Seventy-percent of a particular study claimed they were simply dieting. The
rest used excuses of abdominal pain, difficulty swallowing, or simply a lack of
appetite (Dally, 1979, p.14). Those dieting had innocent intentions at first,
even the approval of family members or peers, but as they reached their target
weight the dieting did not slow down. In some cases it only became more intense.
Hunger does not just disappear into thin air. There is a long and hard battle
against stomach pains, sometimes resulting in lapses. However, the guilt or
disgust felt from giving into the temptation of food results in more willpower
for resisting food in the future. The process of eliminating hunger usually
takes up to a year (Dally, 1979, p.14). Sometimes hunger cannot be ignored. The
girl will think about food all day long as if in pleasure. Ritualistically,
she'll eat very slowly, savoring each bite of food that is cut into small
pieces. She will insist on cooking food for herself and sometimes preferring to
eat only alone, where she can enjoy her food without feeling self-conscious.
Another approach towards hunger is indirect satisfaction by reading cookbooks,
reading about healthy foods and ways to eat, cooking for others, or just
watching others eat. Though an anorectic avoids fattening foods by all costs,
oddly they enjoy cooking fattening feasts for family members to enjoy and are
even offended if any food is not eaten. A majority of anorectic patients are
above average in intelligence, physically attractive, and of the upper class.
They have low self-esteems and strive for perfection. The family they come from
usually tends to be weight-conscious, such as a mother that is always on diet
plans, and somewhat controlling over the daughter's life. Although there are two
types of anorexia nervosa, primary and secondary, primary anorexia nervosa is
the most common, and the type being discussed in this paper. Secondary anorexia
nervosa is developed adults of average intelligence and of middle or lower
class.
Primary anorexia nervosa is developed during puberty between the ages of 11
and 18 and usually by females. Only one of every 10 anorexia nervosa patients
are male. Childhood is a very sensitive time period for all human beings. The
brain is developing while the body grows. Morals and knowledge are being
absorbed by daily activity and outside influences. It is this time that a danger
zone may develop, negative behaviors are adapted and cannot be stopped. There is
no overall difference between the childhood growth of a normal child or the
childhood growth of an anorectic. Most likely they were skinny but had a high
fatness and height growth rate before their peers. As a result, during puberty
the subject may be more sensitive about her appearance. Recalling past
experiences from anorectic patients is difficult because these patients already
have an exaggerated perspective of themselves and are likely to exaggerate what
they went through as children. Through the careful recollection of families,
however, a more likely picture of a soon-to-be-anorectic child can be drawn. As
a child, anorectics are described as tomboys that shared interests with her
father such as sports and watching football. They are described as obedient
children that never wanted to grow up (Crisp, 1980, p.48). Maturation in puberty
develops anxiety in most girls. The first step for females in puberty is the
development of breasts, leading to embarrassment and the feeling of fatness.
Other changes happen that are very undesired such as the thickening of the
stomach and thighs and menstruation. Girls tend to take these natural changes as
changes happening to them instead of a natural process that happens to all
females. They develop distorted images of their bodies, such as a little
potbelly as looking pregnant, or breasts that are bigger than those of their
mothers. Some of these girls get over these self-conscious thoughts while others
become obsessively preoccupied. The first step of treatment for anorexia nervosa
is for family members or loved ones to step in and take her to get serious help.
Most doctors and psychologists suggest that the subject be separated from her
family. A family or an inexperienced therapist may allow the anorectic to
promise and thus procrastinate the process of healing, resulting in no real
physical or mental healing (Dally, 1979, p.106). After being admitted into
treatment starts the difficult process of healing involving psychiatrists,
physicians, nurses, and dieticians.
The first goal of treatment is to determine a target weight for the patient
by figuring out the average height and weight of their age set and to reach
approximately 90% of that ideal weight. The reasons it is important to gain back
the weight before psychological treatment is because anorexia nervosa brings a
halt to physical and psychological maturation as well as emotional development
when it is most important. There are two major ways in which therapists approach
feeding. The more passive technique is to give the patient the food she must eat
but allowing her to consume it at her own pace. The side effects of this is that
lack of patience a nurse may cause some disturbance and frustration, for
sometimes the subject may not even finish her meal before it is time for her
next one. The second approach is much more aggressive. In this approach, tube
feeding is forced if the patient refuses to eat, resulting in much more rapid
weight gain. In both techniques, the more the patient cooperates and recovers,
the more freedom and visitors they are permitted. However, when a patient is
difficult, she will be restrained to her bed and tube fed until she eats
regularly. The next step is cognitive treatment, also known as the Interview. In
this step the therapist can really build a case on the patient and listen to her
story. Questions will be asked about what she thinks of her body, usually with
negative results. On the other hand, when asked about another anorectic with the
same weight and height, the subject studied will comment on how she is too thin.
She will also be asked questions such as, What worst thing that could happen if
you ate more?
