype associated genes. The model discovered that serotine pathway could be used to show the development of anorexia. This is because it is associated with a broad range of relative physiological, biological, and behavioral functions. Further, serotine leads to psychopathological characteristics of anorexia such as impulsivity and perfectionism. Some of the phenotypic characteristics include the drive-for-perfection or self-dissatisfaction. On the other hand, a family linkage analysis has made utilizations of clinical diagnosis of anorexia. The genome-wide association studies have shown that indeed behaviors associated with AN covariates on chromosomes.
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Alternatively, the environment can how cells read genes in context to cellular and phenotypic traits. Epigenetic research is then used to describe how the dynamic changes in the transcriptional potential of a cell. In this case, these changes are not passed on to future generations. Genome-wide methylation is used in confirming the mentioned process. Taking a comparison of people with normal eating habits to those with AN, a higher or lower profile of genome-wide methylation is likely to be identified. Age of onset is linked with differential methylation in gene pathways. In turn, the pathways are associated with the spinal cord and brain development. The chronicity of AN is linked to differential methylation in gene pathways with altered social functioning, immune functions, and neurocognitive deficits.
Appetite regulating hormones can also explain the biology of anorexia. The dysregulation of hormones is a contributor to anorexia. however, this explanation is not quite effective as it is not clear whether individuals with the condition experience normal feelings of hunger. Even so, a support study has shown that ghrelin, endocannabinoids, leptin, brain-derived neurotrophic factor (BDNF), are all affected. This means that the interference of these organs results in a distortion of homeostasis and eating behavior. Similarly, anorexigenic regulators affect both homeostatic and non-homeostatic functions like the emotional or cognitive effect of food intake.
Anorexia lowers the secretion of anorexigenic hormone, leptin and so hunger suppressant signal is not communicated properly to the brain. Furthermore, leptin is significantly involved with reward mechanisms. This is because leptin receptors are found in the ventral tegmentum area (VTA) which influences impulse rates and dopamine release. Essentially, leptin levels of healthy individual increases after a meal whereas these levels in plasma decrease in AN. After recovery from AN these levels are back at optimum levels and so it is a biomarker in AN. Consequently, orexigenicregulators also play a role in anorexia nervosa. Ghrelin is the orexigenic hormone associated with fasting behaviors and thus body mass issues or fat mass. It is secreted by oxyntic cells before meals and the secretion stopped or lowered immediately after meals. Even so, there arises a difference in the secretion of ghrelin between an individual with a restrictive AN and that of binge-type. The secretion of the orexigenic hormone is higher in the individual with restrictive type as opposed to the binge-purge type. Also of consideration is a ghrelin gene product, obestatin, the product ratio is supposed to be low in healthy individuals but in anorexia’s’ case it is quite higher.
In humans, Neuropeptide Y (NPY) acts as neurotransmitter in the autonomic nervous system and the brain. Ghrelin stimulates the production of NPY within the hypothalamus to signal a feeling of hunger to the brain. In turn, appetite increases and so to the feeding behavior. The normal level of NPY is supposed to be 79-83, however, individuals with anorexia have decreased levels of 84-86, or even increased levels. This explains as to why thin people get rapid satisfaction.
Psychological Explanation
Among the mental disorders, AN is considered to have utmost mortality rate with 5.9% fatal cases. AN is far much prevalent in developed countries than developing especially when bearing in mind sub-threshold phenotypes. In other words, the prevalence of this disorder and other EDs is common in a cultural environment with high-energy nutrition. Different models have been used in efforts to elaborate the spectrum of anorexia nervosa in the context of psychology. First, evolutional theories. Reproductive suppression theory puts into consideration the environment necessary for ovulation to take place. For this reason, women consider it as an unconscious method of delaying reproduction in unfriendly environments and so to the ovulation process.
Similarly, cultural and ecological factors are seen to start a female-gendered competition to get sexual attention from men. This creates fears related to body composure ( Culbert et al., 2015) . It is especially common in western societies whereby the ladies with larges body masses experience traumatizing scenarios. Alternatively, reproductive suppression hypothesis considers AN as the result of manipulative behaviors. This is where subordinate females are reproductively troubled by dominants. Another hypothesis is that of an assumption that symptoms of AN prove useful environments that have depleted food sources. All these evolutionary hypotheses are explanatory of AN in the context of food restriction to fit in a presumed environment.
Second, sexual competition hypothesis (SCH). Intrasexual completion is equal for both females and males. However, behavioral expressions defer among the sexes. Males compete through material possessions or wealth, job positions and dominance. On the other hand, females use self-promotion strategies by showing their physical attractiveness. SCH suggests that female-gendered intra-sexual competition is the biological cause for the motive for thinness. The SCH backs its suggestion on the fact that throughout history the female shape is the sign of her reproductive potential. Moreover, thinness has been associated with age (young) and so a strategy for women to show signs of youth. SCH is an etiological outline for AN in the sense that its main psychopathological feature is the preoccupation pf body shape and behaviors to weight reduction. Therefore, the SCH explains the phenomenon of the desire for thinness, the fact that this condition mostly affects ladies of reproductive age.
