Eating+Disorders+and+Studies+2008

Eating disorders are complex psychiatric conditions which are caused by a number of factors including psychological, biological and socio-cultural factors. **Prevalence**: Probably around 0.1 % of the general population. In the highest risk group - young women between15 to 25)- the prevalence is between 0.5 and 1%. The age of onset is during middle-to-late adolescence. There appears to be a higher risk of anorexia developing in middle-class white women from Western cultures.  Anorexia is associated with a large number of physical and psychological symptoms, and in some cases the self-starvation proves fatal.  **Diagnosis** – DSM-IV  15% or more below the normal weight for age and height.  Intense fear of becoming fat, disturbed experience of body weight, size or shape, and denial of severity of weight loss.  Loss of three consecutive consecutive menstrual cycles in females. In males, loss of sexual interest and potency may also be considered diagnostic signs. = Behavioural abnormalities =  The principal behavioural change is a severe restriction of eating, which amounts to self-starvation. Anorexic patients also use various additional strategies to ensure that they will not put on weight. Many make themselves vomit after they have eaten, or abuse laxatives or diuretic drugs in the bid to bring about weight loss. A relatively high proportion engages in activities such as running or gymnastics which demand a high expenditure of energy. Exercise can become compulsive for those who suffer from an eating disorder. = Emotional state = The majority of anorexic patients are emotionally disturbed in some way. Anxiety and depression are very common, and many patients experience rapid mood-swings, e.g. as responses to weight gain or to attempts by family members or health professionals to encourage eating. Anorexic patients have an intense fear of becoming fat and many develop strong aversions towards high calorie foods. Anxiety levels are often high, but the major emotional problem associated with anorexia is depression, and it is generally found that around half of all anorexic patients meet the criteria for clinical depression. Associated with the depression are thoughts and feelings relating to insecurity, loneliness, guilt, inadequacy and helplessness. Few patients have any thoughts of, or any interest in, romantic or sexual relationships. **Cognitive aspects of eating disorders – distorted body-image hypothesis.** A distorted body image seems to be symptomatic of nearly all eating disorders. Body image can be defined as how people perceive their physical appearance, as well as how they think others perceive them. The body image is perhaps to a large extent a reflection of people’s self-esteem based more on emotions than facts. The opinons of family and peers (social factors) as well as cultural ideals (cultural factors) influence how we perceive and relate to our body image. Cultural ideas of what is desirable and attractive have important implications in the development of people’s body image. According to **the body-image distortion hypothesis** (Bruch, 1962), many eating disorder patients suffer from the delusion that they are fat. Research has confirmed that they overestimate their body size. However, the studies have also shown that the degree of distortion varies considerably with contextual factors, including the precise nature of the instructions given to subjects. It appears that at least some of the reports given by patients reflect their //emotional appraisal// rather than their perceptual experience. In their reformulation of the body-image distortion hypothesis, Slade and Brodie (1994) suggest that those who suffer from an eating disorder are in fact //uncertain// about the size and shape of their own body, and that when they are compelled to make a judgement they err on the side of reporting an overestimation of their body size. Anorexics think that they are too fat. Garfinkel and Garner (1982) showed participants pictures of themselves and others. Participants could adjust them with a device up to 20 per cent above or below their actual body size. They found that a person suffering from anorexia was more likely to adjust the picture of herself so that it was larger than the actual size. They did not do the same for photographs of other people. There seems to be a //gender difference// in perception of body images. American undergraduates were shown figures of their own sex and asked to indicate the figure that looked most like their own shape, their ideal figure and the figure they found would be most attractive to the opposite sex. Men selected very similar figures for all three body shapes! Women chose ideal and attractive body shapes that were much thinner than the shape that was indicated as representing their current shape. Women tended to choose thinner body shapes for all three choices (ideal, attractive and current) compared to the men (Fallon and Rozin, 1985). There are two factors at stake in the body-image distortion hypothesis related to //perceptual distortion// as indicated by the body-image distortion hypothesis and //social comparison//. People constantly compare themselves to other people (upward or downward comparison) and their self-esteem is affected by this. Thanks to the media, we have become accustomed to extremely rigid and uniform standards of beauty. TV, billboards, magazines etc mean that 'beautiful people' are exposed to us all the time, making exceptional good looks seem real, normal and attainable. Standards of beauty have in fact become harder and harder to attain, particularly for women and the current media ideal of thinness for women is achievable by less than 5% of the female population!! Evaluation of **cognitive explanation** that people with eating disorders suffer from perceptual distortion. The explanation is more //descriptive// than explanatory as it does not explain how these distortions arose. It is difficult to establish cause and effect since distorted eating patterns may result in distorted thinking rather than vice versa.
