It seemed to me that the older I got, the more obsessed people seemed about
their bodies. Whether it was the diet soda boom of the 80's, or the fact
everyone has always been unhappy with his or her natural bodies; it just took me
a while to comprehend. It always seemed like there were diets here, diets there;
these drugs can do this, or these herbs can do that "Stop the
insanity!" This paper is going to discuss anorexia nervosa, an alarming
disease that is usually developed during puberty of both boys and girls. Like
bulimia, in which the subject binges and then disposes of ingested food by
purging or use of laxatives, those suffering anorexia nervosa have an obsession
with the amount of fat on her body (although one of every ten suffering this
disease are male, I will use the female pronoun since they are the majority).

This results in the loss of appetite completely and dangerous weight loss. More
than thirty years ago one of this century's major sex symbols sang, "Happy
Birthday, Mr. President," on television. With her size fourteen to sixteen
figure, it is doubtful that society's standards would approve Marilyn Monroe
today. Back in those days men and women alike ate what tasted good or what the
body needed and simply bought clothes that would hide any unwanted weight gain.

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Today the story is different. Psychologists that study the influence of
television on children say that television is the most influential medium in our
"visually orientated" society (Velette, 1988, p.3). With the influence
of television and celebrity role models, children don't care that they see a
variety of sizes outside of their home, what they care about are the majority of
people shown on the television set, perfect. Teenagers have typically watched
15,000 hours of television in their lifetime (Valette, 1988, p.4), absorbing the
opinions on the shows or the commercials burning into their retinas. The message
transmitted: "To be successful, beautiful, popular, and loved you must be
thin, you must be thin, you must be THIN." After a lifetime of hearing this
message over and over and over again, children may not think there is any reason
to be happy with what they are and feel thinness is the ultimate goal to be
happy and accepted by others. As a result, some children may skip breakfast, eat
a little for lunch, or even adopt some form of diet. This may only last for a
week or so, but for others, the obsession of thinness is higher and the price
they pay is frightening. This paper is going to discuss the cycles of anorexia
nervosa. It will detail the symptoms, behavior, and clinical observations. It
will describe the possible causes of anorexia nervosa through childhood growth
and puberty, childhood eating and social behavior, and the maturation of
children during puberty. Finally, I will discuss the treatment and results of
treatment for anorexia nervosa. Before diving into the details of anorexia
nervosa, there are a few individual traits that may appear in a person that may
have an eating disorder: low self-esteem, feelings of ineffectiveness or
perfectionism, issues of control, and fear of maturation. The more physical
description is chilling. The anorectic victim does not look "thin" as
society's standards portray, but are in fact a walking skeleton with the absence
of subcutaneous fat. Her weight may range from as little as 56-70 pounds or
77-91 pounds. Though clothes are likely to cover most of her figure, her face
appears gaunt and her skin is cold and red or blue in color. Do to the lack of
fat in her body, her menstrual cycle is likely to have ceased. Despite these
conditions, she still sees herself overweight and thus unacceptable. Thinness is
idealism and perfection. It is her independent choice that no one else can take
away from her. At the beginning of anorexia nervosa the subject will first
change her diet, restricting how much she eats and usually cutting out starchy
foods. Seventy-percent of a particular study claimed they were simply dieting.

The rest used excuses of abdominal pain, difficulty swallowing, or simply a lack
of appetite (Dally, 1979, p.14). Those dieting had innocent intentions at first,
even the approval of family members or peers, but as they reached their target
weight the dieting did not slow down. In some cases it only became more intense.

Hunger does not just disappear into thin air. There is a long and hard battle
against stomach pains, sometimes resulting in lapses. However, the guilt or
disgust felt from giving into the temptation of food results in more willpower
for resisting food in the future. The process of eliminating hunger usually
takes up to a year (Dally, 1979, p.14). Sometimes hunger cannot be ignored. The
girl will think about food all day long as if in pleasure. Ritualistically,
she'll eat very slowly, savoring each bite of food that is cut into small
pieces. She will insist on cooking food for herself and sometimes preferring to
eat only alone, where she can enjoy her food without feeling self-conscious.

Another approach towards hunger is indirect satisfaction by reading cookbooks,
reading about healthy foods and ways to eat, cooking for others, or just
watching others eat. Though an anorectic avoids fattening foods by all costs,
oddly they enjoy cooking fattening feasts for family members to enjoy and are
even offended if any food is not eaten. A majority of anorectic patients are
above average in intelligence, physically attractive, and of the upper class.

