1.1 Amenorrhoea, low blood
pressure, dry and cracking
insufficient sleep, depression
and low self-esteem.
2 Clinical characteristics -
2.1 A BMI of below
18.5 is an indicator
and 15 is clinical.
2.2 Up to 20% of
Clinical AN are
2.3 Weight loss that is
Control of weight through
unusual eating behaviour.
2.4 Anxiety about being
overweight - excessive fear.
Fearful of weight gain.
2.5 Body image distortion - they do
not see their thinness and deny
the seriousness of their
extremely low body weight.
Thinness is vital to self esteem.
184.108.40.206 Hilde Bruch (1973): Origins in early childhood .
Effective parents (responding to child’s needs when
hungry) vs ineffective parents (who fail to respond
to child’s needs). During adolescence they try to
exert control and autonomy (more prevalent at this
time) but they may be unable to do so as they do
not own their own bodies. To overcome this they
can take excessive control over the body shape and
size by developing abnormal eating habits.
220.127.116.11.1.1 Origins in early childhood • Effective parents (responding to
child’s needs when hungry) vs ineffective parents (who fail to
respond to child’s needs) • During adolescence they try to exert
control and autonomy (more prevalent at this time) but they
may be unable to do so as they do not own their own bodies. •
To overcome this they can take excessive control over the
body shape and size by developing abnormal eating habits.
18.104.22.168 Psychodynamic explanations (Freud) – Adolescents don’t want to
grow up and separate from their parents. They become fixated at
the oral stage when they were completely dependent on their
parents. Anorexics lose weight, lose secondary sexual
characteristics, become childlike again (asexual) and return to the
safety of being a ‘little girl’ again (AO2: Gender Bias) . In Freudian
terms, eating and sex are symbolically related. A refusal to eat (the
only control, they feel they have) represents a refusal of: stages of
psychosexual development; eating as manifest representation of
22.214.171.124.1 Supported by observations that parents of
adolescents with AN don’t allow their children to
define their own needs. (Bruch). Explains why the
disorder affects more women and often starts as
126.96.36.199 The result of faulty maladaptive
thought processes about the self, the
body, and food/eating, e.g
misperceiving the body as overweight
when it is actually underweight.
188.8.131.52 Cognitive errors in EDs
184.108.40.206.1 All or nothing thinking ("I ate one
biscuit...that has blown everything!")
220.127.116.11.2 Overgeneralising ("If I fail at controlling
my eating, I fail in life.")
18.104.22.168.3 Magnifying/minimising ("My
weight loss isn't serious.")
22.214.171.124.4 Magical thinking ("If i reach size 8, my life
will be perfect.")
126.96.36.199.5.1 McKenzie et al (1993) – Female ED patients overestimated their
own body size in relation to other women – They judged their
ideal weight to be lower than comparable nonED patients –
Following a sugary snack, they judged their body size to have
increased. Controls did not.
188.8.131.52.1 AN is certainly associated
with biases and distortions in
184.108.40.206.1.1 However, most women are dissatisfied with
their bodies, not all of them develop EDs.
220.127.116.11.2 A good account of what helps to maintain
EDs, but not of what causes them in the
18.104.22.168.1 A learned
22.214.171.124.1.1 Eating can be associated with
anxiety since it can make people
overweight. Losing weight ensures
that the individual reduces these
feelings of anxiety. -> Feel fat/ugly
so diet and associate weight loss
with happiness and weight gain
126.96.36.199.1 Reinforcement of
from others (positive
reinforcement), avoidance of
e.g. bullying (negative
188.8.131.52.1.1 AN is a learned behaviour
which is maintained by
positive reinforcement (an
individual who diets and
loses weight is encouraged
184.108.40.206.1.2 Those that remain overweight get
criticised and are disapproved of
and sometimes face ridicule
because of their bodily
220.127.116.11.1.3 Positive reinforcement for
weight loss becomes so
powerful that the individual
maintains the anorexic
behaviour despite threats to
health which could result in
18.104.22.168 Social Learning
22.214.171.124.1 Media influences
126.96.36.199.1.1 Body image concern amongst adolescent girls
because of the portrayal of thin models. People
imitate and copy people they admire. Young
women see female role models rewarded for being
slim and attractive. Association of being slim with
being successful – vicarious reinforcement. Reward
is being received indirectly by observing another
person being rewarded. When they slim the
reinforcement will be direct.
