They describe anorexia nervosa as an illness presenting many contradictions, a seeming paradox displaying contradictory characteristics. For example, pre-morbidly our patients have been conscientious and compliant but during the illness, they are rebellious and resistant; they see themselves as fat when they are thin; feel well when they are ill; feel full when they are empty.
They starve themselves but sometimes binge, they are obsessed with food but avoid it. They tend to be popular and successful but have low self-esteem; they appear to be in control and controlling but feel they have no control or are out of control.
They look fragile but behave with extraordinary strength and determination; they perceive their tormenting and destructive illness as a friend and a comfort. In the depths of the illness, they can see only advantages and rarely any disadvantages. At times they appear to have insight but can switch instantly to a state of illness denial anosognosia ….
Furthermore, they astutely observe that clinicians often find themselves somewhat entangled in the diverse range of features of the illness, including worries and obsessions revolving around weight, BMI and targets — much the same concerns as our patients, in fact.
Patients do in fact frequently tell us that they have gained weight, as per our prescriptions, but are nevertheless still tormented by anorexic thoughts and feel very sad and anxious. Bryan Lask and Ian Frampton list several reasons in detail for suggesting that such an emphasis is at best unhelpful and at worst counter-productive , as summarised below:.
We should encourage ourselves, and our colleagues, to take into serious consideration the above recommendations in order to continue to improve treatments for our patients and to help them to overcome their struggles. The contradictory dynamics of eating. Perfectionism — a blocked dialogue. Quest for identity: recovering from eating disorders. Purchase Subscription prices and ordering for this journal Short-term Access To purchase short term access, please sign in to your Oxford Academic account above.
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Citing articles via Google Scholar. Latest Most Read Most Cited A systematic review of supermarket automated electronic sales data for population dietary surveillance. Grains — a major source of sustainable protein for health. Starvation impairs the regularity of the menstrual cycle in women. Obviously, this criterion is not used for males. The second two criteria are assessments of patients' perceptions.
Patients need to have an intense fear of gaining weight or becoming fat, even though underweight. Also, patients have a misperception of their physical appearance in that they may even perceive themselves as overweight even though they are emaciated. This misperception contributes to the denial that many anorexic patients have.
Many patients really do not believe they are ill. Anorexia nervosa usually develops during the teenage years and affects about one half of a percent of adolescents. Around ninety to ninety-five percent of the cases are in females, though the disorder is being recognized more and more in males. Interestingly, anorexia nervosa is only found in industrialized nations. However, studies have revealed that when immigrants move from an unindustrialized society to an industrialized one, they have an increased risk for developing anorexia.
This observation gives some insight into the possible causes of anorexia nervosa. Social factors contribute to an individual's predisposition to developing anorexia nervosa. This is easily demonstrated by the above mentioned immigrant observation and the presence of the illness almost exclusively in Westernized cultures where dieting is common behavior. Recently, Westernized cultures have acclaimed thinness.
The media and other societal influences use thinness to promote and advertise.
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