Anorexia and Bulimia Risk Factors

Anorexia and Bulimia Risk Factors Exploring Eating Disorders It is nearly impossible to walk past the aisles in stores without seeing headlines promising secrets to weight loss. Our cell phones are full of advertisements and videos of exercise routines. In the United States being thin has become a national obsession and places unrealistic expectations on what makes a female beautiful. To keep up with these expectations, females become dissatisfied with their bodies. With body dissatisfaction being the single most powerful contributor to the development of eating disorders, it is not surprising that these disorders continue to rise (Comer, 2015). The common eating disorders recognized by the Diagnostic and Statistical Manual are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) (APA, 2013). The focus of this paper is on the formally recognized eating disorders, anorexia and bulimia.   Briefly, these disorders are characterized by disturbances in body image and abnormal eating patterns. While the cause is elusive, to day’s theorists and researchers believe eating disorders arise from the interaction of multiple risk factors. The more of these factors that are present, the likelier they will develop an eating disorder. Among these factors include biological, psychological, and sociocultural (Rikani, 2013). Etiology Biological Factors Studies have shown a genetic contribution to developing eating disorders (Fairburn & Harrison, 2003). Certain genes may leave some people more susceptible to the development of eating disorders and researchers suggest that these diseases are biologically based forms of severe mental illnesses. This has been further supported by twin and family studies. For each disorder the estimated heritability ranges between 50% and 83%, therefore there is a possibility of genetic contribution to eating disorders (Treasure et al, 2003). Studies have also suggested role of serotonin levels since this specific neurotransmitter is important in the regulation of eating and mood (Fairburn & Harrison, 2003). Several studies have confirmed those suffering from anorexia nervosa measured lower serotonin levels and may be an indirect effect of eating disorders (Rikani, 2013). Psychological factors Around 73% of girls and females have a negative body image, compared with 56% of boys and men (Comer, 2013). Body dissatisfaction has been defined as â€Å"discontent with some aspect of one’s physical appearance† (Cash, 2012) and is a risk factor for developing an eating disorder (Stice, 2001). Furthermore, it â€Å"encompasses one’s body-related self-perceptions and self-attitudes, including thoughts, beliefs, feelings, and behaviors† (Cash, 2012). Research has measured as far back to adolescent years and how the onset of puberty could set the stage for their body image perceptions (Rikani, 2013). According to Treasure, Claudina, and Zucker (2003), most eating disorders occur during adolescence.   While females are more concerned about losing weight, their male counterparts are focused on the body image of needing to gain muscle. Additionally, female perceptions have been linked to negative body image and adolescent boys are likelier to have positive feelings about their bodies (Ata et al, 2007). Females ultimately feel discontent with the shape and size of their body at such an early age when they are forming their identities. Specifically, females are trying to fit into the image society has described as the ideal beauty of a woman, thus they become increasingly obsessed with disordered eating (Dittmar et al, 2009). In turn, they can suffer psychologically from low self-esteem, feelings of helplessness, and intense dissatisfaction with the way they look† (APA, 2013). Body image and body dissatisfaction have been measured by examining cognitive components, such as negative attitudes about the body or unrealistic expectations for appearance and behavioral components, such as avoiding perceived body scrutiny from others (e.g., avoiding swimming) (Thompson et al., 1999b). Ata, Ludden, and Lally (2007) also found strong links between eating disorders and feelings of depression and low self-esteem.    Sociocultural factors Many sociocultural factors like friends and family can influence the development of eating disorders. â€Å"Research focusing on the particular effects of teasing on female adolescents found that those who are teased about their weight, body shape, and appearance tend to exhibit poorer body image and are more likely to diet† (Ata et al., 2007). Furthermore, adolescents who have a relationship with their parents that are less supportive and filled with conflict are more likely to choose disordered eating behaviors and have poor body image. In a survey of individuals with eating disorders, they included family factors such as, poor parental control, controlling parents, poor relationship with parent, critical family environment as causal factors with eating disorders (Salafia et al., 