Anorexia nervosa, psychological trauma, and weight restoration by Smith, Abigail A.Call Number: RC552.A5 Thesis eBook
Publication Date: 2020
Abstract: "Anorexia Nervosa (AN) is a complex, psychological disorder that has a poor prognosis, high relapse rates, and high mortality (Himmerich et al., 2019; Khalsa, Portnoff, McCurdy, & Feusner, 2017). Symptoms, including the maintenance of a low body weight, a preoccupation with weight and shape, and an intense fear of gaining weight characterize AN. Physical symptoms of AN include amenorrhea, lethargy, hypotension, bradycardia, dehydration and in severe cases, sudden cardiac death (APA, 2013; Treasure, Claudino & Zucker, 2010). Studies concluded the various symptoms of AN stem from genetic, neurobiological and environmental etiological factors (Bang, Treasure, Rø, & Joos, 2017; Dell'Osso et al., 2016; Dring, 2015; Gander, Sevecke, & Buchheim, 2018). These complex symptoms and etiological factors of AN contribute to the difficulty in the conceptualization, treatment and recovery from the disorder. Historically, AN has been conceptualized from many different perspectives, originating as medical disorder in 1689 and then as a psychological disorder in the late 1800s (Bhanji & Newton, 1985; Charcot, 1889; Gull, 1874). From a psychological perspective, AN was first related to a parenting failure and patients were removed from their family during treatment (Harper, 1983). After Salvador Minuchin proposed that the disorder was related to a problematic, family structure rather than a parenting failure, the family system became an integral part of treatment (Minuchin, Rosman, & Baker, 1978). A rigid, enmeshed, over-involved, and conflict avoidant family context was then seen as a primary etiological factor of AN (Minuchin et al., 1978). More recently, attachment-based theories, a branch of family-system perspectives, have proposed that AN is a survival response developed by individuals to feel safe, secure, seen, and soothed by caregivers, or a sense of a secure attachment (Gander et al., 2018; Robinson et al., 2015; Siegel, 2015). Some of the current treatments for AN still follow the systemic orientation, including Maudsley Family Therapy (MFT) and family-based therapy (FBT), however, most family-based treatments are developed for adolescents rather than adults (Conti et al., 2017; Le Grange, 2016; Schmidt, Wade, & Treasure, 2014). Other perspectives of AN, including cognitive-behavioral theory and social theories, postulate that the disorder is related to maladaptive beliefs and cognitions. Cognitive-behavioral theory views AN as a combination of maladaptive beliefs that elicit behavioral symptoms, such as restricting and over-exercising (Dahlenburg, Gleaves, & Hutchinson, 2019; Garner & Bemis, 1982). A social perspective proposes that AN is a vehicle for acceptance and admiration from peers and society (Dell'Osso et al., 2016). Culture-related stress, such as beauty standards, is another a factor that contributes to the development of AN. These perspectives treat AN by addressing maladaptive beliefs. More recently, studies have looked at the etiological impact of trauma on the development and maintenance of AN, as individuals with AN commonly have a history of child maltreatment, emotional abuse, interpersonal trauma, and adverse childhood circumstances (Gander et al., 2018; Malecki, Rhodes, & Ussher, 2018). This perspective views AN as a physical manifestation, or an embodiment, of trauma (Badenoch, 2018; Malecki et al., 2018). Now, some individuals with eating disorders receive trauma-informed treatment, however, more information is needed about the impact of trauma on individuals with AN (Brewerton, Alexander, & Schaefer, 2018)."