Adolescence is a physically and mentally challenging phase of development that can result in negative body image and body-related dissatisfaction. The adolescence period is characterized by the appearance of secondary sexual characteristics due to increased body hormones leading to body dissatisfaction. The body changes are associated with feelings of decreased social acceptance and a false feeling of insufficiency that can be the starting point for psychological problems (Magrini et al., 2022). The psychological disorder that happens in the context of poor body image following increased body weight is anorexia nervosa. The majority of people take their ability to eat for granted. However, anorexia is a serious psychological disease among young people’s most common chronic illnesses and is usually related to significant personal, familial, and social consequences. Compared to other significant adolescent illnesses like asthma, type I diabetes, and any other mental disease, the mortality of anorexia nervosa is higher.
Causes of Anorexia Nervosa
The relevance of anorexia nervosa to psychology is that its pathogenesis has been based on the cognitive behavioral model. The cognitive-behavioral model focuses on maintaining factors such as judging self-worth based on weight and shape, the need to control eating, and dietary restraint (Jansingh et al., 2020). The first symptoms associated with anorexia nervosa include high body dissatisfaction and a distorted body image. The basis of causes of anorexia nervosa is based on deficits of the self. Deficits in an individual form the foundation of this condition’s psychopathology. For people with anorexia nervosa, their ability to integrate cognitive, conative, and affective functions experiences a challenge. They function with a false self that makes them unable to discriminate between their own and other peoples’ expectations.
The first psychological development during childhood that relates to anorexia nervosa is associated with self-identification during childhood. Among children who have been found to have anorexia nervosa, most of them have been found to have particular conflation with body esteem and self-esteem (Gizzi et al., 2022). They tend to use their bodies as a proxy for building a self-concept about themselves due to a deficit in self- definition during development. Negative self-shames and a negative body image can be understood psychologically as an expression of internalized self–aspects that may be set for the development of anorexia nervosa. Deficits in development caused by problems with body self-definition represent a core factor in the development of anorexia nervosa during childhood.
During early development, the ability to develop psychological attachment is highly dependent on early attachament bonds with primary caregivers’. This attachment to caregivers continues to be an important aspect even during adolescence. Attachment to caregivers plays the role of encouraging individuals to look for protection, intimacy, and dependence (Achermann et al., 2022). During early adolescence and late childhood, however, peer relationships gradually begin to take a more central role in the developing of self-esteem and self-concept.
Adolescence is associated with increased sensitivity to social approval and a heightened need to integrate new thoughts, behaviors, and experiences in relation to self (Gilsbach et al., 2022). Adolescence is a period that is also associated with body changes that are related to structural changes associated with the maturation of sex hormones. The change in adolescence comes with an increased need to seek approval from other people in accordance with looks. As a result, a cohesive attachment that comes with this stage promotes the active mastery and exploration of the environment. Failure for one to be socially appreciated during adolescence produces a specific vulnerability to eating habits. Most individuals, during this stage, are thus more likely to starve themselves in search of weight loss or as a way of seeking approval.
How to Get Help and Who Gets Anorexia Nervosa
Anorexia nervosa applies psychological interventions such as Maudsley’s anorexia nervosa treatment for adults (MANTRA) in treatment (Jansingh et al., 2020). MANTRA is an evidence-based cognitive, interpersonal approach that incorporates neuropsychological and personality traits in treating anorexia nervosa. It includes interpersonal and intra maintain factors in proposing treatment strategies for anorexia nervosa. Therapists and patients work together to describe the perpetuating aspects in anorexia nervosa. The patient is given an active role in their plan of management where they describe their goals in a personal workbook structure. The patients then meet with the psychologist once a week for about fifty minutes to discuss the progress in management. The psychologist together with the patient pays attention to weight gain and working towards achieving normal eating patterns. Attention is specifically paid to motivating patients towards change and maintaining of eating habits that are important to the patient.
Psychology through cognitive behavior therapy is also applied in managing patients with anorexia nervosa. The goal of cognitive behavior therapy is to use psychology in identifying the processes that operate in a given patient and use them to make a treatment plan that fits the specific patient (Stojilikovic-Drobnjak et al., 2022). It is based on the principle of “people learn by doing,” and thus, it focuses on only a few aspects in changing behavior by concentrating on changing the most perpetuating behaviors.
Psychologists apply strategies such as dietary rules, dietary restrain and changes in eating patterns that are coherent with the patient’s mood. Specialist supportive clinics have also been applied psychologists to manage anorexia nervosa. It combines supportive psychotherapy and clinical management in creating sessions that seek to normalize eating habits and restore normal weight. Specialist psycho-education focuses on other symptoms that are associated with anorexia nervosa, such as over exercising and vomiting. Special attention is given to offering patients with psycho education about food and eating disorders. The psychologist seeks to identify the cause of the eating disorder from the patient and their motivation to change such behavior.
Can One Beat Anorexia Nervosa?