2015). Swarr and Richards (1996) found that adolescents who have a healthy relationship with both parents are less likely to have concerns about their weight. During this vulnerable stage of development, adolescents place a high regard to the approval of their peers. Supported evidence shows that those with lower peer acceptance and social support may be linked to negative body image   (Ata et al., 2007). It is not surprising that body image has been an obsession in Western society for decades. The media has portrayed the continually changing concept of beauty through advertisements, social media, magazines, and television, in turn shaping society’s standard of beauty. Mulvey (1998) looked at the history of female beauty and the major changes in the female image over the years. The cinched waist was popular in the 1900’s, while being flat chested without curves were emphasized in the 1920’s. Throughout the 1930’s women were encouraged by societal standards to have curves and this emphasis continued through the 1950’s. Images of full figured women like Marilyn Monroe, Audrey Hepburn and Elizabeth Taylor influenced the way women wanted to look (Mulvey, 1998). It was not until the end of this decade that the thin ideal began to decrease in shape (Rumsey). Women began to alter their bodies through plastic surgery in the 1960’s to reach society’s standards. It was during this time that the body type drastically changed into the depiction of being extremely thin and â€Å"boyish.† The immense pressure to be thin carried throughout the 1970’s and the rail thin image resulted in an increase in eating disorders, especially anorexia (Mulvey, 1998). Fortunately, that image did not last long and women were advertised as being fit and sporty throughout the early 90s, yet thin models and anorexia became rampant again at the end of this decade. Sadly, this image of thinness has continued throughout the 21st century. Prevalence Measuring the prevalence of eating disorders is complex since countless numbers of people with the disorders do not seek treatment (Treasure et al., 2010). Research suggests that the stigma society has placed on eating disorders as being self-inflictive may factor in to why they do not seek help (Salafia et al., 2015). While eating disorders affect both genders, the prevalence among women and girls are 2  ½ times greater for females (NIMH, 2013). Additionally, Wade, Keski-Rahkonen, and Hudson (2011) found that 20 million women and 10 million men suffer from an eating disorder at some point in their life.   According to the National Institute of Mental Health (NIMH), the lifetime prevalence among adults with eating disorders have measured to be 0.6% for both anorexia nervosa and bulimia nervosa for the adult population. The main risk factors that have been linked to anorexia nervosa and bulimia nervosa are general factors such as, being female, adolescent/young adult, and living in Western society (NIMH, ). The National Institute of Mental Health reports of suicide being very common in women who suffer from anorexia nervosa and has the highest mortality rate around 10% among all mental disorders. As mentioned earlier, adolescent females are at a higher risk of developing eating disorders, which were related to low self-esteem, social support, and negative attitudes of their body image. While the age of onset frequently appears during teen years and young adulthood for both disorders, bulimia nervosa has a slightly later age of onset, however can begin the same way as anorexia nervosa (Fairburn & Harrison, 2003). A study found one-third of patients who had an initial diagnosis of anorexia nervosa crossed over to bulimia nervosa during 7 years of follow up (Eddy et al., 2008). Between .3 and .9% of this population are diagnosed with anorexia nervosa and .5 and 5% with bulimia nervosa (Salafia et al., 2015). Furthermore, the NIMH reported the lifetime prevalence of 13-18 year olds to be 2.7% for both eating disorders. Certain professions and subcultures have a higher prevalence of developing eating disorders. These include professions where bodyweight is highly valued, such as athletes, models, performers, and dancers. In studies with female athletes the prevalence rate of eating disorders ranged from 0% and 8%, which is higher than that of the general population. Among these athletes, 33% engage in eating behaviors that put them at risk for such disorders, such as vomiting and using laxatives. Additional factors that increase the risk for this population have been shown to be the transition into the college setting and moving away from home. Cultural Factors/Issues    Historically, there has been a stereotype of eating disorders to effect young, female Caucasians, who are educated and from an upper socio-economic class. However, research increasingly shows that this disorder does not discriminate and is being reported in other race/ethnicities of both upper and lower classes. The prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, with