What we're exploring: How does reductionism influence the diagnosis and treatment of eating disorders?
What's new: What are the consequences of eating disorder treatment?
What we will learn: What motivates a person with an eating disorder?
1. Reductionism permeates the medical sciences and influences how we diagnose, treat, and prevent disease (Ahn E. S. et al. 2006) [1].
2. Practitioners consistently reported strong feelings of incompetence in treating eating disorders. Negative reactions to patients with eating disorders have been associated with a lack of improvement in patients and personality pathology [painful violations of the integrity of the individual (fr. 24.2), ed., author], as well as with stigmatizing beliefs *, inexperience, and gender of clinicians [doctors clinics, ed. author] (Thompson-Brenner H. et al. 2012) [2].
3. Patients with eating disorders (ED) are often difficult to treat. Despite recent advances in treatment, a significant proportion of patients remain refractory to treatment (Kaplan A.S., Garfinkel P.E. 1999) [3].
* A stigmatizing belief is a negative label ("stigma" from ancient Greek, στíγμα – "label, brand"), hung on a patient by a society of doctors of various professional disciplines. For them, this label was formed under the influence of a strong feeling of hostility due to unsuccessful attempts to treat eating disorders [2, 3].
4. What does ED mean? According to ICD-11 *, eating disorders (hereinafter referred to as ED) include anorexia nervosa (AN); Bulimia Nervosa (BN); and binge eating disorder (BED). Other behavioral disorders not related to weight or shape, which are also classified as ED, are not listed here because they are beyond the scope of our topic (ICD-11 code 6B83 - 6B85, 6B8Y). In addition to the differences between anorexia nervosa, bulimia nervosa, and binge eating disorder, some signs unite them. These disorders combine eating behavior that is focused on food, but at the same time does not take into account the individual physiological and psychological needs of a person (fr. 7. 4, 5; 17. 7, 9; 26. 11, 17). This preoccupation with food manifests itself mainly in pronounced problems with body weight and figure (ICD-11, code 6B80 - 6B82, description). There is no point in listing the exact description of the signs of these diseases since they are individual. On the other hand, reductionism has an impact on determining the accuracy of diagnosis, treatment, and prevention of patients with ED.
* ICD-11 – International Classification of Diseases, eleventh revision. The latest version of the ICD, ICD-11, was adopted by the 72nd World Health Assembly in 2019 and entered into force on 1 January 2022. https://www.who.int/standards/classifications/classification-of-diseases
5. The influence of reductionism. For more than the last two centuries, science, including medicine, has been based on the methodological principle of reductionism. Under its influence, preventive measures, diagnosis, and treatment of diseases are formed in modern medicine. Reductionism (from the Latin reduction - reduction) in the science of studying living beings (biology) means reducing the complex human organism, which is difficult to understand, to many separate parts, each of which will be easier to study separately [1]. Each individual part of the human body is treated by a highly specialized doctor (Fr. 3. I. 1). For example, a therapist treats the physical condition of ED—weight abnormalities, delayed growth and development, cardiac abnormalities, dehydration, and other painful changes in the body. An endocrinologist treats hormonal disorders. The psychologist treats psychological disorders ED associated with low self-esteem, personal and interpersonal difficulties, sleep disorders, depression, etc.
6. Reductionism and psychology. In psychology, the human psyche is reduced to individual phenomena of mental processes expressed in behavior. Behavior is considered as individual acts of mental phenomena, which in modern psychology are considered by various approaches or systems. According to some data, there are five main ones, and according to others, ten main and six other psychological systems, each of which has its terminology [4, 5]. What does it mean? This means that, for example, the cause of overeating or refusal to eat in ED can be explained in different ways. The biological approach in psychology views overeating or refusal to eat as a deviation from the normal activity of the hypothalamus, the part of the brain structure that is responsible for regulating eating behavior. The behaviorist approach shows the connection between the stimulus coming from food advertising or body image and the corresponding reaction - overeating or refusing to eat. The cognitive (from the Latin cognitio - knowledge) approach assumes that the so-called human mind and level of cognitive abilities influence his attitude towards food. And so at least two to seven more approaches can consider the acts of overeating or refusing to eat. Just try and figure out whether these are mutually exclusive acts of mental phenomena ED or whether they are the same acts talking about the same thing, only denoted by different terms [ibid.]. How does medicine make a diagnosis in such a fragmented and disjointed approach?
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