188.8.131.52.1.2.1 Goresz et al (2001) support the view that the mass media
portray a slender beauty ideal. Review of 25 studies
showed that this ideal causes body dissatisfaction and
contributes to the development of eating disorders.
Effect most marked in girls under 19 years. Forehand
(2001) found that women feel undue pressure on their
appearance and reported that 27% of girls felt that the
media pressure them to strive to have the perfect body.
Increase in eating disorders in Fiji (Fearn 1999) with the
introduction of American television programmes which
emphasise a westernised idealised body shape.
184.108.40.206.2 People imitate people they admire
(Media/Peers etc) – vicarious
reinforcement (later reward for gaining
the look). They adjust behaviour to
achieve the looks of others and gain
220.127.116.11.1 Face validity in that in the Western society women are exposed to images
of thin women and have a complex relationship with food. Helps to
explain why so many women diet and why so many women are
dissatisfied with their body shape. Problem in that this analysis cannot
explain why only a minority of women develop eating disorders. Does not
help explain why that so many anorexics continue to starve themselves
when they no longer receive praise and compliments about their size – it
could be about the attention that they receive that’s reinforcing being
anorexic. Underplays the cognitive aspects of anorexia – eg it does not
really explain the faulty perceptions of body image that play such a large
part in eating disorders.
18.104.22.168 Neurotransmitters - serotonin and
dopamine . Neurodevelopment -
Pregnancy and birth complications.
Season of birth
22.214.171.124.1.1 Disturbances in these levels. Higher serotonin activity in women
recovering from binge eating/purging type anorexia. Highest levels
of serotonin activity in women who showed the most anxiety. High
levels of serotonin are associated with jittery, anxious feelings. In
order to get rid of these anxious feelings – the person may stop
eating. Suggestion then, that it is the anxiety that triggers Anorexia
and that AN is just a symptom of getting rid of the anxiety.
126.96.36.199.188.8.131.52 Issue in that people with AN when given SSRI’s –
makes no difference. Only when used with recovering
AN patients does it prevent relapse. Lack of food may
stop the SSRI’s from working – but then becomes
successful when food is put back into the body.
184.108.40.206.2.1 PET scans: Comparison of dopamine activity in brains of 10 women
recovering from AN and 12 healthy women. Overactivity in dopamine
receptors in the basal ganglia. This area dopamine plays a part in
interpretation of harm and pleasure. Increased activity alters the way
in which people interpret rewards. People with AN find it difficult to
associate good feelings with what we normally derive pleasure in – e.g.
220.127.116.11.18.104.22.168 Support from adolescent girls who had higher levels of
homovanillic acid (waste product of dopamine).
Improvement in weight levels associated with
homovanillic levels normalising. Obese individuals – had
lower than normal levels of dopamine receptors which
means that dopamine levels are perhaps related
somehow to body weight.
22.214.171.124.3 Neurodevelopment -
Pregnancy and birth
126.96.36.199.3.1 Association between premature birth and AN.
Brain damage through birth complications
causing hypoxia, impairing neurodevelopment of
the baby. If mother has eating disorder then
baby not getting the nutrition needed. Double
disadvantage – as mothers transmit a genetic
vulnerability to AN plus inadequate nutrition.
188.8.131.52.184.108.40.206 Obstetric complications
220.127.116.11.18.104.22.168.1 Support from Favaro et al (2006): perinatal
complications significantly associated with risk of
developing AN – placental infarction (obstructed
blood supply in the placenta) and early eating
difficulties and low birth weight.
22.214.171.124.4 Season of birth
126.96.36.199.4.1 Individuals with Anorexia more likely
to be born in spring time. People will
get infections in the 2nd trimester –
time of year for getting them.
Infections such as intrauterine
infection and high temperature.
