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Introduction
Anorexia nervosa is one of eating disorders which appears, as a rule, in young women in the age 12-25 years. However, cases when males become anorexic patients also can be found.
The main features of anorexia nervosa: weight loss of more than 15% of the initial weight, pathological belief in own obesity despite the extremely low weight, amenorrhea. At the center of disease is persistent desire to lose weight, which patients try to achieve using diets, exercise, and even enemas, vomiting, etc. As a result, weight loss reconstructed metabolic processes, mental changes occur. That is why this eating disorder is extremely dangerous and need special attention from psychotherapists, psychologists, parents, etc.
Anorexia nervosa is a psychological disorder which can be associated with many different reasons. This eating disorder can lead to a death of young people. Understanding of reasons of anorexia nervosa can help to understand ways of preventing this mental problem. That is why it is crucial to learn reasons of anorexia nervosa.
Causes of anorexia nervosa in children and adolescents
Nilsson et al. (2007) conducted the retrospective study to answer questions about perceived reasons of anorexia nervosa. Researchers examined how former patients with anorexia nervosa perceive reasons of onset of the eating disorder. Authors of the article compared answers about reasons of disorder in patients who have recovered and who continued to suffer from anorexia. Also, authors compared how former and actual patients perceive reasons of their disorder after 8 and 16 years of onset of anorexia nervosa in their life.
Using content analysis authors of the study identified three main groups of causes of anorexia nervosa reported by participants of the study. There were factors of self, family factors and socio-cultural factors. Every group included subcategories. For example, the socio-cultural group included reasons of anorexia such as sports, ideals, school incidents, bullying, separation, etc. Family factors included stressful events in a family, overprotection or neglect, sexual and another form of abuse in a family, etc. Individual factors or factors of self-included low self-esteem, the dissatisfaction of own body, dieting, too high self-demands, etc. (Nilsson, Abrahamsson, Torbiornsson &Hägglöf, 2007).
Results of the study indicated that the most common reason for the whole sample of the study was high own demands/perfectionism. Differences between unrecovered and recovered patients regarding their reports of reasons of anorexia have not been found.
However, researchers noticed that only recovered patients chose for reasons of their disorder categories such as sports and separation/moving. Also, unrecovered patients more often reported low self-esteem and bullying/problems with peers, although this difference was not statistically significant (Nilsson, Abrahamsson, Torbiornsson &Hägglöf, 2007).
Participants of the second follow-up (after 16 years of initial admission to a clinic with the problem of anorexia) were more reflective about family reasons of their disorder and more often reported family factors as reasons for the onset of the disorder (Nilsson, Abrahamsson, Torbiornsson &Hägglöf, 2007).
Tozzi et al. (2003) also conducted the retrospective study of patients with eating disorders. However, results of the study of Tozzi and his colleagues demonstrated that recovered and unrecovered anorectic patients reported as main reasons of onset of anorexia nervosa dysfunctional families (with different family problems), stressful events which triggered the onset of the disorder and uncontrolled dieting behavior.
Skårderud (2007) indicates that eating disorder can be concerned as one of the shame-based syndromes and that shame can be the consequence of the disorder as well as a reason for its onset. The author indicates in his study two subcategories of shame: the general feeling of own worthlessness (globalized internal shame) and shame for different feelings, actions, etc. (focuses of shame). On the basis of his study Skårderud identifies shame for sexual abuse, for self-destructive behavior, for own appearance, for achievement failures, for the eating disorder, for low self-control, etc. among anorexic female patients.
Shame, feeling of dissatisfaction with own appearance or with own life and personality generally can lead to the onset of anorexia nervosa. In the case of this disorder, shame causes a desire to change oneself and the body of a person becomes a target for changes.
Skårderud also discusses pride as feeling opposite to shame and its role in the development of anorexia nervosa. However, pride is opposite to shame it also contribute to Anorexia Nervosa's symptoms. The author identifies that anorexic patients can be proud for their self-control, their appearance, their protest and for their ability to be extraordinary. For example, anorexic patients can be proud because they can control own desire to eat, because they are extremely thin, etc.
Garner & Garfinkel (1980) examined how socio-cultural factors can influence the development of anorexia nervosa among young females. Authors of the study indicate that cultural pressure on women encourages them to be thin, to meet standards of beauty widespread in modern society. That is why social-cultural factors can predispose women to anorexia nervosa as well as individuals (personal traits) and family factors.
Garner & Garfinkel (1980) conducted the study on the sample of professional dance students and students of a model school. Researchers assumed that these students are more vulnerable to become anorectic patients or demonstrate signs of anorexia nervosa. They compared future professional dancers and models with anorectic patients and with students whose future professional specialization was not associated with dances or model career.
Authors indicated that at higher risk of anorexia disorder is students of those dance schools where the level of expectations and competitiveness are higher. Researchers compared students of dance schools with high competitive programs and with students of music schools with the high competitive program to identify if high expectations and competitive conditions play any role in the development of anorexia nervosa (AN).