The relevance of anorexia nervosa to nursing is that nurses have a role in establishing trusting relationships and emotional alliances with patients. These relationships between patients and nurses are essential to help accomplish changes that direct patients towards recovery. Often, nurses are usually the first point of entry to care for most patients, including those with eating disorders. As the first point of care, nurses carry the important responsibility of identifying patients with anorexia nervosa and help them establish the foundation for recovery, especially for those patients who do not realize they have a problem by themselves (Gizzi et al., 2022). Nurses should possess the skill of identifying patients with eating disorders by being able to break down myths associated with eating disorders. Even after identifying patients with eating disorders, most of them are not convinced that they need any form of treatment or they are ashamed to seek help from health care professionals.
Given that nurses are familiar with psychological, clinical and behavioral symptoms, they can better recruit newly diagnosed patients into treatment. This knowledge can also help nurses to work closely with physicians during mental and physical assessments of patients. Nurses have the responsibility of addressing the motivations that are expressed by patients at the early stages of treatment to help maintain positive attitudes towards change. Nurses ensure that during the management of patients with anorexia nervosa they gather knowledge that seeks to identify the factors that promote relationships that promote patients health. These relationships promote patients health by reducing the length of care and increase treatment results, reduce suffering during care and reduce the length of care (Magrini et al., 2022). Nurses hold the best position among health care workers in which they can impact the quality of care given to patients with anorexia nervosa, given their ability to manage complex relationships with their patients.
The nursing role in managing patients with anorexia nervosa is to have knowledge that will enable them to monitor the patients’ food intake. Nurses should be able to remember that most patients with anorexia nervosa may also be receiving treatment for other psychological conditions and thus the management they institute should consider all the other disorders. Nurses ensure that they observe patients nutritional status and ensure they maintain adequate nutrition with electrolyte balance (Achermann et al., 2022). They also play the role of supervision of patients after every meal to prevent the common practice of vomiting after eating. They help patients set realistic goals for time limits for every meal time and ensure patients are in a relaxed environment that that helps reduce anxiety and stress. Nurses also act as educators to patients and their relatives about the disorder. They encourage the patient’s family to participate in providing care and support to the patient.
Nurses ensure equality and participation between psychologists and patients in ensuring that everyone is involved in patient management. Equality and participation relationships are important as they ensure that patients are free to express their feelings as well as the health care providers are able to express their expectations from the patients (Stojiljkovic-Drobnjak et al., 2021). Lack of patient involvement especially in anorexia nervosa works to hamper recovery or even worsen the illness given the false self believe among most patients. Nurses are mandated to show commitment in their work to ensure that their patients feel the meaning of care given to them. Patients with anorexia nervosa have a lot of psychological issues within them and failure to show commitment in managing them creates a sense of us versus them. Commitment can be achieved through patient centered conversations that seek to take the patient through the entire health process.
Conclusion
Anorexia nervosa is an eating disorder that affects many people across the globe, most of who have not been diagnosed. For those patients who have been diagnosed, recovery is an extremely complex process that requires the cooperation of multiple stake holders. In order to achieve long standing recovery for patients with anorexia nervosa, psychological, physical and social well- being of the patient must all be put into consideration.
References
Achermann, M., Günther, J., Goth, K., Schmeck, K., Munsch, S., & Wöckel, L. (2022). Body-Related Attitudes, Personality, and Identity in Female Adolescents with Anorexia Nervosa or Other Mental Disorders. International Journal of Environmental Research and Public Health, 19(7), 4316. 10.3390/ijerph19074316
Gilsbach, S., Plana, M. T., Castro-Fornieles, J., Gatta, M., Karlsson, G. P., Flamarique, I., … & Herpertz-Dahlmann, B. (2022). Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries. Child and Adolescent Psychiatry and Mental Health, 16(1), 1-7. https://doi.org/10.1186/s13034-022-00482-x
Gizzi, G., Cataldi, S., Mazzeschi, C., Delvecchio, E., Ceccarini, M. R., Codini, M., & Albi, E. (2022). Hypercholesterolemia in Cancer and in Anorexia Nervosa: A Hypothesis for a Crosstalk. International Journal of Molecular Sciences, 23(13), 7466. 10.3390/ijms23137466
Magrini, M., Curzio, O., Tampucci, M., Donzelli, G., Cori, L., Imiotti, M. C., … & Moroni, D. (2022). Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal. International Journal of Environmental Research and Public Health, 19(5), 2533. 10.3390/ijerph19052533
Jansingh, A., Danner, U. N., Hoek, H. W., & van Elburg, A. A. (2020). Developments in the psychological treatment of anorexia nervosa and their implications for daily practice. Current Opinion in Psychiatry, 33(6), 534. 10.1097/YCO.0000000000000642
Stojiljkovic-Drobnjak, S., Fischer, S., Arnold, M., Langhans, W., Kuebler, U., & Ehlert, U. (2021). Dysfunctional eating behaviour and leptin in middle-aged women: role of menopause and a history of anorexia nervosa. International Journal of Behavioral Medicine, 28(5), 641-646. 10.1007/s12529-021-09958-0
write