Evaluation of the Contribution of the Biological and Psychoanalytic Schools of Thought in Psychology to the Understanding of Anorexia Nervosa

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Denitsa Radeva-Petrova, 09249520

Biological and Psychoanalytic Approaches to Anorexia Nervosa

Individual Differences and Conceptual/Historical Issues in Psychology, 7PSY0076

Evaluation of the Contribution of the Biological and Psychoanalytic Schools of Thought in Psychology to the Understanding of Anorexia Nervosa Anorexia Nervosa (AN) is an eating disorder, characterised by a refusal to maintain body weight that is at least 85% of what is considered normal for an individual’s height and age (APA, 2000). It is associated with an obsessive fear of gaining weight, which typically intensifies as the Body-Mass Index (BMI) decreases. People with anorexia believe that they are overweight and continue to diet even when they are severely emaciated (Hansell & Damour, 2005), which supports the idea of a distorted self-image or perception of one’s own weight and shape. Another important diagnostic criterion includes the absence of at least three consecutive menstrual cycles in postmenarcheal females (APA, 2000). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) distinguishes between two subtypes of AN, based on the method of weight loss. Anorexics who lose weight by bingeing and purging (self-induced vomiting), or by misuse of laxatives and diuretics, are classified as having binge-eating/purging type anorexia. Those who lose weight by restricting their food intake but do not engage in binge-eating or purging behaviour are classified as having restricting type anorexia (APA, 2000). The incidence and prevalence rates of AN are relatively low. The reported incidence ranges from 4.2 to 8.3 per 100,000 person-years (Miller & Golden, 2010). The disorder usually affects women. The male-to-female ratio is estimated at about 1:10 to 1:15 (HerpertzDahlmann, 2009). Incidence rates are highest for females aged 15-24. The 15- to 19-year-old female age group is at highest risk (Wakeling, 1996). The average point prevalence rate in young females is 0.29% (Hoek & van Hoeken, 2003). In spite of the fact that the prevalence of strictly defined AN is only about 0.5%, in some regions and countries AN is underreported. Also, the prevalence rates of partial syndromes are substantially higher and most studies suggest that its incidence has increased significantly during the last 50 years (APA, 2000), not only in the Western, more developed and industrialised countries, but all over the world, and not only in females, but in males as well. Where the age of onset is 8-15, about 25% are boys (Gross, 2009). AN had been described as the third commonest illness in 2

Denitsa Radeva-Petrova, 09249520

Biological and Psychoanalytic Approaches to Anorexia Nervosa

Individual Differences and Conceptual/Historical Issues in Psychology, 7PSY0076

adolescence (more specifically, in girls aged 15-19), after obesity and asthma (Wakeling, 1996). It has a high incidence of comorbidity and is defined as the mental disorder with the highest mortality rate, with a crude mortality rate (the proportion of deaths in the study population) reported to be up to 10% and as high as 15%-16% in studies with a 20-year follow-up period. According to the Eating Disorders Association, mortality rates may reach 20%, death arising from both the effects of starvation and suicide (Gross, 2009). Anorexic women are 12 times more likely to die than age-matched controls in the general population (Miller & Golden, 2010). AN has been recognised and named in the late nineteenth century but even nowadays its aetiology, or what triggers its onset, largely remains an enigma. The seriousness and complexity of the disorder explain the numerous attempts made by researchers to find out its underlying causes, medical history, the “key” to early diagnosis and treatment, as well as the ways to successfully maintain the restored weight in patients who have responded favourably to treatment. Each of the major theoretical perspectives in psychology has offered...
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