Ethics in Mental HealthCare (Anorexia)
Eating disorders consist of a variety of symptoms with psychological, social, and physical characteristics. While the physical complications associated with these disorders may cause significant concern to the family members and the health care team, bulimia nervosa and anorexia nervosa are two of the common eating disorders having substantial long-term social and physical sequelae that make recovery difficult. The long-term disabilities associated with these eating disorders include fertility, poor relationships, poor parenting, and negative influence on the employment. The impacts of one’s eating disorder are significant at the family level as they carry the burden of the effects for a long period. In most cases, family members and the health care providers find difficulties in identifying the support needed by the affected. This essay analyzes the ethical issues surrounding the provision of health care to the anorexic patients and analyzes the ways, which the health care provider can respond efficiently to the needs of the anorexic patients. However, the essay will begin by discussing some of the behaviors and the factors that predispose individuals to anorexia (Dare 13).
According to the WHO, approximately one in every 250 females experience anorexia in female while one in 2000 males experience anorexia (Fairburn, Christopher 28). Anorexia commonly develops during the adolescence stage due factors such as the influence from the media and the society, sports, artistic activities, peer pressure, social isolation and realization of the perceived image of gender has more effect on the psychological well-being of an adolescent. Genetic predisposition also plays a significant role in predisposing individuals to anorexia. Children from families with a history of anorexia are twice at risk of becoming anorexic at one point of their livelihood as compared to children born to non-anorexic families (Keel, Pamel, and Klump 756). Some studies implicate certain environmental factors to play a role in predisposing individuals to anorexia. Interplay between the social factors and environmental factors makes management of anorexia a challenging process. The two creates a conflicting situation characterized by severe tension as each of them has a significant impact on the health and treatment behaviors required for its control.
Development of the eating disorders at the adolescence stage has a significant effect on the education of the victims. Depressed mood, which is a common feature due to the severe consequences and the nature of the distressing symptoms, makes it difficult for them to realize their academic goals. The adverse physical effects of anorexia, which is evident, include severe weight loss, purging behavior, and abnormal eating is always notable (Tan 18). Severe cases of anorexia prove fatal as may result in mortality and relapse. For example, according to Treasure, Janet (160), anorexia nervosa contributes to high mortality rates (15%) in the youths under the age of 20 years diagnosed with mental disorders. The statistics coincide with a report released by the WHO in the year 2012 that stated that, eating disorders contribute to the high rate of mortality among the adolescents diagnosed with any psychiatric disorder.
Diagnosing individuals with anorexia is far much difficult because more than half of the cases identified fail to be diagnosed in the primary care setups. As a result, the conditions progress to the severe state that makes hard for effective management. Factors like ambivalence, secrecy, denial, and shame create complexities associated with early diagnosis of anorexia. Effective management of anorexia relies on a detailed assessment of the psychological, physical, and risk status that influences them management of the condition. Other factors contributing to the challenges witnessed with the management of anorexia include organizational, financial, legal, and ethical dilemmas involved when providing care to the anorexic patients receiving/refusing to adhere to the treatment (Isserlin, Leanna, and Jennifer 48).
In-patients with severe anorexia, treatment options available in the health care setups diminish to the extent of threatening the life of the patient. In such scenarios, the question of introducing the most effective emergent intervention becomes a challenge owing to the ethical, medical, and legal issues surrounding the care and management of anorexic patients. Ethical issues related to the management of anorexia vary considerably across different jurisdictions. The pertinent issues that contribute to the variance in the ethical issues contribute to the ethical dilemma in the management of anorexic patients. Among the factors contributing to the variance include; differences in the conceptualization of anorexia as a mental disorder, the lack of clarity in the medical-legal aspects of capacity and competence in managing patients with anorexia, and the socio-cultural differences that influence the legal and medical provisions for the use of alternative approaches in treating patients with anorexia (Treasure, Janet 159).
