Structural Discontinuity and the Development of Anorexia Nervosa

Abstract

Anorexia nervosa is a complex disorder in which emotional, physiological, and interpersonal processes are altered. Various studies have indicated that the disorder occurs disproportionately among females, with adolescents and young women particularly vulnerable. While explanations for this distribution have traditionally focused on medical or psychological phenomena, it is my contention that anorexia nervosa can only be understood in a sociocultural context. It is suggested that the following conditions are necessary for the disorder to occur: (1) individuals must be biologically predisposed; (2) they must be exposed to cultural pressures for slimness; (3) they must lack meaningful peer attachments; and (4) they must be embedded in a social structure regulated by universalism and achievement. The position taken here is that the co-occurrence of these variables is a relatively recent historical development and may account for the disorder's apparent increase during the past 15 to 20 years.     

The Different Meanings of Food in Chinese Patients Suffering from Anorexia Nervosa

Abstract

The metaphoric meanings of food have cast new lights on Social Work intervention with Chinese patients suffering from anorexia nervosa (AN) and their families. Hitherto, there is inadequate documentation on the different meanings of food in families with a daughter suffering from AN in a Chinese context. To fill this knowledge gap, this article reports the 3-year clinical observations of a sample of 34 adolescents and young women suffering from AN, as well as their families under family treatment. These observations show that food can be conceptualized in the following ways: (1) eating as an expression of filial piety; (2) food preparation as part of the woman's nurturing role; (3) self-starvation as refusal to grow up; (4) self-starvation as struggle for autonomy; (5) assignment of food as part of the family hierarchy; and (6) assignment of food as part of parental control. Its implications for clinical social work practice and the roles of social workers in helping are discussed.     

Moral Residue: Difficult Ethical Choices in the Treatment of Refractory Anorexia Nervosa

The case of a 30-year-old woman with treatment refractory anorexia is presented through a first person narrative and countertransference experience. The case study attempts to explore how ethical treatment decisions are made, while also addressing how we live with those choices.     

Therapeutic Change and Anorexia Nervosa: Views of a Family and a Therapist

Answers to the question ‘Why do people change in family therapy?’ remain somewhat elusive and may to some extent always remain partial. However, the perceptions of important participants in the therapeutic system, namely family members themselves, seem somewhat under-utilised. A regular examination and integration of the families' views may lead to enrichment of our understanding of this complex area. In this paper the therapist's (and therapy team's) views of the possible catalysts of change in therapy are compared with one family's ideas twelve months after termination of treatment. The family had attended for family therapy because the middle daughter had been suffering from anorexia nervosa.     

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.     

Anorexia nervosa in males: A case report and review of the literature

Only 5–10% of the diagnosed cases of anorexia nervosa occur in males. Anorexia nervosa can be difficult to identify in males because it may occur in a different subset of the population as compared to females and because anorectic males use different terms to express conflicts regarding body size and shape than their female counterparts. This case study illustrates how a young prepubescent male responded to traumatic events in his life by developing anorexia nervosa with an eventual loss of 33% of his premorbid weight. Precipitants of this patient's illness were his parent's divorce, his mother's remarriage, a precipitous relocation, his mother's pregnancy, and his sister's development of a life-threatening disease, all occurring during the early stages of puberty. The study concludes that anorexia nervosa in young males can result from multiple psychologically traumatic events which occur at a particular stage of development.     

The Maudsley Model of Family Therapy for Children and Adolescents with Anorexia Nervosa: Theory,Clinical Practice,and Empirical Support

The aim of this paper is to present the Maudsley model of family therapy for children and adolescents with anorexia nervosa, one that integrates principles and skills from a variety of models. The Maudsley model is of prime importance because of its non‐pathologising approach to families, because its techniques have been published in sufficient detail for standardised application by clinicians, and because of its strong history of empirical support. It is also a model that integrates both modernist and constructivist influences from the history of family therapy.     

The Role of Perceived Loneliness and Isolation in the Relapse from Recovery in Patients with Anorexia and Bulimia Nervosa

Rates of relapse in the treatment of anorexia nervosa and bulimia nervosa are problematic as is reflected in the literature. While there are some studies that examine the contributing factors associated with relapse, there is much that remains unclear. This paper explores the role of perceived isolation and loneliness as contributing factors in the relapse of patients in the course of treatment for these disorders. A review of the literature on relapse, clinical case material, treatment outcomes, and implications for future treatment and study are discussed.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Experiences,Burdens, and Support Needs in Siblings of Girls and Women with Anorexia Nervosa: Results from a Qualitative Interview Study

For many years, siblings of women and girls suffering from anorexia have been regarded as “the forgotten kin,” as they have been overlooked by both researchers and clinicians. Therefore, the goal of this explorative study was to investigate siblings’ experiences, burdens, and support needs in a differentiated manner. Siblings (n = 16) of patients with an ICD-10 diagnosis “anorexia nervosa” (F 50.0) took part in a qualitative, in-depth interview study; the data were assessed using content analysis. The results of this study should be especially interesting for clinical social work. Using the findings, a variety of concrete recommendations for psycho-social practice can be made, for example regarding the inclusion of siblings in treatment settings, as well as specific support concepts for siblings of anorexic women and girls in different age groups.     

AIDS: A case management approach. The illinois experience

The Illinois Department of Children and Family Services provides through their Medical Foster Care Program substitute living arrangements for wards of the state with positive antibody tests, ARC, and AIDS. At present there are ten children (eight in Cook County) that fall into one of these categories. Half (5) of these children are infants under the age of one year. Three (3) are adolescents who were exposed through intravenous drug abuse and/or prostitution. Case illustrations and discussion together with case planning and management techniques are presented for two of the cases: an adolescent with a positive antibody test, and a three-year-old with AIDS. Current trends and future issues for investigation are also presented.     

A Review of Language: The Cultural Tool by Daniel L. Everett

The Analysis of Verbal Behavior - Language: The Cultural Tool by Daniel Everett covers a broad spectrum of issues concerning the nature of language from the perspective of an anthropological...     

The unionization of professionals: A case study

In 1999 the U.S. economy concluded its ninth year of expansion, and the GDP increased by 4.3 percent while the rate of unemployment remained at 4.1 percent, its lowest level in thirty years. However, there has not been a corresponding expansion in the rate of unionization. Recognizing that they can no longer depend on their traditional base of members, unions have targeted the rapidly expanding area of professional employment as a potential growth area. If unions can adapt to the needs of these workers and achieve organizing successes in nontraditional areas, rapid growth of the union movement could occur. Utilizing the case study methodology, I explore the motivations of a group of professional employees to turn to union representation to address their dissatisfaction with the workplace.     

The case for mandatory outpatient treatment

Research on the effectiveness of mandatory outpatient treatment, which is court-ordered mental health follow up, supports its use with individuals who have serious mental illness. Many states already have some kind of mandatory outpatient treatment in place, but it is often underused. Much of the criticism of mandatory outpatient treatment is based on the fact that research demonstrating its efficacy is limited and that its implementation infringes on individuals' rights. However, sufficient evidence can be found in the literature to support its use for some individuals with chronic mental illness living in the community. In addition, the ethical principles of beneficence, utilitarianism, and communitarianism support its use in some situations. Mandatory outpatient treatment is an ethical and effective method shown to be helpful with individuals who have mental illness and are nonadherent to treatment. Expanding its use in appropriate situations is in the best interest of those with serious mental illness and society in general.