Results demonstrated that there were no clinical cases of AN among musicians while 8 students of dance schools demonstrated primary AN. Also, only 3% of students-musicians scored on EAT 30 and greater while this percent was significantly higher among students-dancers (43%).
Primary anorexia was found among 6, 5% (12 cases) of students of dance schools and among 7% of future models (4 cases). Results of the study demonstrated that most of dancers and models began to demonstrate signs anorexia nervosa after they had become students of model and dance schools, although several girls (2 from the model school and 1 from the dance school) had primary anorexia nervosa before they have become students of professional dance and model school. 25% of subjects from dance and model schools scored on EAT 30 and higher what indicated that this 25 percent of dancers and models have cases of anorexia nervosa.
Therefore, a hypothesis of the study was confirmed by results of the study. Future professional models and dancers, according to results of the research, were at higher risk for AN due to demands of their future professions.
Canetti et al. examined family intergenerational causes of AN. There are many theories about the family role in the development of AN in children and adolescents. For example, Minuchin emphasized on the role family boundaries in the development of the disorder and pointed out that AN as well as many other mental disorders is the disease of the whole family and not only a disease of a one family member. Minuchin also indicated that failure to resolve effectively family conflicts can induce psychological problems in family members (Canetti, Kanyas, Lerer, Latzer& Bachar, 2008).
Results of the current study demonstrated that parental bonding can influence not only the development of AN but also a severity of its symptoms. Anorectic patients who participated in the study perceived their parents as more controlling and less caring. However, researchers concluded that parental control is less significant than the lack of affection, warmth in relationships of children and parents. According to results of the study, it seems, that the lack of the care play more salient role in onset and severity of AN than high control of parents (Canetti, Kanyas, Lerer, Latzer& Bachar, 2008).
Fosson et al. (1987) examined the development of anorexia nervosa in early adolescence and preadolescence periods. Subjects of their studies were individuals in the 14 years and younger. Researchers concluded that parents tend to control younger children and females offspring more than elder children and boys. Therefore, early onset of the eating disorder can be considered as the result of overprotection and high control of parents over their children. Apparently, children`s anorexia nervosa is their trial to get more autonomy and separation from parents.
Conclusions
Analysis of results of different studies demonstrates that there are many reasons of anorexia nervosa. Anorexia can be associated with social, behavioral and other factors. Social-cultural factors can be associated with standards of beauty, fashion, different mass media production. Social factors are connected to the relationship of a person with friends, peers, schoolmates, etc.
Family factors which may contribute to anorexia include a variety of stressful family events, family conflicts, dysfunctions in parent-child interactions, parental attitudes toward own and their child`s appearance, failure of parents to resolve family conflicts, etc.
Many types of research examine anorexia nervosa of adolescents. At the same time, the topic of anorexia nervosa in childhood seems to be less explored. A significant feature of childhood anorexia nervosa is a greater number of males among anorectic patients. In the preadolescence males are more vulnerable to develop anorexia nervosa than in adolescence.
Anorexia nervosa is not the disorder which arises only on the basis of one group of factors. This eating disorder determined by multiple reasons. For example, only socio-cultural factors are not enough to cause anorexia nervosa. However, in the case when a person has, for example, particular personal traits which increase the risk of AN, and grow up in the dysfunctional family environment, he/she will be vulnerable to develop AN.
Apparently, individual traits such as perfectionism and high demands toward oneself influence development of anorexia nervosa. Investigation of shame and pride and its role in the development of anorexia nervosa is an interesting approach to a study of determinants of anorexia, although it needs further statistical analyzes to indicate if shame and pride.
References
Canetti, L., Kanyas, K., Lerer, B., Latzer, Y., & Bachar, E. (2008). Anorexia nervosa and parental bonding: the contribution of parent–grandparent relationships to eating disorder psychopathology. Journal Of Clinical Psychology, 64(6), 703-716. doi:10.1002/jclp.20482
Fosson, A., Knibbs, J., Bryant-Waugh, R., & Lask, B. (1987). Early onset anorexia nervosa. Archives of Disease in Childhood, 62(2), 114-118.
Garner, D. M., & Garfinkel, P. E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological medicine, 10(04), 647-656.
Nilsson, K., Abrahamsson, E., Torbiornsson, A., &Hägglöf, B. (2007). Causes of Adolescent
Onset Anorexia Nervosa: Patient Perspectives. Eating Disorders, 15(2), 125-133.
Skårderud, F. (2007). Shame and pride in anorexia nervosa: a qualitative descriptive study. European Eating Disorders Review, 15(2), 81-97.
Tozzi, F., Sullivan, P. F., Fear, J. L., McKenzie, J., & Bulik, C. M. (2003). Causes and recovery in anorexia nervosa: The patient's perspective. International Journal of Eating Disorders, 33(2), 143-154.
