CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents a brief review of literature and studies both local and foreign that is

related to these studies. Those literature and studies that were also included in this chapter helps

in familiarizing information that are relevant and similar to the present study.

RELATED LITERATURE

According to Columbia University Irving Medical Center (2017), anorexia nervosa is a multi-

determined illness. It has a variety of environmental and genetic factors that play a role in

increasing the risk of developing this disorder. Several of these risk factors include: Gender,

Dieting, Temperament, Environmental and Genetics.

The article states that there is a variety of environmental and genetic factor that plays a role in

increasing the development of anorexia nervosa.

As stated by Encyclopedia of Children’s Health (2013) on Anorexia Nervosa: Social

Influences, one of the factors that trigger anorexia nervosa is the society’s overemphasis on female

appearance, the increase in cases of anorexia includes “copycat” behavior, developing the said

disorder caused by imitating other girls. In connection, there is a rising incidence of anorexia

nervosa, thought to reflect the present idealization of thinness as a badge of upper-class status of

the female beauty.

Idealization and imitation of women from other women or girls increases the incidence of

developing anorexia nervosa.

 Along with Pujate (2013), hospitalization for most of the patient is the first step for anorexic

people. Anorexics are in denial about extremely low body weight or the serious complications,

including naturally malnutrition. Anorexics can undergo psychotherapy which means counseling

by a qualified therapist and/or cognitive behavioral therapy in which identified unhealthy habits

are replaced with positive ones.

Anorexic patients that are hospitalized because of malnutrition are commonly in denial about

the extreme low body weight or serious complication.

According to the Pilipino Star Ngayon (2016) in the article “7 Signs of Eating Disorder”,

in some studies the reason why people cannot get proper medical treatment is the lack of

knowledge of people around them to identify the different signs of eating disorder. So the

following are the signs of eating disorder that individual may experience: weight concern, over

exercise, lack of vitality, mood swing, having an odd behavior, food control and meal preparation

becomes big deal. Not many symptoms are known or recorded about the anorexia nervosa.

It is stated in the article that not many people are knowledgeable about the eating disorder

anorexia nervosa. It is quite alarming because someone in your household may suffer anorexia

while you don’t know it. A lot of symptoms or signs about it is not known or recorded but still

there are some signs that can be of help to determine someone having an eating disorder.

With regards to the US National Institute of Health (2013), anorexia nervosa is an “eating

disorder that involves limiting the amount of food a person eats resulting in starvation and an

inability to stay at the minimum body weight considered healthy” At some point, it becomes a

psychiatric issue because the victim has an intense fear of weight gain even when in fact she/he is

underweight.
 It is stated that the eating disorder anorexia nervosa may become a psychiatric issue

because of having an intense fear of gaining weight. At some point it is very alarming especially

to those who are surrounded by negative people.

As written in the Journal of the American Academy of Child Psychiatry (2015), the effects

of anorexia nervosa extend to the patient's social environment. The relationship to the social

environment therefore becomes another factor in the assessment of recovery, though again it is

difficult to obtain relevant data on the subject's behavior in school, at work, in the family, in

marriage, on their attitudes to sexuality and on their social contacts.

Effects of anorexia nervosa can vary and extend to some point. It is stated that obtaining

data to further know the said eating disorder is difficult because of the different behavior a patient

can portray on different settings.

Furthermore the Alternative Medicine Review (2002), anorexia nervosa has the highest

mortality of any psychiatric diagnosis, estimated at 10 percent occurring within 10 years of

diagnosis, and is the leading cause of death in young females 15 to 24 years of age. Death occurs

due to suicide, infection, or succumbing to the effects of chronic starvation.

The data shows that anorexia nervosa has the highest mortality rate out of any psychiatric

diagnosis within the 10 year period of diagnosis.

In addtion stated by Frank (2017) in American Journal of Psychiatrist anorexia nervosa is

hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate

12 times higher than the death rate for all causes of death for females 15-24 years old. He also

said, "But with studies like this we are learning more and more about what is actually happening

in the brain. And if we understand the system, we can develop better strategies to treat the disease."
 Females are the common patient that are diagnosed with the anorexia nervosa. Anorexia

having the 12 times higher death rate than all causes of death for females 15-24 years old is very

alarming to everybody.

International Journal of Basic and Clinical Pharmacology (2016), the estimated prevalence

in the lifetime of anorexic people in the United States is estimated to be 0.3-1%. According to

some studies 13% are suffering from disordered eating behavior for women and the rate for men

is lower (0.1-0.3%).

The data shows that more women suffers from anorexia nervosa than men.

Lastly from Morris (2007), anorexia nervosa has the highest mortality of any psychiatric

disorder. It has a prevalence of about 0.3% in young women. It is more than twice as common in

teenage girls, with an average age of onset of 15 years; 80-90% of patients with anorexia are

female. He also stated that anorexia is the most common cause of weight loss in young women

and of admission to child and adolescent hospital services.

