Dimensions of physical and mental health

Dimensions of Physical and Mental Health 1

Dimensions of Physical and Mental Health

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Introduction

Tania is a 23 years old female living with her parents in the metro area. Her parents are

doctors while her younger brother is also a student of law, although both the parents are working

long hours but are caring and loving. As the parents are too busy hence for last one year Tania

cooks the food for the family yet never eats with the parents. She is gaining height but losing

weight which has come down from 66kg to 40 kg in one year. The parents, being doctors

themselves, are aware of the fact that there was no history of her being engaged in self-induced

vomiting, laxative abuse are concerned with her excessive exercise and self-induced food

restrictions. She became very fussy about eating because she thinks that she must lose weight as

she has turned fat. For two month she is checked by the family general physician for any visible

gastrointestinal disturbance and also to know why she seldom faints. Tania was advised to eat

fibrous diet and have an ECG. Tania believes that her parents are worried for no reason and are

trespassing her private life style which also is causing disharmony at the home. She denies any

physical complaints. Specifically, she denies any history of fatigue, fever, appetite or weight

change. She is active and a review of symptoms is completely negative. A psychosocial

(HEADSS) screening interview shows no existence of any disagreements with her parents. On a

separate interview with her parents, you discover that they have been concerned about her losing

weight since she began "eating healthier" over the past several months.

Negative self-image is considered as typical eating disorders, which are so complex

psychiatric disorders which causes psychosocial suffering for the affected persons. This disorder

affects young girls and adolescents, at a rate which has grown in the last several decades. Science

has proved that eating disorder is not only a psychological disorder that requires psychological


treatment. “Eating disorders are not a ‘state of the mind’ or lifestyle choice (Smolak, L. 2004).

These are serious mental disorders that have severe medical complications that can be fatal. Also

there is a high risk of suicide in these patients,” Familial, biological, social and cultural factors

are usually responsible for eating disorders. Body dissatisfaction and dieting, both common

among adolescents, are recognized risk factors for eating disorders. Eating disorders were a rare

phenomenon when Gull reported it for the first time in 1873, but now the prevalence rate among

adolescent and young adult women is raising concerns; there are between 8 and 13 anorexia

cases per 100,000 persons in the United States. ED rate is much higher in females between 15

and19 years (Van Hoeken, Seidell, & Hoek, 2003).

The psychopathology of eating disorder is known by the refusal to maintain normal

weight in anorexia nervosa, and by binge eating in bulimia nervosa. Adolescents also tend to be

socially withdrawn and are in the habit of dieting (Beumont, 2002). An ED person can express

different forms of negative self-evaluation (Lask, 2000). It is evident by the compulsive attitude

of being thinner (Garner, 2002) and an attitude of self-destruction is also present (Stein,

Lilenfeld, Wildman and Marcus, 2004).

Eating disorder, past and present

Young girls in developed countries are primarily affected with eating disorders. Persons

with anorexia are honest, do not disobey, and hide their inner feeling, tend to be good in

whatever they do and often excellent athletes. Research says that anorexia people eat less to gain

a sense of control over their lives. It is always easy to eat to one's heart content, but very hard to

stop eating even when the stomach demands more (Putterman, E., & Linden, W. 2004). The


disorder primarily affects young girls in the western society and usually has its onset in

adolescence. Hypotheses of an underlying psychological disturbance in young women with the

disorder include conflicts. Controlling their weight appears to offer two initial advantages: they

can take control of their bodies and gain approval from others. It eventually becomes clear

however, that they are out of control and dangerously thin. Lower self-esteem combined with

self-image which is negative are the typical characteristics of eating disorders, studies have

acknowledged that people with ED have dangerously low levels of self-image compared to

normal persons (Jhonson, Smith & Amer, 2001).

