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CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter presents some of the related literature and studies

regarding anorexia nervosa itself.

Eating disorders are associated with a number of

psychological and medical concerns that can range from

mildly problematic to fatal. There are a number of reported

estimates regarding the incidence of death and anorexia

with a figure of 5% most often cited in the literature.

However, most of these figures are based on female samples

and include death by suicide as well as emaciation. Other

problems associated with self-starvation include, but are not

limited to:

Cardiac irregularities and dysrhythymia which can result in

sudden death; dehydration; electrolyte imbalances resulting

in severe bloating, edema, and muscle spasms; vitamin and

mineral deficiencies; organ dysfunction resulting in bowel

and kidney difficulties; osteoporosis; tooth decay; and


hormonal imbalances as evidenced by lowered testosterone

levels in men and amenorrhea in women.1

Anderson (1990) remarks that if one can understand

the nature, course, and treatment of eating disorders, then

one will also understand most of the field of psychiatry,

cultural issues, and internal medicine as these disorders

impact every organ system of the body as well as one’s

personal and interpersonal life.

In 1994 the National Association of Anorexia and

Associated Disorders (ANAD) reported there were 7 million

females and 1 million males in the United States who had an

eating disorder. Anorexia Nervosa and Related Eating

Disorders, Inc. (ANRED) states that while there are no solid

statistical figures, it is believed that about 5% to 10% of the

total number of people with anorexia nervosa are male .

Arbetter (1994) offers a slightly more conservative figure

suggesting that eating disorders in general affect 2 million

1
http://scholar.lib.vt.edu/theses/available/etd-111599-131446/unrestricted/etd.pdf
females between the ages of 12-18 years and half a million

males yearly. All of these figures must be viewed with

caution, as it is likely that this is a disorder that is

underreported and misdiagnosed in the male population. It is

important to note that even if only 5 or 10 percent of the

individuals who are diagnosed with this disorder are males,

this still accounts for a tremendous number of people.2

Dorian and Garfinkel (1999) state: Anorexia nervosa

and bulimia nervosa have been considered to be influenced

by cultural forces; as these forces change, the disorders

themselves may be altered. Such changes could affect the

rates of the disorders, the ages of onset, the global

characteristics of the disorders, or the particular syndromal

characteristics of the disorders. Awareness of the impact of

socio cultural forces is critical to enhancing the

understanding the etiology and pathogenesis, and to

informing models of care.

2
http://scholar.lib.vt.edu/theses/available/etd-111599-131446/unrestricted/etd.pdf
Adults, adolescents, and an increasingly larger number

of children, are obsessed with body image and how they

appear to others. Paxton et al. (1991) found that

dissatisfaction with body image is common during the

teenage years and that excessive exercise is a frequent

behavior among adolescent males as a means of losing

weight, whereas dieting behavior tends to be more

prominent in adolescent females.3

Research has demonstrated that for females, the

images dictated by culture regarding ideal beauty through

magazines, films, television, beauty pageants, and even

dolls, such as Barbie, can trigger an obsession with weight

and consequently, an eating disorder.

However, females are not the only ones whose body

images are affected by the media. Pope (1999) discusses the

3
http://scholar.lib.vt.edu/theses/available/etd-111599-131446/unrestricted/etd.pdf
changing physiques of male action figures over the last 10

years and how these “muscle-bound play figures” may be a

contributing factor in the growing problem of body image

disturbance in males.

It is critical then, that counselors, educators, public

health, and medical personnel become acquainted with the

skills necessary to better identify, treat, and prevent

anorexia nervosa in both males and females.4

4
http://scholar.lib.vt.edu/theses/available/etd-111599-131446/unrestricted/etd.pdf