Third, life history theory (LHT). To start with, mating is finding and keeping the mate while parenting is producing and taking care of the offspring. These trade-offs can be aligned on a symmetrical scale going from slow to fast (LHT) ( Nettersheim et al., 2018) . Some individuals seek much attention in mating life rather than parenting and vice-versa. For those who prefer mating can be considered to be slow strategies while those of parenting, fast strategies. For those who consider the slow strategy can be assumed that they consider risks but the fast-paced are impulsive or offer little social support. These ideas clear up the LHT theory. Individuals with AN may be opting for a slow LHT strategy in an aim of pursuing long-term mates by displaying their body shapes (thinness) and thus a reproductive potential. Also, they pursue the current reproduction for future benefits.
Sociocultural Explanation
Anorexia and other major EDs are commonly discussed as cultural-bound syndromes. In the past, AN was seen as a condition that is greatly prevalent in girls attending educational institutions in urbanized places and also from families believed to a high value on success and adaptability. However, this has now changed with the spread of the disease across distinct strata. This means that social class, either from urban or rural populations is very important as a risk factor and a course of AN. More evidenced approach to look at this mechanism is the general physiognomies found in the western culture. To be thin is a common socio-culture pressure of which is a risk factor for AN. The pressure to become thin is considered a fundamental risk factor for dieting, body dissatisfaction and eating pathology. Surprisingly, having an ideal body has become mandatory for women in western countries.
Research has also shown that parental attitudes have also contributed to the body standards. These attitudes have led to the development of eating pathology and specifically on criticizing family members’ body shape and food. Anorexia disorder in mothers do constitute an essential factor for the improvement of eating pathology in offspring. The correlation that people have with food is subjected to socio-economic changes. For instance, in countries like Poland, obesity signified a high economic class ( Pilecki et al.., 2016) . However, with the social changes, it has become a signifier of poverty and backwardness.
Treatment
The goals of treating anorexia nervosa are to improve weight loss, start nutrition rehabilitation for weight gain, reduce purging behaviors and treat psychological disturbances and other distorted thoughts, and ensure lasting behavioral changes. The treatment is dependent on the needs of the patient ( Resmark et al., 2019) . First, psychotherapy involves individual counseling of the mental, and behavior of a person diagnosed with anorexia. Psychotherapy incorporates various methods for changing the cognition or attitude towards food. These methods include acceptance and commitment therapy, cognitive behavior therapy (CBT), family-based treatment, cognitive remediation therapy, interpersonal therapy, and psychodynamic therapy.
Physicians consider medication as a possible treatment of anorexia. The antipsychotic olanzapine is found to be useful in improving body weight. However, the drug does not necessarily help in weight gain but rather as an antidepressant to control anxiety associated with AN and other eating disorders. Alternatively, nutrition counseling is also used to teach on proper dieting. It teaches the importance of considering a healthy body weight to restore typical eating behaviors. Group therapy is crucial in the treatment process. It helps create awareness of the eating disorder by being able to identify the signs and symptoms. Affected individuals can open up about their inner feelings regarding anorexia to others who suffer from the same. Lastly, the treatment of an individual with the disorder can take place in an inpatient facility, hospitalization. Though, this form of treatment is limited to patients at extreme conditions. Those who are medically and psychiatrically unstable and so the need for daily medical monitoring.
There are complications involved with the treatment of anorexia nervosa. Refeeding is the most common complication. It occurs when a malnourished person starts to receive nourishment again. This is because the metabolic processes were already weakened and thus an occurrence of a life-threatening condition. Moreover, patients experiencing this condition may develop heart failures, lung problems, muscle weakness, gastrointestinal problems, and even death. In conclusion, people suffering from AN should undertake appropriate diet plans to sustain their energy needs.
References
Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders–a synthesis of sociocultural, psychological, and biological research. Journal of Child Psychology and Psychiatry , 56 (11), 1141-1164.
Nettersheim, J., Gerlach, G., Herpertz, S., Abed, R., Figueredo, A. J., & Brüne, M. (2018). Evolutionary Psychology of Eating Disorders: An Explorative Study in Patients With Anorexia Nervosa and Bulimia Nervosa. Frontiers in psychology , 9 , 2122. doi:10.3389/fpsyg.2018.02122
Pilecki, M., Sałapa, K., & Józefik, B. (2016). Socio-cultural context of eating disorders in Poland. Journal Of Eating Disorders , 4 (1). doi: 10.1186/s40337-016-0093-3
Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of Anorexia Nervosa—new evidence-based guidelines. Journal of clinical medicine , 8 (2), 153.
Sjogren, M. (2015). A Brief Review of the Biology of Anorexia Nervosa. Journal of Psychology and Clinical Psychiatry , 4 (4), 00222.
