Anorexia and Bulimia Essay Example
Anorexia and Bulimia Essay Example

Anorexia and Bulimia Essay Example

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  • Pages: 12 (3177 words)
  • Published: September 1, 2017
  • Type: Research Paper
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The Modular-transformational approach is focused on tackling the increasing occurrence of anorexia/bulimia and the difficulties associated with its treatment. Experts in psychiatry and psychoanalysis are making significant efforts to understand and intervene in order to effectively address this epidemic and distinctive pathology of our current era (Lucas, 1991).

The objective of this paper is to examine and tackle different elements of the disorder. We aim to evaluate its present condition and provide theoretical and clinical approaches. More specifically, we explore whether it is a psychosomatic illness, a behavioral disorder, a distortion of body image, or a disruption of narcissistic equilibrium.

Is anorexia/bulimia now becoming an epidemic disorder with the same causes as cases documented by psychiatry for over a century? Does the history of hypocritical psychiatry trace back to Corpus, a case of a syndrome that

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can have various causes but still exhibits a specific structure and symptomatic dynamics? Does adolescent anorexia/bulimia always result from a previous period of infantile anorexia? Is it a disorder specific to females?

Is there any resemblance between the "epidemic" of hysteria in the past century and the prevalence of anorexia/bulimia today? Upon analyzing these queries, one immediately encounters a challenge in simplifying conceptions, as there is an attempt to unify them - be it the early psychogenesis of the mother-daughter relationship or a distressful disorder related to the misinterpretation of hunger sensations - resulting in the formation of an imagined psychopathological identity such as that of "anorectic" or "bulimic" individuals.

The clinic sample presents a variety of underlying configurations that all share the common trait of deep narcissistic vulnerability during puberty and adolescence. It highlights the illusion that

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refinancing offers in optimizing her culture's deliquesce. Puppetry Ana adolescence Tamale explains recreational conceptions as a regression to premedical or reactivation stages of the oedipal process and/or separation/individuation in incomplete infancy. It also emphasizes the complexity and extent of the unpublished problematic adolescence that is prevalent in the present era.

Engaging in sexual activities early on and being active in it can put women at risk, compromising their physical well-being and jeopardizing their safety. This can lead to conflicts between sexual desires and the need for self-preservation. Another danger is the potential loss of important emotional connections at a young age, which are essential for personal growth throughout life. These risks are further heightened by the increasing emphasis on narcissistic ideas about gender neutrality or distorted portrayals of female identity. Moreover, individuals may face conflicts between their desire for personal excellence and fulfillment and societal pressure to conform to unrealistic standards of body image and beauty.

It is always possible to resort to the resource of female adolescent body perfectionism in order to compensate for the various effects of anxiety, such as loss of primary attachment references, sexual challenges, and ego collapse. This compensation takes the form of maintaining thinness as a universal narcissistic defense that aligns with the cultural values.

Just like hysteria, anorexia/bulimia disorder is a physical condition that has no substance but has harmful impacts on the patient's personality and life. Hence, it is important to first investigate the epidemiological and psychiatric aspects before analyzing the structural/dynamic components. Having a grasp of these aspects is vital in designing customized treatment approaches for each specific case.

Topics for discussion will cover various

aspects pertaining to anorexia and bulimia, such as the conceptual definition of these disorders, prevalence in society, the relationship between symptoms and underlying factors, the importance of understanding the history of infantile anorexia, the role of mother's body image and female puberty as potential causes, and approaches to treating these conditions in adolescent women.

Conceptual definition of anorexia / bulimia: Various proposals have been given to define the conceptual aspects of psychosomatic illness (Deutsche, 1940; Blitzed, 1961 Spelling, in Wilson, 1983; Strauss, 1987), eating disorders (ADSM), pathology weight or weight phobia (Crisp, 1970; Chalky, 1977; Hall, 1986), and narcissistic balance deregulation (Jammed, 1991). These proposals refer to different levels of analysis of the disorder. The first level involves the motivation that triggers the behavior, such as the pursuit of thinness and self-narcissistic balance. The second level focuses on the pathogenesis and the methods used for weight loss, such as induced vomiting, laxatives, and diuretics, which may lead to self-centeredness, rituals, and isolation. The third level encompasses the symptoms of the disorder, including weight loss, impaired judgment about body image, malnutrition, body involvement, and the risk of death. Therefore, these various characterizations reflect components that are all present in anorexia/bulimia and influence its causation, procedures, and consequences.

