The Social Construction of Anorexia Nervosa, Research Paper Example

Introduction

Few illnesses are as challenging as Anorexia Nervosa (AN), both in terms of comprehension and treatment.  This is, in no uncertain terms, a serious illness that reflects psychological, biological, and social components of the individual’s life, and exponentially so; as the disease takes hold, effects tend to exacerbate the condition itself.  Exact causes of AN are unknown (Lock, Le Grange, 2012,  p. 4), but extensive evidence supports that it is a pathology induced by severe issues with self-image, which result in sufferers starving themselves.  Moreover, the illness as generated by such issues is reinforced by the fact that the vast majority of victims are adolescent females, gripped by a disorder demanding they reshape their bodies to conform to cultural ideals.  That AN is so inherently complex, and influenced by emotional and physical states, renders treatment difficult.  Research continues but, as will be explored, it appears that no substantive progress may be made in the fight with AN until the culture addresses those ideals prompting it.

Analysis

The actual complexity of AN may be best seen through examining the difficulties in diagnosis alone.  In arenas of mental health, diagnosis is typically problematic; with AN, it’s something of a mine field.  On one level, AN sufferers frequently exhibit identical symptoms: mood swings, the comorbid state of depression, sporadic sleep patterns, low self-esteem, inability to concentrate, and the key symptom of disjointed and usually minimalized eating.  AN, differences in types and dilemmas in diagnosis aside, is definitely an eating disorder wherein the individual willfully starves the body.  This is, as noted, widely considered a consequence, at least in part, of cultural influences.  The sufferer – female, in nine out of 10 cases – perceives themselves to be overweight and unattractive, and thus denies themselves food to a radically unhealthy extent (Hepworth, 1999,  p. 72).  At the same time, many symptoms may be related to other pathologies, in which cases the AN itself is more a symptom than the core illness.  For example, it is noted that male AN sufferers tend to be more harsh in their refusal of food to the body, but this may be due to clinical schizophrenia rather than to AN (Hepworth, 1999, p. 73).  Then, studies uniformly affirm that severe anxiety disorders accompany at least one-third of potential AN cases, as clinical depression is identified in nearly 60 percent (Hersen, Turner, Beidel, 2011, p. 580).  In plain terms, when extreme depression and a variety of other symptoms of mental distress are present, it becomes all the more difficult to identify AN as the chief disorder.

Further complicating the arena is that AN is often confused with bulimia, or binge-eating, when the reality is that bulimia is more likely to be symptomatic of another disorder.  Part of this is due to the shared trait of a resistance or antipathy to food, but the complication is exacerbated by the linking of the two illnesses in the public mind.  When stories of girls starving themselves are reported in the media, for example, it is usual for the case to be identified as both AN and bulimic, as occurred in the news of singer Karen Carpenter’s death (Hepworth, 1999,  p. 59).  There are, however, important distinctions between the disorders, even as bulimia is often characterized as a “sub-pathology” of AN.  The most critical difference goes to intake of food.  The bulimic may be a purging type, inducing vomiting or laxatives to expel food consumed, or the non-purging type who employs behaviors like excess exercise to counter perceived weight gain.  The bulimic, however, eats, whereas the AN sufferer makes every possible effort to avoid eating (Hersen, Turner, Beidel, 2011, p. 572).  Both disorders are linked by the impetus of poor self-esteem as related to self-image, but the manifestations are importantly different.

In true cases of AN, there is a very real risk of death.  The body image is so distorted in the individual’s mind that starvation is rendered virtually necessary.  Given the scope of the distortion, there is no “ideal” weight; only becoming more thin is desired.  Consequently, AN behaviors run along similar paths.  As may be obvious, the individual goes to great lengths to avoid eating, prompted by a pathological dread of gaining weight.  As far more females are victims, another diagnostic instrument is that of menstruation, as girls with AN typically cease to menstruate at a certain point because the starved body is incapable of carrying out this function (Harari, Legge, 2001, p. 17).  Various methods of treatment, as will be discussed, are developed and applied, but the pathology is often so extreme that death by starvation occurs.  The AN victim so adamantly perceives themselves as not being underweight that even forced feedings are often inadequate.  There also exists in such radical interventions the likely exacerbating of psychological conflict; as the force-fed AN patient is coerced, the progress made by therapeutic treatment is reduced, and the mental disorder is actually amplified (APA, 2006, p. 1158).  This is, in no uncertain terms, an illness that claims lives.

With regard to causal agents, there is some evidence that AN, or symptoms of AN, may be rooted in biological factors.  Unusual hormonal and glandular activity have been identified as consistent with AN, and some researchers believe these agents generate the condition.  More common is the thinking that such biological processes maintain, rather than cause, AN (Hepworth, 1999,  p. 84).  There is no strict dichotomy between the mind and body and, when someone undergoing severe psychological dysfunction at the level of AN, the body responds in ways that exacerbate the illness and amplify the mental disturbance.  For example, extreme anxiety, noted as typical in AN cases, is something of a self-perpetuating condition.  In the case of AN, it is probable that increased fears regarding exposure, as well as an ongoing dissatisfaction with weight, only increase anxiety levels.  Then, as the body is starved, sleep deprivation further creates unease.  No matter the actual biological occurrences in AN, it seems evident that they are inextricably linked to the pathology of the disease.