188.8.131.52.184.108.40.206 Support by Willoughby et al (2005) - they found no
seasonality effect in the development
of AN where it is hot all year round.
220.127.116.11.18.104.22.168 Support by Eagles et al 2005 – AN individuals are later
in birth order compared with healthy controls. The
more elder siblings the child has whilst in the womb
the more likely the mother will be exposed to common
infections. Critical period for brain development is
22.214.171.124 The reproductive suppression hypothesis.
The adapted to flee hypothesis (AFFH)
126.96.36.199.1 The reproductive
188.8.131.52.1.1 Evolution delays the onset of
sexual maturation in response to
cues in the environment about
the probability of poor
reproductive success. It enables
the female to avoid giving birth at
a time when conditions are not
conducive to the survival of her
offspring. Anorexia Nervosa is a
‘disordered variant’ of the
adaptive ability – when may feel
unable to cope with biological,
emotional and social
responsibility of womanhood.
184.108.40.206.1.2.1 Weight loss was a strategy
for suppressing reproductive
capability when food was in
limited supply. Pregnancy
would have been risky for the
mother and survival chances
for the infant would have
been reduced in the absence
of contraceptives. Weight
loss would prevent
pregnancy at times when it
would be too risky
220.127.116.11.1.3 Based on 2
18.104.22.168.1.3.1 The reproduction
22.214.171.124.126.96.36.199 Because reproduction is costly to
females, a female facing
unfavourable to reproduction can
increase her lifetime
reproductive success by delaying
reproduction until conditions
188.8.131.52.1.3.2 The critical fat
184.108.40.206.220.127.116.11 Because a minimum amount of body fat (17%) is
needed before menstruation begins and
additional fat accumulation (22%) is needed to
maintain regular ovulation (Frisch, 1985; Frisch
and Barbieri, 2002). Altering the trajectory of
adolescent weight gain, or the loss of five pounds
or so, could have been an effective mechanism for
controlling sexual maturation and fertility in
18.104.22.168.1.4.1 More females than males -
more competition from
other females = not all
females can mate, so those
that don’t need to ‘save’ up
for lost time
22.214.171.124.1.4.2 Attention from ‘undesirable’ males - the youngest
females are the most vulnerable because they lack
emotional maturity/confidence to rebuff
unwanted attention = makes sense to delay
reproductive ability until older (when more likely
to make the ‘right’ choice of a mate).
126.96.36.199.1.5.1 For: Amenorrhea & the
onset of puberty is
delayed . Based upon
observations of species
188.8.131.52.1.5.2 Against: How are the symptoms passed on because
this behaviour (AN) will decrease fertility & can kill?
General problems with the Evolutionary theory
184.108.40.206.2 "Adapted to flee"
hypothesis (AFH) -
220.127.116.11.2.1 Symptoms reflect adaptive mechanisms that caused
migration when local famine conditions occurred. Food
restriction is a common feature when competition for
food, and migration behaviour. Therefore for
modern-day individuals, those with a genetic
pre-disposition to Anorexia, losing too much weight may
trigger ancestral mechanisms. e.g. ‘Holy Anorexia’ in
Middle Ages (saints recognised for miraculous ability to
live without food)
18.104.22.168.2.2.1 For: Treatment Implications – Guisinger claims AFH
‘relieves therapists of the need to search for familial
reasons for Anorexia’. Awareness of this causal
influence can help treatment and encourage
parents to be more compassionate towards their
22.214.171.124.126.96.36.199 This treatment implication is Reductionist as it is
ignoring other possible and more complex explanations.
188.8.131.52.2.2.2 Against: How have the symptoms
been passed on? Anorexia would
function effectively in ancestral
conditions but can be deadly outside
the ecological setting.
184.108.40.206 General criticisms of
220.127.116.11.1 Reductionist – not search for more complex
explanation, such as the emotional relationships
within families as a cause. Deterministic – view
that an individual’s behaviour is shaped/controlled
by internal forces rather than an individual’s will to
do something. Cultural Influence – doesn’t
acknowledge the importance of cultural influences,
e.g. if it is adaptive & innate then why doesn’t it
happen in all cultures?