One prominent explanation for anorexia/bulimia is that it is a psychosomatic illness characterized by symptoms such as amenorrhea or hypothermia. However, treatment centers primarily focus on modifying eating habits rather than addressing underlying imbalances. In some cases, hospital admission may be necessary to address the risk of death or restore physical health through weight gain. The ultimate objective is to comprehend the causes and consequences of the disorder: does

the cause precede the consequence? If viewed as a psychosomatic illness, it is believed to originate from psychological factors that impact the body's normal physiology.

The fundamental idea behind psychosomatic illness is that the underlying cause is psychological, often unknown or as broad as stress or distress, and not a detectable organic factor. These ailments, which remain undetermined and are based on empirical testing and statistics, are suspected to be linked to the psyche. In contrast, those who suffer from hypertension or stomach ulcers seek medical solutions. This is not the case with anorexia/bulimia, where individuals experiencing symptoms such as hypothermia or amenorrhea are aware that their desire is not related to weight gain, and the associated consequences do not seem to concern them. As a result, if proper nutrition is significantly affected, it directly stems from a determined psychic element that persists throughout the duration of the disorder.

The act of hand washing, if it leads to severe dermatological and sleep problems or the repetition of physical symptoms, cannot be justified as a psychosomatic condition. Hence, it is more suitable to perceive anorexia/bulimia as a mental illness, similar to how Lassegue (1884) and Gull (1874) initially did in their research. They connected these disorders with femininity and strong mental states. In these disorders, the body is considered the root cause, with a shared emphasis on weight concerns, calorie counting, food choices, mood fluctuations related to eating, and difficulties in managing anger and maintaining proper nutrition.

According to the psychoanalytic literature, mental emptiness is characterized by a lack of imagination and difficulty in making associations and remembering (Stromberg, 1976). These characteristics are believed to be

caused by a deficit in mental content. Individuals with less mental content are more likely to experience conflicts in their body. Some experts suggest that these traits may be a result of a constitutional defect in the ability to fantasize, which is often seen in patients with organic diseases who struggle to express emotions (Ossifies and Anemia, 1967). It is thought that there is a neurological issue that impairs symbolization and increases the tendency to resolve tension through physical means. This explanation can also be applied to understanding anorexia/bulimia (Zones of Guerrilla, 1996).

Marty et al (1992) also incorporate this concept as a fundamental aspect in their understanding of psychosomatic diseases. They propose that flaws in the structure of the mental apparatus, particularly weaknesses in the preconscious, hinder the processing of emotions through psychic representation. As a result, the registration of bodily sensations becomes altered. This can manifest in various ways, ranging from an excessive focus on bodily sensations to a failure in recognizing personal and social boundaries. Individuals may use expressions such as feeling full, stuck, invaded, or drowned to convey their experiences. Furthermore, individuals may have difficulty expressing their emotions and sensations accurately, using phrases like "I'm empty" or "I can't grasp my limit." Brunch (1969) was among the first to address the deficiencies in self-perception and regulation of hunger-related feelings in individuals with eating disorders. This aspect is now included in the Eating Disorders Inventory (EDI, Garner, Olmsted, and Polivy, 1983) under the category of "interoceptive awareness," which assesses the individual's ability to recognize and accurately identify emotions and feelings of hunger and satiety. Brunch highlights that the perception of hunger

is not entirely innate; rather, it requires a sequence of events involving signal emission, recognition by an adult, appropriate response, and eventual relief.

The text highlights that postnatal regulation cannot be ensured solely by instinct. It mentions the recent suggestions emphasizing the significance of confirming, reinforcing, or inhibitory responses from attachment figures in innate components for the healthy development of self-perception and defecation.

The sensitivity of the attachment figure is crucial for the infant's ability to differentiate between bodily sensations and emotional states. However, it should be acknowledged that a defect in the mother can impact both male and female infants. This is evident in cases of infantile anorexia, which challenges the prevailing notion that anorexia/bulimia primarily affects women. In 1969, Brunch established a connection between obesity and eating disorders, emphasizing how childhood difficulties in distinguishing between different sensations can lead to both childhood and adult obesity in both genders. Although obesity is categorized as a behavioral disorder related to eating, there are several distinguishing factors.

According to studies conducted by Capper et al. (1977) and Garfield & Kaplan (1985), patients' preoccupation with mental content about food may be directly linked to famine. Keys et al. (1950) carried out a research at the University of Minnesota, where they monitored the food intake of 38 normal male volunteers for 3 months and then reduced it by half for the following 6-month period. This resulted in a weight loss of around 25% from their original weight and led to various changes similar to those observed in individuals with anorexia: intense focus on food, decreased interest in other subjects and activities, restlessness, irritability, and difficulty engaging in conversation with

them.