Anorexia nervosa commonly prevails to women as stated in the article, most commonly to

teenage girls. It is also stated that anorexia is the most common cause of weight loss in young

people.

RELATED STUDIES

According to a research entitled “The fault is not in her parents but in her insula--a

neurobiological hypothesis of anorexia nervosa” by Nunn, Frampton, Gordon, and Lask (2008)

has shown that anorexia nervosa is associated with brain abnormalities, including impairment of

neural circuits in several brain structures, such as the insula, hippocampus and amygdala.
 Effects of anorexia nervosa is not only seen from the body but brain abnormalities also

occur because of it as stated in the study above.

A study entitled “Deriving behavioral phenotypes in an international, multi-centre study of

eating disorders” by the Price Foundation Collaborative group (2001) attempted to derive

behavioral phenotypes in a large sample of eating disordered patients that primarily comprised

anorexic individuals: 312 out of the 348 patients were anorexia nervosa patients.

The study shows that more than fifty percent of the patients sample for behavioral

phenotypes of the eating disorder were anorexia nervosa patients.

A research entitled “The Effect of Eating Disorders on Work Performance” conducted by

Smith (2009) stated that, treatment for patients with anorexia nervosa is typically a combination

of therapeutic modalities. It is said that patients who are severely underweight should be

hospitalized until they are able to reach a weight that is considered to be adequate by their

physician. They must maintain this weight for at least 2 days before they are able to be discharged

from the hospital.

The study shows that therapeutic modalities are used for treatment for patients with

anorexia nervosa. Gaining and maintaining the weight their physician has seen adequate for two

days is the requirement before a patient is discharged.

As stated from a research entitled “Anorexia Nervosa: treatment expectations – a

qualitative study” conducted by Gunilla Paulson-Karlsson and Lauri Nevonen (2012), young

adults with anorexic symptoms who were seeking treatment revealed that their expectations were

multifaceted, and the motivations they expressed illuminated their positive attitude toward

attending treatment and their recovery. Patients’ expectations and express motivations should be
discussed both before treatment and continually thereafter, in order to enhance the therapeutic

relationship.

It is stated from the study that emotional positivity of the patient is important in their fast

recovery from the eating disorder.

According to Lock, et al., (2015) there is evidence that anorexia nervosa symptoms may

be expressed differently in childhood and adolescence as compared to adulthood. Children and

adolescents are often incapable of verbalizing abstract thoughts; therefore, behaviors such as food

refusal that lead to malnutrition may manifest as nonverbal representations of emotional

experiences. As a result, parental reports about the child’s behavior are critical, as self-report is

often unreliable because of a lack of insight, minimization, and denial by the child or adolescent.

The study shows that different symptoms may occur to different generation such as

childhood and adolescence. Because of the incapability of verbalizing their thoughts it is said from

the study that it leads to refusal of food and it manifest malnutriotion.

A Finish epidemiological study by Ackard et al., (2015) reported that about 50% of people

with anorexia nervosa in the community do not have access to treatment. Those who do engage in

treatment typically show varying degrees of ambivalence about change. However, with treatment,

at least 40% of people with anorexia nervosa (and more in younger samples) will make a full

recovery.

This study shows that half of the people that has anorexia nervosa do not have access to

treatment. It is very alarming because anorexia nervosa may cause sever damage to the body of a

patient if it is left unchecked.

 According to a study published in Behavior Modification (2014) body weight, binge eating,

compensatory behavior, too much concern with shape and weight, dietary restraint, body image

disturbance, affective disturbance are all domains of interest common to those with eating

disorders, particularly anorexia nervosa and bulimia nervosa.

This study shows that there are a lot of factors or interests that particularly seen from

anorexia nervosa or bulimia nervosa.

Moore et al. (2005) patients who had Anorexia Nervosa or during their teenage years but

had recovered by the time they reached early adulthood. In this study, the investigators reviewed

health services use by the patients over the past year. There were three different patient

populations; those patients who had recovered from anorexia nervosa, women who were diagnosed

with a 5 Psychiatric disorder but had not suffered from an eating disorder, and healthy women to

be used as a control.

This study shows the health services used by the adult and teenagers that had recovered

form having anorexia nervosa which may be helpful for the further gathering of information about

the eating disorder.

A study published by a University of Colorado School of Medicine (2012) shows that

reward circuits in the brain are sensitized in anorexic women and desensitized in obese

women. The findings also suggest that eating behavior is related to brain dopamine pathways

involved in addictions. The researcher examined brain activity in 63 women who were either

anorexic or obese, scientists compared them to women considered “normal” weight.

The study shows that brain affects the behavior of women involving them to be either

anorexic or obese.