the exception that anorexia nervosa is more common among Non-Hispanic Whites (Hudson et al., 2007; Wade et al., 2011). One report found that views about body image and eating disorders varies among cultures and Caucasian women have the lowest body satisfaction and self esteem while Latina women score in the middle in terms of self-esteem and body satisfaction (Eating Disorder Hope, 2013). The literature among African American women is scarce, however Lee & Lock (2007) found that this group had the highest level of self-esteem and body satisfaction. With more and more studies comcluding that eating disorders are occurring in other ethnic groups, it becomes imperative to note different cultural views and beliefs may influence this disorder. Common barriers among minority groups regarding treatment resistance, include language difficulties, lack of health insurance or transportation and lack of resources. Barriers can be present in all ethnicities with eating disorders, but ultimately their cultural beliefs tends to be the greatest influence   in their decision to whether they seek treatment (McCaslin, 2014). Clinical picture Mental disorders have been portrayed throughout movies and literature. While most do not portray a clear clinical picture of those disorders, a compelling illustration is of actress, Portia de Rossi, is able to show what it looks like and a raw mage of the eating disorder in her book, Unbearable Lightness: A Story of Loss and Gain. She writes about her personal struggle with body image and testimony of her eating disorder. Her struggle with anorexia and bulimia began when she was modeling at the age of 12 after her agents informed her she needed to go on a diet. She was influenced by her older colleagues to vomit to maintain the rail-thin figure directors favored. The actress discussed her disordered eating behaviors, such as taking 20 laxatives a day and restricting her caloric intake to 300 calories a day. She explained the overwhelming desire for perfectionism. Her personal account of her struggle with an eating disorder and illustrates the clinical picture of what it looks like t o live through anorexia. From the competitiveness, obsessions, and distorted thoughts, she reveals a life of trying to measure up to the relentless pursuit to measure up to society’s standards of beauty. Ronald Comer’s text, Abnormal Psychology, also gives a clinical insight into the nature of eating disorders. Sufferers have dysfunctional eating attitudes towards food. The main goal for people who suffer from anorexia nervosa is to become thin. They are fearful of gaining weight and the loss of control over the size and shape of their body. People with this disorder are so preoccupied with food that it results in food deprivation. Their thinking becomes distorted and are likely to have negative perceptions and poor body image. Distorted thinking can lead to psychological problems, such as depression, anxiety low self-esteem, and insomnia in those who suffer from anorexia nervosa. Comer (2015) provides research that suggests sufferers may also display symptoms of obsessive-compulsive patterns. The American Psychiatric Association (APA) confirms this finding of eating disorders being linked to other mental health issues. The APA reported 50-70% suffer from depression, 42-75% have a present personality disorder, 30-37% of bulimic sufferers engage in substance abuse as well as 12-18% of anorexic sufferers. Approximately 25% have OCD and 4-6% suffer from bipolar disorder.   It is common for sufferers to engage in over exercising, misusage of laxatives and diuretics, and a decreased interest in the outside world (Fairburn & Harrison, 2003). Research has considered the main physical features of anorexia nervosa. The physical symptoms have included, heightened sensitivity to cold, gastrointestinal problems, dizziness, amenorrhea, and insomnia. The physical signs of a sufferer of this disorder may show signs of emaciation, dry skin, erosion of teeth, and cardiac arrhythmias (Fairburn & Harrison, 2003). Bulimia Nervosa is defined by the DSM-V as eating behaviors that involve binging and purging to avoid weight gain (APA, 2013). Similar to anorexia nervosa, symptoms of depression and anxiety are often seen and sufferers may also engage in substance misuse or self-injury, or both (Fairburn & Harrison, 2003). Mitchell et al. (1983) found physiological electrolyte abnormalities in patients with bulimia nervosa, which can lead to irregular heartbeat and seizures. Other health complications of this eating disorder may include edema/swelling, dehydration, vitamin/mineral deficiencies, gastrointestinal problems, inflammation or possible rupture of the esophagus, tooth decay, and even chronic kidney problems/failure (Alliance for Eating Disorders Awareness, 2013). Evaluating the prevelance of having eating disorders is fairly new for researchers and health care providers, however, continues to be challenging with the major gap in