They have low self-esteems and strive for perfection. The family they come from
usually tends to be weight-conscious, such as a mother that is always on diet
plans, and somewhat controlling over the daughter's life. Although there are two
types of anorexia nervosa, primary and secondary, primary anorexia nervosa is
the most common, and the type being discussed in this paper. Secondary anorexia
nervosa is developed adults of average intelligence and of middle or lower
class. Primary anorexia nervosa is developed during puberty between the ages of
11 and 18 and usually by females. Only one of every 10 anorexia nervosa patients
are male. Childhood is a very sensitive time period for all human beings. The
brain is developing while the body grows. Morals and knowledge are being
absorbed by daily activity and outside influences. It is this time that a danger
zone may develop, negative behaviors are adapted and cannot be stopped. There is
no overall difference between the childhood growth of a normal child or the
childhood growth of an anorectic. Most likely they were skinny but had a high
fatness and height growth rate before their peers. As a result, during puberty
the subject may be more sensitive about her appearance. Recalling past
experiences from anorectic patients is difficult because these patients already
have an exaggerated perspective of themselves and are likely to exaggerate what
they went through as children. Through the careful recollection of families,
however, a more likely picture of a soon-to-be-anorectic child can be drawn. As
a child, anorectics are described as tomboys that shared interests with her
father such as sports and watching football. They are described as obedient
children that never wanted to grow up (Crisp, 1980, p.48). Maturation in puberty
develops anxiety in most girls. The first step for females in puberty is the
development of breasts, leading to embarrassment and the feeling of
"fatness". Other changes happen that are very undesired such as the
thickening of the stomach and thighs and menstruation. Girls tend to take these
natural changes as changes happening to them instead of a natural process that
happens to all females. They develop distorted images of their bodies, such as a
little potbelly as looking pregnant, or breasts that are bigger than those of
their mothers. Some of these girls get over these self-conscious thoughts while
others become obsessively preoccupied. The first step of treatment for anorexia
nervosa is for family members or loved ones to step in and take her to get
serious help. Most doctors and psychologists suggest that the subject be
separated from her family. A family or an inexperienced therapist may allow the
anorectic to promise and thus procrastinate the process of healing, resulting in
no real physical or mental healing (Dally, 1979, p.106). After being admitted
into treatment starts the difficult process of healing involving psychiatrists,
physicians, nurses, and dieticians. The first goal of treatment is to determine
a target weight for the patient by figuring out the average height and weight of
their age set and to reach approximately 90% of that ideal weight. The reasons
it is important to gain back the weight before psychological treatment is
because anorexia nervosa brings a halt to physical and psychological maturation
as well as emotional development when it is most important. There are two major
ways in which therapists approach feeding. The more passive technique is to give
the patient the food she must eat but allowing her to consume it at her own
pace. The side effects of this is that lack of patience a nurse may cause some
disturbance and frustration, for sometimes the subject may not even finish her
meal before it is time for her next one. The second approach is much more
aggressive. In this approach, tube feeding is forced if the patient refuses to
eat, resulting in much more rapid weight gain. In both techniques, the more the
patient cooperates and recovers, the more freedom and visitors they are
permitted. However, when a patient is difficult, she will be restrained to her
bed and tube fed until she eats regularly. The next step is cognitive treatment,
also known as the "Interview". In this step the therapist can really
build a case on the patient and listen to her story. Questions will be asked
about what she thinks of her body, usually with negative results. On the other
hand, when asked about another anorectic with the same weight and height, the
subject studied will comment on how she is too thin. She will also be asked
questions such as, "What worst thing that could happen if you ate
more?" Questions like these may bring a reality into the anorectic's mind
after similar questions are brought up to think about (Long, 1992). Once both
weight and clear thinking is resolved, the patient is ready to return home. Like
alcoholics and other substance abusers, once freedom is allowed, chances of
relapse are possible. The therapist must make sure the patient is
self-disciplined with lifetime goals by resolving any emotional conflicts that
may lead the patient back to her previous lifestyle for satisfaction. It is also
important for the family of the anorectic to attend family therapy as well, to
get over being too protective or in denial of any conflicts and to approach the
problem of their daughter or son in a different fashion. The support of peers
and family are very important for the anorectic so not to return to the
self-satisfying lifestyle of pursuing a "perfect" weight. Anorexia
nervosa is a frightening disease for the families and for society to deal with.

As social animals, the signals sent out by the people around us and the media
tell us that if we want to be happy, successful, or loved we need to be thin and
beautiful. When we were children our mom would be talking on the phone to a
friend, "I think Jennifer could date Mike easily if she just lost 15
pounds." Almost every female is envious of another and unhappy with the
body that she is blessed to have. Being skinny has been pounded into our minds
since the day we develop self-esteem by those depicted on television and the
natural need to feel desired or accepted by others. When I was in high school I
was always self-conscious about how others viewed my physical appearance. I
would compare my body to that of other girls in the class. I went on varying
diets, from eating healthier food to crash diets. It was a ridiculous mindset
when I look back upon it. It wasn't until my last year of high school that I
decided that I was happy with my appearance and did not need to be preoccupied
by what others thought of me or what the media told me I should be. What was
frightening to me was learning in health class about anorexia and bulimia and in
the back of my mind thinking of those ruinous lifestyles as future alternatives.

Afterwards, I thought about how many other girls in that class, or that has seen
that video, were thinking the same thing and possibly acting upon these
thoughts. What can parents and peers do about this problem? With 1 out of every
500 teenage girls suffering this disease, I believe parents and teachers should
be educated about the subject, this way as soon as symptoms become apparent,
intervention occurs before major growing or developing problems may occur. We
cannot change society's general view of what perfection is, or expect influences
to consider what it has done to the self-esteem of our children. However, we can
influence the way our children view weight and physical appearance by teaching
them how to accept who they are. This may be accomplished by explaining the
natural changes in their bodies during puberty and offering healthy approaches
towards building self-confidence such as activities that do not revolve around
physical ability or appearance. Children cannot help but absorb the world around
them, it is our duty as adults to help them filter out what may lead to
self-destruction.


Bibliography
Banks, Tyra. (1998). Tyra's beauty: inside and out. New York. Harper Pernnial.

Berk, Laura E. (1997). Child development. Boston. Allen and Bacon. Crisp, A.H.

(1980). Anorexia nervosa: let me be. London. Academic Press Inc. Dally, Peter
and Gomez, Joan. (1979). Anorexia nervosa. London. William Heinemann Medical
Books Ltd. Long, Phillip W. (1997). Eating disorders. Harvard Mental Health
Letter, 9. 47 paragraphs. Online. Available at http://www.mentalhealth.com/mag1/p5h-et03.html
1999, March 1. Valette, Brett. (1988). A parent's guide to eating disorders.

New York. Walker
Psychology