People with eating disorders may recover still they most of the time suffer residual

characteristics of this disorder like doubts about body image and weight (Button & Warren

2002). Some people with ED experience it for a short time while the other may suffer from it for

whole life. The outcome on ED research also has a number of problems, which are logical, like

using various outcome measures has been cited as one such explanation of the variability in the

rates of outcome found in ED (Calsen, 2004)

Literature Review

The general aims of the present thesis were to estimate the prevalence and incidence of

ED according to the DSM-IV in the general population of females (18-30 years), as well as risk

factors for the development of clinical ED across the ED diagnoses. There are at present no

perfect instruments for the assessment and evaluation of many complex psychological variables

(e.g., self-esteem and body concern). In fact, criticism can be raised against all instruments, since


the constructs they are intended to measure are so immensely complex, changing or even

controversial.

An Ecological Perspective of the Eating Disorder Phenomenon Since there has not been a

consensus between researchers pinpointing the etiology of eating disorders; I propose an

ecological model as the framework for which to examine this specific societal problem.

Sociocultural pressures are present in the family, through peers, and in the media. Such messages

manifest through relationships with other people. If we can increase awareness in families to

make them conscious of these sociocultural reinforcements, then we might be able to decrease

the problem of eating disorders (Fassino et al.2002).

It is, therefore, essential to understand that the adolescent woman and her family exist at

the center of an ecological model of eating disorders. With an ecological model, the individual

experiences her social environment in layers: first as a self, second through interaction with the

family, third though social interaction with institutions and peers, fourth with the media, and

finally with sociocultural norms and the ideology of her culture (Austin, 2000). Since the family

is the closest layer to the center (the individual), the family has the most potential to influence

eating attitudes and behaviors through its influence on development (Hoek, H. W., & van

Hoeken, D. 2003).

Parents have the most influence over their children’s behavior because they are the

“primary socializing agent” (Crowther, Kichler, Sherwood, & Kuhnert, 2002, p.149) of their

children’s behaviors. The family then is the first intervening variable in the development of


eating disorders. Applying a family systems perspective allows us to consider that “eating

disorders are not only an individual illness but also a „valid diagnoses of the family system‟”

(Prescott & Le Poire, 2002, p. 62). Families therefore have the potential to curb the problem of

eating pathology by channeling their children into activities that make them feel better about

their bodies and their capabilities. Also, parental connectedness and support, which includes

praise, encouragement, and physical affection, are indicators of adolescent adaptation and

positive development in youth (Corr PA, 2002).

While there are multiple risk factors for eating disorders reported in the literature, to date,

there have not been any conclusive results as to a direct cause and effect relationship of disorder

development. Thus, from the last five decades of research, risk factors have been named from

studies as “influences that increase the likelihood that disordered eating will occur” (McVey et

al., 2002, p. 76). The ecological model is useful when examining eating disorders because it

allows the researcher to move beyond exclusively blaming the media, peer influence,

sociocultural influence, or the family environment and helps the researcher examine the eating

disorder phenomenon more broadly.

Diagnosis and Clinical features

Women, from an early age, are challenged by the sociocultural messages about how

should the look, behave, although these messages are communicated through school or college

friends, workplace friends, family members, but it is through the mass media, especially the

electronic media which puts on the pressures and increases the chances of being not so satisfied


about their bodies which leads to negative effects, like anxiety about body image and weight

(Brambilla F. 2001). As these pressures are more on women than men hence the prevalence of

ED amongst them is high.

Eating disorders were a rare phenomenon when Gull reported it for the first time in 1873.

Eating disorder research has suffered in the past due to the problems of definitions of what

actually is eating disorder. Recently Fairburn and Walsh (2002) said that ED can be said to be ' a

persistent disturbance of eating behavior intended to lose weight, which significantly impairs

physical health or psychosocial functioning’. The refusal to have normal weight, or of obesity or

about body image are the characteristics of Anorexia nervosa which is of two different types, the

restricting type, when a person is not engaged in binge eating or diuretics' use and the purging

type, when a person engages is binge eating and uses diuretics. While Bulimia nervosa is about

recurrent episodes of binge eating. Binge eating is the consumption of excess food, hence person

suffering from bulimia nervosa self-induce vomiting, indulge in excessive exercise and use

laxatives. Bulimina nervosa is also of two types, the pruging type, when a person engages in

vomiting or uses laxatives and the non-purging type where the person indulges in excessive

exercise and is afraid about body image (Machado et al.2007).

