Human Behavior: Eating Disorders
Abstract
Eating disorders are complex conditions characterized by persistent negative eating habits that adversely affect one’s health. These disorders also influence emotions and thought leading to impairment of daily living. One of these eating disorders is anorexia nervosa. The paper explores the relationship between anorexia nervosa and body dysmorphic disorder. It investigates the similarities evident in these two conditions and how they affect an individual, especially when occurring together. The paper also tries to understand the various causative factors ad treatment modalities suitable for anorexia nervosa and dysmorphic disorder. The different assumptions about these conditions are also described, including how they affect individual daily functioning.
Human Behavior: Eating Disorders
Statement of the Problem
Eating disorders are complex mental health problems that affect millions of people. These conditions also affect the physical, psychological, as well as social aspects of a person’s life (de Vos et al., 2017). Sometimes eating disorders can occur accompanied by other mental health problems. For example, Hartmann, Greenberg, and Wilhelm (2013) argue that anorexia nervosa (AN) and body dysmorphic disorder (BDD) are distinct disorders but have overlapping medical features. AN and BDD are both adverse body image conditions that hinder an individual’s daily functioning (de Vos et al., 2017). These similarities have raised interest for further study into these disorders.
However, despite evidence of similarity, the relationship between AN and BDD is often overlooked. Grant and Phillips (2004) assert that a large portion of psychiatric literature tends to explore the obsessions and repetitive behaviors evident in BDD while relating it to obsessive-compulsive disorder (OCD). BDD has also been linked to social phobia and major depressive disorder, although, to a lesser degree (Grant & Phillips, 2004). Regardless of extreme body image concerns found in anorexia and BDD, little research explores other aspects of how these two conditions overlap. On this note, this paper explores the relationship between AN and BDD in terms of clinical personality features related to body image disturbances, cognition, self-esteem, and delusions. It is also essential to explore treatment modalities that help address the underlying issues.
Evidence
A significant relationship between AN and BDD is body image distortion and attractiveness beliefs. Hartmann et al. (2013) note that individuals with AN have the perception they are overweight even though one is at a significantly low weight. DSM 5 indicates that patients perceive themselves as “fat” or suffer disturbance in their perception of body weight and shape (American, 2013). Similarly, individuals with BDD possess significant dissatisfaction with their general appearance, including specific body parts (Hartmann et al., 2013). For example, the person develops a preoccupation with perceived physical defects that are not evident or seem slight to others. The individual may be dissatisfied with one’s skin, facial appearance, hair, nose, or any other body part. Both disorders are marked with repetitive behaviors that focus on appearance, such as constant mirror checking, excessive grooming, and even people with BDD engage in extreme diet or exercises (Grant & Phillips, 2004). People with AN and BDD also avoid places or activities because of increased self-consciousness about one’s appearance (Hartmann et al., 2013). They may also develop intense fear about being in social places because of these perceptions.
Distorted beliefs and poor self-esteem also mark these conditions. Often individuals develop transitional beliefs such as “I am not attractive,” “I am worthless” (Hartmann et al., 2013). These beliefs make it harder to engage in social interactions. The perceptions about body image directly lead to low self-esteem among individuals with BDD and AN (Hartmann et al., 2013). Salafia et al. (2015) argue that as the disease progresses, the perceived flaws contribute to lower self-esteem and self-confidence. The more an individual engages in behaviors that improve appearance, the more self-esteem issues crop up.
Delusions become another significant symptom in people suffering from AN and BDD. Hartmann et al. (2013) state that studies show that approximately 20 to 24 percent of individuals with AN present significant impairment on insight. Poor insight when it comes to eating disorders is often associated with intentional denial of being ill. Similarly, most patients with BDD display delusional beliefs about their appearance or ideas about body perception. For example, an individual has constant misconceptions such as “she is looking at me because I’m not beautiful.” Salafia et al. (2015) argue that studies show that AN patients with chronic BDD display increased levels of delusionality compared to AN patients without BDD. The presence of these delusions largely impair daily functioning.
Evidence also reveals that AN and BDD possess similarities in terms of cognitive processing. Hartmann et al. (2013) assert that both disorders indicate bias in regards to the interpretation of ambiguous circumstances. In both diseases, individuals refer back to themselves with a negative outcome, while interpretation of other events is understood through shape and weight (Fuglset et al., 2016). Also, the similarity is evident in individuals’ interpretation of different emotions. Fuglset et al. (2016) claim that patients with AN and BDD show deficits in the recognition of mixed emotions. For example, there is particular emphasis on negative emotions compared to positive emotions, while neutral emotions are often interpreted negatively (Hartmann et al., 2013). In both disorders, body-related, as well as body-independent emotions such as disgust, guilt, or shame, are significantly higher than in healthy individuals. Patients with these two disorders also possess intrusive negative perceptions related to appearance and thought, such as worry (Hartmann et al., 2013). The intensity of these thoughts is higher than one would find in healthy individuals.