At the end of the experience, a significant percentage of individuals took between 8 months to a year to recover from Nils' constant restriction on Ana's normal tie. Despite appearing physically healthy, many patients with bulimia may exhibit psychological and physical symptoms, such as depression, irritability, and obsessive tendencies. The psychic symptoms often revolve around food-related issues, dyslectic states, irritability, social isolation, and mental exhaustion. These symptoms closely correlate with the effects of a high metabolic imbalance that affects one's ability to regulate the mind. Although individuals with anorexia/bulimia typically resist treatment and aim to control their food intake, their bodily effects can alarm the psyche and highlight the experiences of individuals who had no initial motivation for food deprivation but were forced to participate in a human experiment.

Both anorexia and bulimia have symptoms that range along a continuum. Patients can show different degrees of restrictive behaviors as well as behaviors associated with bulimia. Some individuals who have anorexia may also exhibit symptoms of bulimia, like purging or vomiting after binge-eating episodes. On the other hand, some individuals may only vomit without engaging in bingeing or purging. Both disorders share common features including being preoccupied with weight and having an overvaluation of shape and thinness. Many patients display a combination of both bulimic and anorexic behaviors (Practice Guideline, Am J Psychiatry, 2000).

The knowledge about anorexia/bulimia dates back to ancient times, with references in the works of Hippocrates, Galen, and the Talmud. Historical documentation even mentions Teresa of Avila inducing vomiting using an olive branch. Over the past century, publications by Lassegue in 1873, Gull in the British Medical Journal in 1874, and

Lancet's photographs of Miss KERR in 1888 have all contributed to our understanding of this disorder. Psychiatric and psychoanalytic literature has also played a role in explaining the disorder through individual cases. However, it was not until the late 20th century, particularly from the 1970s onwards, that there was a significant increase in incidence and an epidemic-like phenomenon observed. The reasons behind this rise in anorexia/bulimia cases both historically and currently are worth exploring.

The text discusses the prevalence of isolated symptoms in adolescents with severe eating disorders. This population includes those who seek consultation in clinics or hospitals, as well as those who go unnoticed in private consultations. An epidemic of anorexia/bulimia is primarily based on this latter group, as exemplified by the case of Ellen West mentioned by Binger in 1945. Ellen was a purging anorexic with prominent symptoms and tragically took her own life. Various analysts provided different diagnoses for Ellen, including hysteria, single melancholy, simple schizophrenia, psychopathic constitution progressive development, and endocrine endogenous psychosis.

Comparing Ellen West's case to data from a recent study by Golden et al. (1999), which evaluated 136 cases and identified three clusters of eating disorders, it was found that 18.4% exhibited high scores on psychopathic traits and were diagnosed with borderline disorders. Furthermore, 49.3% showed some compulsive traits and interpersonal difficulties, while 32.4% were considered normal by the control group.

The current cases reveal that 18.4% of severe pathology is associated with individuals who are still anorexic/bulimic similar to previous findings. However, there are additional factors present in the remaining cases that further complicate this enigmatic disorder.

The rarity of complete frames of anorexia/bulimia that meet all diagnostic criteria

is 0.5 to 1%. In contrast, there are more partial or incomplete cases, ranging from 3% to 5% (Walters; Kindler, 1995; Funnel et al., 1990). Therefore, the obsession with thinness can be seen as the distinguishing factor between current cases of anorexia/bulimia, which can trigger symptoms of the syndrome through various motivational approaches. Certain clinical data such as neurotic, synoptic Ana borderline conditions have a specific causal link with anorexia/bulimia. Despite this connection, many authors consider it a syndrome.

According to Risen (1982) and Selling Palazzo (1999), the various causes of a syndrome can be divided into individual, family, and cultural factors. However, despite the different causes, there is a specific structure and dynamics of the symptom.
One manifestation of this syndrome is through the pursuit of the current beauty aesthetic pattern, specifically through weight loss diets. In these cases, which are prevalent among women due to the culture of thinness (Garner et al., 1983), the motivation is to achieve a better silhouette and gain narcissistic satisfaction. The prevailing literature explains that around 10-1 of women have this disorder. These individuals seek mental well-being through recognition of their bodies' beauty and thinness. The psychological condition varies widely, but the ultimate goal unifies them.
In clinical practice, we often encounter cases of girls who imitate their dieting classmates at school. These individuals display a perfectionist tendency and fit the profile of young models with excellent academic records, beauty, and sociability. However, they may feel disadvantaged due to their physical weight and believe that thinness is necessary for attracting the opposite sex. They compensate for their feelings of distress by engaging in an illusory diet.