As a result, managing anorexia raises many ethical issues that affect the care given to the anorexic patients. The issues have a strong relationship with the physical problems that complex the symptoms accompanying the condition. Unlike other diseases/disorders caused by microorganisms such as viruses and bacteria, anorexia is a conscious condition/disorder/disease. In addition, anorexia is a conscious disease as compared to other mental conditions such as schizophrenia and bipolar disorders. Anorexic patients make conscious choices about their health behaviors and eating habits. The inability to control or make decisions on when to stop eating brings a difference to a healthy person. This creates an ethical dilemma because, many health care providers find asking themselves on the modalities of treating someone who chooses to inflict conditions for themselves (Fairburn, Christopher 27).
This implies that health care providers find it unethical and inhumane to force the anorexic patients to take healthy actions to manage the conditions inflicted by themselves. The health care providers also face the challenge of deciding when to provide treatment and when to stop it. The premise of defining the severity of the disease creates an ethical issue of the responsible parties required for designing a treatment plan for the patient. As a result, it creates an issue when deciding on the qualification of a design effective for the management of the anorexic patient. Empirical studies show that, issues of disagreement between the health care providers and the family affects the nature of the relationship and care needed by the patients. As such, this might result in cases of counter-transference, which affects the nature, and the method of care provided to the anorexic patients (Keel, Pamela, and Klump 762).
Severe cases of anorexia may be considered as a violation of the patient’s rights. This includes violation of the patient’s right to autonomy, no malfeasance, beneficence, and justice. Health care providers consider decisions like forcing them to adhere to some desired treatment program as unethical. In most cases, patients feel that their basic rights have been violated. Anorexic patients do not pose any risk to self and others; they do not have suicidal behaviors, although their behaviors contribute to their slow death. This raises the ethical issue since introducing therapeutic treatments against their will is a sign of violation of their rights thereby prosecutable by the law. Because of this, most health care providers face a dilemma of deciding on the best medical intervention applicable to managing anorexia without violating the patient’s rights to quality and dignified care (Treasure, Janet 157).
Responding to anorexia by the health care providers is much challenging process than it seems to the eye. The treatment required by the patients varies significantly across the conditions. Empirical studies show that successful recovery from anorexia relies on the form of outpatient treatment employed. Cognitive behavioral therapy has been efficient in enabling the anorexic patients achieve their desired health status. Combining behavioral therapy and interpersonal therapy provide significant improvement in the patient’s condition. The strategies contribute to motivational enhancement: empathic understanding and reflective listening enhance discrepancies between the patient’s beliefs on their health and motivation to change. Research shows that, avoiding argumentative flavor and judgmental attitude affects negatively on the outcomes of the management adopted by the health care providers (Isserlin, Leanna, and Jennifer 49).
Psychotherapy models and approaches such as family therapy can prove useful to the health care providers. Family therapy is effective in providing care to adolescents who still live with their parents. Family therapy works on the principle that, regardless of the condition one suffers from, involving the family in developing solutions to the problem is always beneficial to the clients. Family therapy techniques such as communication therapy, relationship education, reality therapy, and attachment therapy enhance the minimization of relapse incidences of the condition. In addition, family therapy provides patients with opportunities for setting realistic and common goals and objectives in collaboration with the family members. As a result, it provides opportunities for discussion and the development of supportive strategies aiming at helping the client overcome the anorexia (Lock and James 1030).
When a patient resists therapeutic treatment provided, it is necessary to establish honest relationship with the patient and provide honest information to the patient on issues related to treatment, results, and validating the symptoms related to the condition. It is after this that, health care providers provide cognitive restructuring services that elicits faulty thoughts from the patient and employing loci to correct the revealed faulty thoughts. The health care provider takes the responsibility of eliciting preceding cognitions then challenges them in an intellectual manner without taking a forceful position. This proves helpful as it enhances behavior change through the provision of practical ideas and experiences to the patient (Isserlin, Leanna, and Jennifer 29).
Embracing psychodynamic approaches help the health care providers address the needs of an anorexic patient efficiently. The approach examines factors, which might have contributed to the condition. The strategy teases the patients the adaptive roles of the anorexia to develop alternative strategies and paradigms to facilitate recovery from the condition. After the success of these strategies, research has shown that helping the patient to overcome the effects of obsessive-compulsive personality associated with the condition is highly recommended. The health care providers help the client achieve this through helping them to point out unrealistic demands that might cause a relapse of the condition. It is during this phase that effective medications can be administered to manage the patient’s obsessive behavior as the recovery takes place (Treasure, Janet 165).