literature. Eating disorders are severe conditions and often associated with comorbidity and adverse medical conditions, as described earlier. Therefore, a large part of research only focuses on the psychiatric comorbidity in eating disorders, including depression, personality disorder, substance abuse, and obsessive compulsive disorder. The stigma society has placed on eating disorders also influences the accuracy regarding the costs of these disorders, whether they are impacted directly or indirectly. The lack of reporting within the health care sector continues to make it difficult to estimate costs and prevalence. It is very common for sufferers to seek treatment for the physical problems than the eating disorder itself and one in four individuals actually seek treatment specifically directed at improving their eating disorder symptoms (Striegel-Moore et al., 2003). In past research that reviewed insurance claims regarding eating disorders, it was found that many insurance companies did not cover treatment for these disorders, which often resulted in the treatment providers to use different diagnostic codes when submitting the claims (Striegel-Moore et al., 2003).   One clinical trial that reviewed health records and insurance codes found that 42% of the claims related to weight or eating disorders, however, only 4% had an actual eating disorder diagnosis (Rosselli, 2016). Samnaliev et al. (2015) measured the impact of eating disorders on health care costs, employment status, and income in the United States. Their evaluation indicated that individuals with eating disorders had more health care costs than those who did not have an eating disorder. In addition, if one had a comorbid then they saw an increase in annual costs, compared to those with no comorbidities. Another impact of the disease that they found during their analysis was lower rates of employment for those with eating disorders. The study also found a link between higher hospitalization costs for sufferers of anorexia nervosa compared to those with bulimia nervosa. Another study (Agras, 2001) found the average cost for inpatient treatment for female anorexics was $17,384 compared to the cost of $9088 for bulimic patients. The same study found treatment for outpatient settings for treatment of anorexia and bulimia to average around $2344. The costs of treating eating disorders were compared to schizophrenia and OCD and indicated costs for anorexia were not significantly different from schizophrenia, however much more expensive than treatment for OCD (Agras, 2001). Research While there has been a significant amount of research speculating the factors that influence the development to eating disorders, it continues to remain challenging. Questions remain unanswered regarding the etiology, prevelance cross-culturally, and effective treatment approaches. The only promising finding in current research has been the evidence that heritable factors make a significant contribution to the etiology of these disorders. (Walsh, 2004). Another issue regarding the research is that a considerable amount is focuses on the eating disorders of Caucasian females in Western society in part due to the stigma placed on eating disorders. Past studies found that eating behaviors of young African American women were more positive than those of young white American women. However, over the past decade research has suggested that body image concerns/dissatisfaction, and disordered eating behaviors have increased for young African American women, as well as women of other minority groups. Despite these trends, society continues to believe that it is likelier for a white American female to develop an eating disorder, rather than a woman of a minority group (Comer, 2015).   It is clear that eating disorders are happening within other cultures, however, the prevelance continues to be an issue to measure. There are also issues regarding treatment. There is ongoing research on the efficacy of treatment for bulimia nervosa, but not for sufferers of anorexia nervosa, which suggests that future research should focus on interventions and treatments for this type of eating disorder. Furthermore, with culture being a risk factor in eating disorders, the development of culturally specific interventions and their efficacy could be beneficial for   future research (Walsh, 2004). Prevention It would be helpful for clinicians to hold a multidemensial risk perspective regarding eating disorders until findings point to the exact etiology of the disorder. With new research and data strongly suggesting genetic influence, it is promising that the etiology may eventually be explained. It is importance to understand that all eating disorders occur in all races and ethnicities. Sala et al. (2014) made suggestions for prevention of the disorders, such as public health campaigns to increase awareness and peer recognition since adolescents place a higher value to what their peers think of them. If awareness is brought