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Anorexia nervosa is an eating disorder which is usually onset in early to middle adolescence. There are actually two types of anorexia nervosa; the restricting type and the binge-eating-purging type. The restricting type is the type that people are most commonly aware of, in which a person loses weight by greatly restricting intake. Binge-eating-purging type anorexia is less well known and consists of occasional episodes of binge eating and purging (using self-induced vomiting or laxatives) in addition to restrictive intake of food. Around two thirds of patients who begin with restricting type anorexia will end up transferring to binge-eating-purging type anorexia. Many patients with anorexia nervosa also exercise excessively.
The diagnostic criteria of anorexia nervosa are as follows:
- Refusal to maintain a normal weight. Usually a person weighs less than 85% of what is considered normal for their height.
- An intense fear of gaining weight or being too fat. This fear is not reduced by weight loss.
- Distorted body image or sense of body shape. Those with anorexia nervosa always feel they are too fat and usually weigh and measure themselves frequently. They often spend a lot of time criticizing themselves in front of mirrors.
- In women, amenorrhea (loss of periods) which signifies being significantly underweight.
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Why Do Men Get Anorexia?
Anorexia nervosa is typically thought of as a female disorder. Indeed, it is at least ten times more frequent in women. This difference is thought to reflect the cultural emphasis on the female body. Women are predominantly judged on their appearance and the female body is of greater focus in the media in comparison to the male body. However, while the female body is still undoubtedly in the spotlight, the male body is also becoming a subject of scrutiny. There is more focus on men's appearance than ever before. The ideal female body that is promoted by the media is unrealistically thin and this is thought to be a primary cause of anorexia nervosa. While the male ideal is usually seen to be a toned and muscular body there is also an emerging parallel ideal of an equally thin male. Therefore, it is unsurprising that cases of male anorexia are increasing.
Male and female cases of anorexia nervosa have been found to have similar symptomatology and patients report similar backgrounds. Therefore, there is not thought to be any significant difference between male and female anorexia and therefore the same treatments are used. Anorexia nervosa is difficult to treat and the risk of death is twice as high as that of other disorders. Death is usually caused by physical complications caused by being extremely underweight or by suicide.
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Family Therapy as a Treatment for Male Anorexia
The principle treatment for anorexia nervosa is family therapy. This is because it is thought that family interactions play an important role in the development and maintenance of the disorder. However, regardless of whichever treatment is attempted the first goal of treatment is usually to help the patient gain weight in the short term. The patient is often desperately thin by the time treatment is sought. Sometimes hospitalisation and force feeding is necessary but operant conditioning behavior therapy programs have been shown to be effective in the short term.
Once the patient is out of immediate danger treatment can concentrate on helping the family to work through the disorder and enabling the patient to maintain a healthy weight. Family therapy sessions are usually conducted at lunchtime as it is thought that conflicts related to anorexia are most evident at meal times.
In family therapy there are three main goals:
- To change the 'patient role' of the person with anorexia.
- To redefine the eating problems as interpersonal rather than individual.
- To prevent family members from using the disorder as a means of avoiding conflict.
It is thought that by doing this the symptomatic family member is freed from having to maintain their disorder. A typical strategy in family therapy is to have both parents try individually to force their child to eat. This is expected to fail. The parents then work together. This stops eating being a source of conflict and allows eating to produce cooperation and increase parental effectiveness. There is not as much research on treating anorexia nervosa, particularly male anorexia, as would be expected, probably because it is so difficult to treat. Medications have also been found to be unsuccessful. The limited research that does exist suggests that family therapy is a mostly effective treatment.
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Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.
Hall, A., Delahunt, J.W. & Ellis, P.M. (1985) Anorexia nervosa in the male: clinical features and follow up on nine patients. Journal of Psychiatric Research, 19, 315-321.