Conclusion

There is a difference between anorexia nervosa and obesity, two different pathologies

with some mechanisms which appear to be the same. Obesity is an addiction like drug, where

food serves as the natural drug. While anorexia nervosa or ED is highly distractible, it has more


common anxiety disorder malfunctioning. Because anorexia nervosa is connected with the

functioning of the brain, hence there is greater need of such controls which reduces anxiety, like

relaxation, meditation and yoga.

References

Brambilla F. (2001) Social stress in anorexia nervosa a review of immunoendocrine relationship.

Physiology and Behavior 73:365-369.

Clausen, L. (2004) Time course of symptoms remission in eating disorders. International Journal

of Eating Disorders, 36(3), 296-306.

Corr PA (2002). J.A. Gray’s reinforcement sensitivity theory: tests of the joint subsystem

hypothesis of anxiety and impulsivity, Pers and Individ Diff. 33 511–532.

Fassino SP, Daga GA, Leombruni P, Mortara P, Rovera GG.(2002) Attentional biases and

frontal functioning in anorexia nervosa. International Journal of Eating Disorders 31,

274-283.

Garner. D.M. (2002) Easurement of eating disorder psychopathology. In C.G Fairhurn and K.D.

Brownell EEds) Eating disorders and Obseity. A comprehensive handbook (2nd ed pp.

141-151). New York. The Guilford Press.

Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating

disorders. International Journal of Eating Disorders, 34, 383-396

Jhonson, P., Smith, G.J., & Amner, G. (2001). The troubled self in women with severe eating

disorders (anorexia nervosa and bulimia nervosa). A study using interviews, self reports

and percep-genetic methods. Nordic Journal of Psychiatry, 55(5)m 3430349.

Lask, B. (2000). Aeitiology. In B.Bryant-Waugh & Lask, R. (Eds), Anorexia Nervosa and

Related Eating Disorders in Childhood and Adolescene (2nd ed., pp.66) East Sussea,

Psychology Press Ltd.

Machado, P. P., Machado, B. C., Goncalves, S., & Hoek, H. W. (2007). The prevalence of eating

disorders not otherwise specified. International Journal of Eating Disorders, 40, 212-217


Putterman, E., & Linden, W. (2004). Apperance versus health: does the reason for dieting affect

dieting behaviour? Journal of Behavioral Medicine, 27, 185- 204.

Smolak, L. (2004). Body image in children and adolescents: where do we go from here? Body

Image, 1, 15-28.

Stein, D., Lilenfeld, L.R., Wildman, P.C., & Marcus, M.D (2004). Attempted suicide and self

injury in patients diagnosed with eating disorders. Comprehensive Psychiatry, 45 (6),

447-451.

Veumont, P.J.V (2002). Clinical presentation of anorexia nervosa and bulimia nervosa. In C.G.

Fairburn ^ CK.D. Brownell (Eds), Eating Disorders and Obesity, A Comprehensive

Handbook (2nd, ed, pp. 162-171), New York: The Guilford Press.

.


Putterman, E., & Linden, W. (2004). Apperance versus health: does the reason for dieting affect

dieting behaviour? Journal of Behavioral Medicine, 27, 185- 204.

Smolak, L. (2004). Body image in children and adolescents: where do we go from here? Body

Image, 1, 15-28.

Stein, D., Lilenfeld, L.R., Wildman, P.C., & Marcus, M.D (2004). Attempted suicide and self

injury in patients diagnosed with eating disorders. Comprehensive Psychiatry, 45 (6),

447-451.

Veumont, P.J.V (2002). Clinical presentation of anorexia nervosa and bulimia nervosa. In C.G.

Fairburn ^ CK.D. Brownell (Eds), Eating Disorders and Obesity, A Comprehensive

Handbook (2nd, ed, pp. 162-171), New York: The Guilford Press.

.

Health & Medicine

Dimensions of physical and mental health