about in schools than earlier detection may prevent eating disorders among adolescents. Also, since studies suggest that the family has an influence on the younger population, they could be used to inform prevention approaches at the family level (Langdon-Daly & Serpell, 2017). Treatment Being familiar with the factors invluencing the development of the eating disorder is imperative in order to understand and adequately help the person suffering from anorexia or bulimia. With that being said, the lack of empirical research regarding the treatment of anorexia nervosa is scarce, thus making it difficult to treat. Studies have shown a strong emphasis on a multidisciplinary approach for sufferers of anorexia is helpful. This approach involves a team of medical, nutritional, social, and psycholological professionals. Therpists typically use a combination of psychotherapy and family therapyto overcome the underlying issue of anorexia nervosa sufferers ( Comer, 2015). Treatment for bulimia nervosa is often in clinic settings with the goals of eliminating the binge-purge patterns, developing healthier eating behaviors, and removing the underlying influence (Comer, 2015) A large amount of research concerning the treatment of bulimia nervosa suggests that Cognitive Behavioral Therapy is the treatment of choice, while other data suggests CBT being unsuccessful for anorexia. This proves of the need for new interventions and treatment models for eating disorders, specifically anorexia. Strong evidence from pharmacological trials have found that Pharmacotherapy is effective in treatment for bulimia in the short term. Other models of treatment regarding bulimia focus on emotional regulation, such as dialectical behavior therapy (Treasure et al., 2010). A new approach that has gained preliminary support is Acceptance and Commitment Therapy (ACT). ACT focuses on accepting unwanted feelings/thoughts and seeing them as part of being human. One study suggested that ACT could be neneficial with patients of eating disorders. Treatment interventions that target negative body image may be beneficial when developing newer interventions and approaches towards treatment since both eating disorders have a strong desire to control their urges, thoughts, and feelings (Butryn et al., 2013). Conclusion Eating disorders are complex and various factors can influence the development of an eating disorder. These disorders cross all cultural and social backgrounds. While the exact etiology is unknown the overlapping theories help in understanding the combination of factors that influence the causes of eating disorders, It is important to understand they are severe mental disorders and have serious medical consequences.   The advancement in today’s research is encouraging and may eventually offer better treatment options and specific links to the development of an eating disorders. References Agras, W. S. (2001). THE CONSEQUENCES AND COSTS OF THE EATING DISORDERS. Psychiatric Clinics, 24(2), 371–379 Alliance for Eating Disorders Awareness. (2013). Eating Disorders. Retrieved from https://www.allianceforeatingdisorders Alvarenga, M. S., Koritar, P., Pisciolaro, F., Mancini, M., Cordà ¡s, T. A., & Scagliusi, F. B. (2014). Eating attitudes of anorexia nervosa, bulimia nervosa, binge eating disorder and obesity without eating disorder female patients: differences and similarities.  Physiology & behavior,  131, 99-104. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC. Ata, R. N., Ludden, A. B., & Lally, M. M. (2007). The effects of gender and family, friend, and media influences on eating behaviors and body image during adolescence.  Journal of Youth and Adolescence,  36(8), 1024-1037. Barth, D. F., & Starkman, H. (2016). Introduction to Body Meets Mind: Eating Disorders and Body Image A Twenty First Century Perspective. Clinical Social Work Journal , 44 (1), 1-3. Brown, J. M., Selth, S., Stretton, A., & Simpson, S. (2016). Do dysfunctional coping modes mediate the relationship between perceived parenting style and disordered eating behaviors?  Journal of eating disorders,  4(1), 27. Butryn, M. L., Juarascio, A., Shaw, J., Kerrigan, S. G., Clark, V., O’Planick, A., & Forman, E. M. (2013). Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment. Eating Behaviors, 14(1), 13–16. Cash TF, Pruzinsky T, editors. Body Image: A Handbook of Theory, Research, and Clinical Practice. New York: Guilford Press; 2002. Comer, R. J. (2015). Abnormal Psychology. New York, New York: Worth Publishers. Cui, H., Moore, J., Ashimi, S. S., Mason, B. L., Drawbridge, J. N., Han, S., & Pieper, A. A. (2013). Eating disorder predisposition is associated with ESRRA and HDAC4 mutations.  The Journal of clinical investigation,  123(11). Dittmar, Helga, Emma Halliwell, and Emma Striling. â€Å"Understanding the Impact of Thin Media Models on Women’s Body-Focused Affect: The Roles of thin-Ideal Internalization and Weight-Related Self-Discrepancy Activation in Experimental Exposure Effects.