An interprofessional approach is required in the treatment of eating disorders and BDD. Liyanage, Suraweera, and Rodrigo (2019) note that psychotherapy treatments are effective for patients with BDD and AN. Cognitive-behavioral therapy is especially useful in treating AN and BDD by helping change distorted thought patterns, beliefs, and attitudes (Liyanage et al., 2019). It also involves psychoeducation about eating disorders, impaired thinking, and weight restoration techniques. Family-based CBT is promoted among teens struggling with eating disorders and BDD. For patients with AN, support from a nutritionist remains a priority. Nutritionists work with patients to design appropriate diet, nutrients, and food choices that can help maintain a healthy weight (Liyanage et al., 2019). Pharmacology treatments are also crucial in the treatment of AN and BDD. For example, serotine reuptake inhibitors (SSRIs) are supported by evidence in treating BDD and various eating disorders. These are antidepressants that stabilize chemicals in the brain to control the negative thoughts, as well as repetitive behaviors (Hartmann et al., 2013). In most cases, pharmacology is administered in combination with psychotherapy and psychosocial interventions.
Influence of Contexts and Assumptions
One of the assumptions about eating disorders and BDD relates to the media. Salafia et al. (2015) argue that many misconceptions about the development of eating disorders are connected to the media. For example, there is an assumption that eating disorders and body image disturbances occur because of media influence. Often, it is assumed that young people, and especially women, suffer from eating and body image disturbances because they allow the media to influence them. However, research proves that AN and BDD are serious mental health problems that can occur at any age and can affect both men and women (Salafia et al., 2015). While the media can influence aspects of body image, it cannot solely be attributed to the development of eating disorders and BDD.
The other assumption is that the symptoms of these disorders mirror those of OCD. BDD has primarily been linked to OCD compared to its relationship with eating disorders. In the DSM 5, BDD is classified under the obsessive-compulsive and related disorders making its connection to eating disorders less evident. Phillips and Kaye (2007) claim that OCD obsessions such as repetitive behaviors and unwanted thoughts have similarities to BDD and AN. Also, compulsions such as continually comparing oneself to others, mirror checking, and excessive grooming evident in BDD and AN do related to OCD compulsions (Phillips & Kaye, 2007). A lot of research has made the connection between eating disorders and BDD to OCD symptoms. However, further study is required to confirm the relationship.
Student’s Position
My interest in this topic is based on my personal experience. Our family has had to face the challenges of having a loved one suffering from an eating disorder. My sister in law suffers from both AN and BDD, which has affected her quality of life. When her symptoms began, she would spend hours checking what she eats and persistent preoccupation with her weight, as well as appearance. She also has an intense fixation on her physical features, which she believed others were noticing. My sister in law is not happy with her facial and body shape. These impend her ability to focus on other daily obligations. As the symptoms intensified, she would spend hours grooming making it challenging to take care of her home and children. This created depression and anxiety as her life was spiraling out of control.
The family did not know what caused her to develop these disorders. However, after conducting research, it is evident that genes play a role. Cerniglia et al. (2017) argue that some people have genes that predispose them to the risk of eating disorders. A family history of eating disorders is a risk factor for developing the disorder. It was after her diagnosis that we learned that her great grandmother also had some sort of eating disorder even though it was not officially diagnosed. Another cause of AN and BDD can also occur among individuals with another mental health problem. For example, my sister in law was diagnosed with AN and later BDD.
Through the support of the family, my sister in law started treatment. She has been going for therapy. CBT is one treatment that can help my sister in law learn to control maladaptive thought patterns and beliefs. She also goes to a support group once a week. A support group allows individuals to share their experiences and offer each other support based on their shared understanding (Cerniglia et al., 2017). Support groups strengthen one’s resolve to address the problem, knowing that one is not alone.
Conclusions and Related Outcomes
People with eating disorders may also have other accompanying mental health problems. For example, AN and BDD can occur at the same time. A relationship does exist between AN and BDD. One of the similarities between AN and BDD involves distortion of body image, especially in regards to body weight in AN and appearance in BDD. Individuals with these disorders also have low self-esteem owing to distorted beliefs and perceptions. It is also common to have negative emotions and thoughts about one’s body image and appearance. AN and BDD requires treatment to address underlying problems. Most treatments focus on medication and therapy. CBT is one treatment that can effectively address the distorted thoughts and beliefs evident in AN and BDD. Future studies should examine how other similarities that may help explain the similarities in these two conditions.
References
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