The motivation behind restrictive

behavior is triggered by a narcissistic system that is linked to a bodily attribute. This attribute serves as both a gender stereotype, ensuring mirroring, and an essential qualification for activities such as gymnastics, modeling, acrobatics, climbing (Nude, 1989; Manna, 1983; Rowley, 1987). Another way to control anxiety is by relating anorexia/bulimia to obsessive-compulsive disorder, as it has high morbidity and prevalence throughout the life cycle (McElroy, 1994; Stein, 1993; Thiele, 1998; Fay, 1993; Skives, 1986; Rubberiest, 1992). Some authors, like Noshing et al. (1991), argue that the high incidence of anorexia/bulimia in women can be explained by a divergent gender factor. We agree with these authors on the importance of gender equality and believe that control mechanisms should be applied to issues governed by the ego ideal.

The relevance lies in the connection between different motivational systems, where each subject selects a control system for surveillance. In this case, it pertains to narcissism and its association with the ability to control body image. This double determination consists of a basic function of decreased defense anxiety that feels uncontrollable, and the fulfillment of the narcissistic motivational system. In the context of anorexia/bulimia, anxieties associated with symptom observation can be varied, but weight control serves as the universal manifestation underlying this diversity.

The symptom itself arises from a conflict that can be attributed to Oedipal conflicts, generating panic and rejection of sexuality, or sexual abuse. Studies exploring the potential connection between sexual abuse and anorexia/bulimia indicate a prevalence of bulimic symptoms. Body involvement serves as a symptomatic resolution and defense mechanism against the emotional turmoil caused by sexual abuse. This can manifest as either inhibiting sexuality and

erasing the body as an object of abuse or engaging in compulsive activities to diminish oneself as a sexual object.

Symptom exchange situations disrupt the attachment bond between teenagers. These difficulties can arise from the changes in their life situations and can be seen as a type of adolescent crisis.

According to a previous personality typology, Palazzo's is included in cases of changes in residence for study or work purposes (1999, p. 196). These cases, referred to as "anorexic reactions" by Carney (1996), often have a good prognosis with a partial or incomplete clinical picture. Depressive states are considered a predisposing condition or a consequence of anorexia, and they share similar symptoms such as sleep disorders, social withdrawal, decreased sexual desire, lack of pleasure in activities, irritability, and decreased appetite(Hobby; Hernandez, 1998; Capper).

The text discusses various mental disorders that are related to food restriction and anxiety. Panic disorders with severe panic symptoms, moderately serious borderline disorders with high levels of anxiety and impulsivity, as well as food restriction during schizophrenic psychosis periods are described. These conditions often persist chronically, leading to recurrent hospitalizations lasting for many years. This indicates the presence of significant factors that contribute to maintaining these disorders, both biologically and psychologically. Despite normalizing intake, nutritional patterns continue to change over time, as observed in studies conducted by Keys in 1950 and Garfield and Kaplan in 1985.

The original motivation behind supporting table maintenance in culture is to promote a specific body image for women, which idealizes a thin and youthful appearance. This ideal is not considered narcissistic at first, but it ultimately leads to interpersonal narcissistic gain. Moreover, achieving and maintaining this

desired physical state has complex implications for self-assessment among women. Therefore, we must question whether anorexia/bulimia has a stable and specific psychological structure or if it should be viewed as fluid and transparent. Alternatively, we could categorize it into different subtypes of psychopathology or underlying characteristics based on the works of Connors (1988), Swift, Stern (1982), and Selling Palazzo" (1999).

Through the integration of Jammed and Brushes' (1991) research, we have explored the potential application of addiction knowledge to this specific case. Their findings suggest that any emotional or relational state, whether obvious or concealed, holds the possibility of leading to addictive behavior (p. 84). In essence, individuals who prioritize their physical appearance extensively to support their narcissism may be susceptible to anorexic or bulimic tendencies, regardless of gender. The crucial factor for these symptoms to manifest is the extent to which an individual's narcissism is linked with their body and appearance. Studies indicate that a significant proportion of men affected by anorexia or bulimia are either gay or experience substantial concerns about their male identity.

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