† Journal of Social and Clinical Psychology 28.1, 43-72, 2009. Easter, M. M. (2012). Not all my fault†: Genetics, stigma, and personal responsibility for women with eating disorders.  Social Science & Medicine (1982),  75(8), 1408–1416. Eating Disorder Hope. (2013, July 26). Retrieved April 25, 2017, from https://www.eatingdisorderhope.com/information/eating-disorder/ethnic-minorities Eddy  KT, Dorer  DJ, Franko  DL, Tahilani  K, Thompson-Brenner  H, Herzog  DB.  Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V.  Ã‚  Am J Psychiatry.  2008;165(2):245-250 Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders.  The Lancet,  361(9355), 407-416. Fogelkvist, M., Parling, T., Kjellin, L., & Gustafsson, S. A. (2016). A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy.  Journal of Eating Disorders,  4(1), 29. Heaner, M. K., & Walsh, B. T. (2013). A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa.  Appetite,  65, 185-188. Hoek HW. Classification, epidemiology and treatment of DSM-5 feeding and eating disorders. Curr Opin Psychiatry. 2013;26(5):529–31. Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders.  International Journal of Eating Disorders, 34(4), 383-396 Kaye, Walter. â€Å"Eating Disorders: Hope Despite Mortal Risk.† Am J Psychiatry 166.23, 2009. Kelly, Amy M., Melanie Wall, Marle E. Eisenberg, Mary Story, and Dianne Neumark-Sztainer. â€Å"Adolescent Girls with High Body Satisfaction: Who are they and what can they teach us?† Journal of Adolescent Health 37.5, 391-396, 2005. Langdon-Daly, J., & Serpell, L. (2017). Protective factors against disordered eating in family systems: a systematic review of research.  Journal of Eating Disorders,  5(1), 12. Lee HY and Lock, J: Anorexia nervosa in Asian-American adolescents: do they differ from their non-Asian peers? International Journal of Eating Disorders 2007;40:227-231. McCaslin, K. K. (2014). Eating Disorders in Women Across Cultures (Masters thesis, University of Redlands). Retrieved from h p://inspire.redlands.edu/proudian/1. Miller, KJ et al: Comparisons of body image dimensions by racve/ethnicity and gender in a university population. International Journal of Eating Disorders 2000;27:310-316. Mitchell, J. E., Pyle, R. L., Eckert, E. D., Hatsukami, D., & Lentz, R. (1983). Electrolyte and other physiological abnormalities in patients with bulimia.  Psychological Medicine,  13(2), 273-278. National Institute of Mental Health (2013). Eating Disorders. Retrieved April 20, 20157, from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml Rikani, A. e. (2013). A critique of the literature on etiology of eating disorders. Annals of Neurosciences , 20 (4), 157-161. Rosselli, F. (2017). Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness.  Behavior Research and Therapy,  88, 49-64. Sala, M., Reyes-Rodrà ­guez, M. L., Bulik, C. M., & Bardone-Cone, A. (2013). Race, Ethnicity, and Eating Disorder Recognition by Peers.  Eating Disorders,  21(5), 423–436. Salafia, E. H. B., Jones, M. E., Haugen, E. C., & Schaefer, M. K. (2015). Perceptions of the causes of eating disorders: a comparison of individuals with and without eating disorders.  Journal of eating disorders,  3(1), 32. Samnaliev, M., Noh, H. L., Sonneville, K. R., & Austin, S. B. (2015). The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the US Medical Expenditures Panel Survey.  Preventive medicine reports,  2, 32-34. Sharan, P., & Sundar, A. S. (2015). Eating disorders in women.  Indian Journal of Psychiatry,  57(Suppl 2), S286–S295. Soh, N. L. W., & Walter, G. (2013). Publications on cross-cultural aspects of eating disorders.  Journal of eating disorders,  1(1), 4. Striegel-Moore, R. H., Dohm, F. A., Kraemer, H. C., Taylor, C. B., Daniels, S., Crawford, P. B., & Schreiber, G. B. (2003). Eating disorders in white and black women. American Journal of Psychiatry, 160(7), 1326e1331. Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull. 2002;128:825–48. Surgenor, L. J., & Maguire, S. (2013). Assessment of anorexia nervosa: an overview of universal issues and contextual challenges.  Journal of eating disorders,  1(1), 29. Swarr AE, Richards MH (1996) Longitudinal effects of adolescent girls’ pubertal development, perceptions of pubertal timing, and parental relations on eating problems. Dev Psychol 32(4):636–646. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S (1999b) Exacting beauty: Theory, assessment, and treatment of body image disturbance. 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Colombia Report Essay -- essays research papers