That cultural influences play a significant part in the development of AN, however, appears irrefutable.  It is widely established that, certainly in Western societies, the cultural norms have consistently favored an ideal of women as very slender.  The vast majority of AN cases being female reinforces this factor.  In such cultures, a kind of social imperative is attached to female body weight.  To be very thin  is to be attractive, successful, popular, and happy; to be overweight is to be rejected, undesired, and miserable.  Some of the cultural interpretations surrounding AN theories is subject to intense debate, particularly in regard to how family dynamics and sexual identity are viewed.  Freudian theory here, by no means unconsidered even today, asserts that AN is an hysterical reaction caused by the girl’s unwillingness to achieve a state of woman as a sexual being; starved, the body cannot maintain sexual function.  The AN reflects an absolute refusal of femininity, and it is hardly surprising that feminist discourse on the subject, commencing in the 1970s, perceived such thinking as repressive and removed from the core issues generating AN (Hepworth, 1999,  p. 49).  Nonetheless, psychiatrists today, if setting aside Freudian views regarding a female propensity to hysteria and other aspects, do not dismiss the sexual component as fueling AN.  This is an element simultaneously and powerfully linked to the individual’s sense of identity, gender worth, and social value.

Perhaps most interesting in regard to social and cultural influences in AN are the theories holding how the illness is, in a sense, an effort on the part of the female to free herself from cultural boundaries.  As noted, Western culture has emphatically endorsed excessive slimness in women, and it is reasonable to then conclude that young girls, eager to be accepted by their society, would develop a pathology to enforce this state of being in themselves.  At the same time, and partially – and ironically – due to the media attention given to AN, it is believed by some researchers to be a mode of liberation.  Some AN cases, it is felt, fully embrace that the self-destructive nature of the illness separates them from the mainstream (Hepworth, 1999,  p. 60); in starvation a more true identity is felt to be achieved, just as the starving girl is defying all the precepts of the culture.

As noted, designing treatment for AN is an ongoing and controversial process.  The forcing of foods, either orally or intravenously, is generally considered a last resort measure.  More typical are various psychiatric and therapeutic treatments, in which the individual degree of the pathology may be addressed as such.  AN encompasses a wide range of levels of illness, just as each victim reflects a differing level of accepting therapy.  A recent focus, however, is on family-based therapy (FBT), in which the environment most intimately known by the AN patient is employed to effect change.  That so many AN patients are adolescent girls is valuable here, for they are still within the home and the scope of family influence.  One form FBT takes, in concert with family therapy sessions, is the establishing of eating regimens in the home: “The parents must create a culture in which there is no alternative to eating” (Lock, Le Grange,  2012, p. 66).  There has been indication of success here, primarily because the key factor of the home culture is altered.  At the same time, new research continues to formulate new methods of treatment, as new information regarding influences and causes generates further options.

Conclusion

The inescapable complexity of AN renders the treatment of it highly problematic.  As debate still rages regarding actual cause, and as controversy still surrounds diagnosis, it is then unlikely that a single and effective approach be developed.  Meanwhile, people, and primarily young girls, are literally starving themselves to death.  Factors promoting this grossly unhealthy pathology continue to be explored, and include early Freudian theories on a deep-seated female unwillingness to sexually mature to the effects of hormonal imbalances.  What is not disputed, however, is that culture plays a significant part in the illness.  The connection is too blatant, as girls starve themselves in societies wherein they are bombarded with images of female perfection as hyper-thin.  Added to this is the bitterly ironic component of AN as having attained a kind of cultural presence or prestige unto itself, which may influence women not specifically reacting to the threat of the cultural stereotype.  Further work must be done in identifying and countering this extraordinary and insidious illness, and the efforts are being made, particularly in regard to the benefits of family therapies.  Nonetheless, given the clear attachment between culture and sufferer, no definitive progress may be made in the battle with AN until the society addresses the unhealthy and pervasive ideals prompting it.

References

American Psychiatric Association (APA). (2006).  American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006.  Arlington: APA.

Harari, P., & Legge, K.  (2001).  Psychology and Health.  Chicago: Heinemann.

Hepworth, J. (1999).  The Social Construction of Anorexia Nervosa.  Thousand Oaks: Sage Publications.

Hersen, M., Turner, S. M., & Beidel, D.C.  (2011).  Adult Psychopathology and Diagnosis. Hoboken: John Wiley & Sons.

Lock, J., & Le Grange, D.  (2012).  Treatment Manual for Anorexia Nervosa, Second Edition:

A Family-Based Approach.  New York: Guilford Press.