The health care provider should consider incorporating other strategies of psychotherapy such as reconnection to facilitate full recovery from anorexia. Reconnection aims to make the patient come into reality with the needs of the society. This entails helping the patient re-establish positive relationships with peers, resume of their activities of the daily living and strengthening the need for attending regular residential or outpatient treatment. This helps restore the patients’ role in the society, thereby, ensuring their active participation in the social activities and the establishment of a pathway to recovery (Tan 16).
As stated in the above analysis, negative perception of self among the anorexic patients drives them to adopt behaviors aimed at ensuring reduction of their body weight. This implies that, a health care provider should employ strategies aimed at helping the patient understand and accept the dynamics behind his/her body issues. This entails helping them come into reality with their state and developing strategies that will promote their acceptance in the society. Interventions such as helping the express their needs and feelings, sound decision making, and establishing boundaries in their behavior helps them build their assertive skills that help in maintaining the desired behavior and eventual recovery from anorexia (Isserlin, Leanna, and Jennifer 46).
Research conducted by Lock and James (1028) showed that group therapy is beneficial is promoting management and recovery of patients from anorexia. Group therapy provides the necessary support during the early stages of management when the patient is compromised physically and psychologically. Group therapy helps the patient build relationships, express feeling, and develop skills required for maintaining positive health behaviors. Group therapy stabilizes patient’s physical and psychological functioning. Besides, it enables them to explore their relationship issues and dynamics that affect their health outcomes.
It is highly recognizable that, reemergence and/or relapse of symptoms of anorexia might occur. This implies the need for the health care provider to develop strategies aimed at managing incidences of relapse and reemergence of symptoms of anorexia. Therefore, the care provider should develop strategies aiming at managing conflicts and failure to adhere to the management regime as provided by the health care provider (Treasure, Janet 160). Other strategies that have proved effective in responding to resistance of anorexic patients include deep brain stimulation, a technique that helps the patients gain weight. However, the technique has not gained full support due to its costs and minimal application in most populations (Isserlin, Leanna, and Jennifer 48).
Anorexia is a serious health problem that affects the health and health outcomes of the larger population comprised majorly of the youth. The condition is socially constructed as most of the cases occur because of the influence of social pressure. Developing strategies that aim at creating awareness among the population proves to become the most effective method of reducing the cases of anorexia. Therefore, strengthening the need for social inclusion, acceptance, and provision of services promoting active involvement of the anorexic must be embraced in order to provide support and reduce incidences of anorexia in the society.
Dare, C. Psychological Therapies for Adults with Anorexia Nervosa: Randomised Controlled Trial of out-Patient Treatments. Vol. 178. (2001): 12-25
Fairburn, Christopher. “Evidence-Based Treatment of Anorexia Nervosa.” The International Journal of Eating Disorders 37 (2005): 26 — 30.
Isserlin, Leanna, and Jennifer Couturier. “Therapeutic Alliance and Family-Based Treatment for Adolescents with Anorexia Nervosa.” Psychotherapy (Chicago, Ill.) 49 (2012): 46 — 51.
Keel, Pamela, and Kelly L. Klump. “Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing Their Etiology.” Psychological bulletin 129 (2003): 747 — 769.
Lock, James. “Randomized Clinical Trial Comparing Family-Based Treatment with Adolescent-Focused Individual Therapy for Adolescents with Anorexia Nervosa.” Archives of general psychiatry 67 (2010): 1025 — 1032.
Tan James. “Attitudes of Patients with Anorexia Nervosa to Compulsory Treatment and Coercion.” International Journal of Law and Psychiatry 33 (2010): 13 — 19.
Treasure, Janet et al. “Working with Families of Adults with Anorexia Nervosa.” Journal of Family Therapy 27 (2005): 158 — 170.
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