The Deaf population in the United States is composed both of individuals Deaf since early childhood and individuals who lost their hearing later in life. The "Deaf Community", a heterogeneous mix of people from all walks of life, represents every socio-economic and racial category. However, this group of people consider themselves "a community" because they are bound by a common culture, history, heritage and, most importantly, a common language. This language, which forms the foundation of the Deaf Community, is known as American Sign Language (ASL). ASL is a beautiful and expressive visual language that holds the Deaf Community together. (Lake) Unfortunately, deaf/Hard of hearing people have long been victims of discrimination. Lacking a â€Å"voice†, hearing people have assumed that Deaf people are incapable, and have made decisions for Deaf people on their behalf. Even today the attitude toward Deaf people is that they are incapable of accomplishing anything including their own dreams. This message of incapability is sinking into the heads of many Deaf children and adults. Deaf people as a group are underemployed or unemployed period. Many community based services are unwilling to make accommodations to meet the needs of this unique population. Being deaf means that you can’t hear the conversations in supermarkets, in banks, at the post office, at work, at school, etc. All of these which hearing people take for granted. This means that a deaf person is often found in situations where they can’t follow what is being said and are often confused, scared, and isolated. The attitudes of hearing people toward Deaf people tend to pervade deaf/HOH people’s relationships with their family, educational environment, employers, and fellow co-workers. Some examples are, accepting lower expectations of themselves based on perceptions of hearing people, and lacking confidence as a result of being raised in an overprotective environment, or having things done for them. When it comes to education, deaf/HOH people are also discriminated against. Unfortunately, residential schools for the deaf are often sorely deficient in actual education. The teachers rarely use ASL or teach Deaf history and in most places are not required to. The administrations are often made up of hearing people who are still... ...imination that goes on is to start raising awareness of the deaf community. There are some very easy things that you can do to learn about the deaf culture. One very easy way is to attend a deaf awareness event. Many amusement parks such as Paramount Kings Dominion in Virginia and Six Flags hold deaf awareness days. There are also many baseball teams that hold deaf awareness nights at the ballpark. Many schools, programs, and organizations for the deaf also hold annual deaf awareness events or festivals. These are some very easy ways to learn about the deaf culture and have fun at the same time. Another way is to join or volunteer to an organization. There are many deaf groups and organizations that are in need of volunteers to get involved and help with the deaf community. As I said before, we are lacking interpreters and people to interact with the Deaf and we can start to improve that area by having more people get involved and learn about the deaf community. In conclusion, deafness is a disability of communication. Given equal opportunities to communicate at home, in school, and at work, the Deaf individual can and will succeed and make a positive impact on the community.

“After twenty years” by O. Henry Essay

The short story â€Å"After twenty years† is a classical story written by O. Henry. The story is about the two characters that were actually best of friends. They grew up in New York until lost sight of each other. One of them leave the place and tried to live in West to make easy money, thus he ended up being a criminal in Chicago while the other man felt that his place in his hometown is better and he ended up as a policeman. The two friends made a promise that after twenty years both of them will meet again at the same restaurant for the purpose of knowing each achievements that they have done after those years. those years. The story began at the specific place of their appointed place and time. It is nearly 10 o’clock at night and really dark out there. A policeman making his rounds, rattling door knobs to make sure everything is secure on his beat. In the doorway of a hardware store that is closed, he comes across a man who has an unlit cigar in his mouth. Before the officer can begin to question him, the man assures him that he is not a burglar that he is merely waiting for a friend. He goes on to light his cigar and tell the officer why he and his friend are meeting at such a dark and desolate place. The man, who is Bob, told him that he was waiting for a friend he has not seen for twenty years. Years before he and his friend had agreed to meet at the very spot to discuss how their life had turned out. The man keeps on telling to the policeman how his life turned out good that he actually became rich and successful. Talking about his best friend, he told the policeman that Jimmy will never fail to appear in their agreement for he has been a constant good companion. After saying all these to the policeman, the latter dismisses himself. Twenty minutes after the policeman left, another man went to greet his friend Bob. Both of them cheered and make themselves comfortable with each other as they try to unleash the gap on their acquaintance. Shortly, as they approach the front door of the drug store, Bob realizes that this man is not his old friend Jimmy as his nose looks completely different. After the confronting scenario, it turns out that the man has just pretended to be Jimmy and that Bob has under arrest for ten minutes. The man then gives a note to Bob explaining that the first patrolman had been Jimmy and that he went because he did not have the nerve to arrest his old friend, s o he had left before he  could be recognized and found a plainclothes officer to arrest him. Friendship is at the heart of â€Å"After Twenty Years.† The character who does the most talking, Bob, seems to be indisputably fervent about seeing his old friend Jimmy. He speaks glowingly about what a great friend Jimmy was and relates that he has travelled across the country, over a thousand miles, to see him again. However, the story is indeed quite of surprise especially at the conclusion where it greatly shows how Jimmy Wells portrayed a noble act both to the law and to his friend. I find him loyal in coming to the arranged appointment with his friend and in apprehending into the law where he took an oath to serve in just and humane way. The conflict indeed is between Jimmy and his inner being where he was stocked in a very sensitive situation. Either he will let Bob go away and forget the crime he has done or arrest him and stay true to his society under his duty. It seems very impossible but the dilemma has solved well on a clever decision of Jimmy. Moreover, the scene where Jimmy sends another man to arrest Bob is my favourite part. Although, it was difficult for him I view this as an act of courtesy to Bob. It simply shows how strong their sentimental bond is. Jimmy also shows great sympathy and honour to his friend despite of the circumstances. Life is indeed unpredictable. You cannot deeply fathom how things really work on its unique way. Sometimes people turn bad and sometimes others were naturally made good. However life is once again a matter of choice. What happened to Bob’s career and future was primarily his choice and Jimmy couldn’t do about it. On the other hand, Jimmy Wells made a good catch in himself as he remained in his hometown, got a noble job and performed well in realizing his duty. Thus, he never compromises the built friendship between him and Bob. After all a choice can be good or the other way around. One may choose to follow a good path by working on the side of the law and the other may choose to follow a bad path by breaking the law. The most important thing is you did the very thing that God wants you to do and I felt it in the story. Jimmy did a right thing and he solved the dilemma well. The last part of the story which is a note for Bob really moved me. His note is terse and offers no apology for having Bob arrested, but that is the best that Jimmy can do when he and a man who was once his best friend are on opposite sides of the law.

Marx And Engels The Communist Manifesto - 896 Words

The Communist Manifesto had little influence when it was first published, in 1848. Marx and Engels start out the document with the phrase, â€Å"[a] specter is haunting Europe – the specter of communism† (Marx and Engels, 14). Marx and Engels are referring to the fear of communism that was spreading in Europe. The fear towards communism, first surfaced by groups that were attempting to flaunt enormous power, saw the risk of their interests being affected; therefore, they promoted a generalized panic that had a critical social impact. The manifesto of the Communist Party simply explains that throughout history, humanity there has been a war between the dominant and oppressed classes. Marx and Engels called these groups the bourgeoisies and the proletariats. The Communist Manifesto has been directly associated with the laborer’s movement. Marx predicted upcoming battles for the working class, and signaled the objective and tasks that the proletariats had to achieve. Unfortunately, during the period that Marx lived, the conditions for the movement of the proletariats, to be victorious, hadn’t matured. The age of imperialism and the proletariat revolutions were produced after the deaths of Karl Marx and Friedrich Engels. The decisive victory for the proletariats was achieved during this new time period. Furthermore, not only was the document considered radical and appalling at the time of its publishment. It made those who were oppressed aware of their status and instilled a senseShow MoreRelatedCommunist Manifesto By Marx Engels1031 Words   |  5 PagesAfter firstly briefly reading part of â€Å"communist manifesto† from The Marx-Engels Reader, I have a general understanding about The Communist Manifesto presents an analytical approach to the class struggle (historical and present) and the problems of capitalism. I am more like concerning on bourgeoisie and proletarians. 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