 * Eating disorders **

The cultural demand for thinness hypothesis
The perfect figure has changed over the years in the West. In the 1950s female sex symbols had much larger bodies compared with present-day female sex symbols. Film stars represent an ideal that people compare themselves to so they set up standards for how we should look whether they intend to or not. The fact that at other times, and in other cultures, a more rounded figure has been considered ideal suggests that the current position might be open to change. Many eating disorders begin when a young woman who is not substantially overweight comes to believe that she //needs// to go on a diet. Aspects of the woman’s personal history may contribute to her dissatisfaction with her own body shape, but the desire to be thin is often powerfully influenced by media images and messages. The media both reflects and helps to shape a strong cultural pressure towards thinness. The rise in the incidence of eating disorders which has become evident in recent years throughout Europe, in North America and in Japan is frequently attributed to an increase in this cultural emphasis on thinness as an ideal body shape. The cultural pressure towards thinness was perhaps intensified in the 1960s, when many leading fashion models such as Twiggy appeared pre-pubescent, boyish and rather emaciated. Women are much more likely than men or children to be the target for the media propaganda that exalts thinness, but no group is immune. The representation of the ideal female as thin is apparent in the media coverage of children’s fashion and also in the design of dolls, so that even very young girls are subjected to distorted models of the ideal body shape. Sanders and Bazalgette (1993) analysed the body shape of three of the most popular dolls available for young girls (Barbie, Sindy and Little Mermaid), measuring their height, hips, waist and bust. They then transformed these measurements to apply to a woman of average height and found that, relative to real women; the dolls all had tiny hips and waists, and greatly exaggerated inside leg measurements. Distorted ideas about what is normal and acceptable mean that many children (especially girls) become dissatisfied with their own shape even though it is within the healthy range. Studies indicate that by the age of 12, food and eating are often regarded as moral issues and that body shape is often a major criterion in self-evaluation of others. Furthermore, many parents of young children are unhappy with their child’s body shape, and many children are aware of their parents’ dissatisfaction. When we consider the numerous sources of social pressure that coerce even young children towards being thin, it may seem unsurprising that as may as one-third of 9-years old girls are dissatisfied with their body shape, and that by this age many have already started dieting. Men, too, are now coming under pressure to conform to an ‘abnormal’ ideal. There is a growing emphasis on the ‘worked-out’ male figure, and many men feel a strong demand to ‘get in shape’. A 1993 MORI survey of adult males in the UK indicated that one-third of men had been on a diet and that nearly two-thirds believed that a change in shape would make them more sexually attractive. It remains to be seen whether the growing emphasis on an ideal male shape will lead to an increase in the number of men who suffer from eating disorders. Jaeger et al. (2002) studied cross-cultural differences in body dissatisfaction, a risk factor for bulimia. Jaeger et al. aimed to investigate body dissatisfaction because it is identified in past research as being a risk factor for bulimia and dependent on cultural factors. It is suggested that eating disorders are in fact Western culture-bound syndromes. However, few past studies have compared cultures using rigorous methodology. Thus, this research aims to gather reliable information about body dissatisfaction and interrelated factors (self esteem and dieting behaviour), and consequent cultural differences in vulnerability to bulimia. In total, 1751 medical and nursing students were sampled across 12 nations, including both Western and non-Western countries. This was a natural experiment as the independent variable (culture) cannot be controlled by the experimenter. A self-report method was used to obtain data on body dissatisfaction, self-esteem, and dieting behaviour. A series of 10 body silhouettes, designed to be as culture-free as possible, were shown to the participants to assess body dissatisfaction. Body mass index (BMI), which takes account of height and weight, was also measured. Significant differences between cultures were obtained. Most extreme body dissatisfaction was found in Mediterranean countries followed by northern European countries. Countries in the process of Westernisation showed an intermediate amount of body dissatisfaction. Non-Western countries showed the least amount of body dissatisfaction. Body dissatisfaction was the most important influence on dieting behaviour in most countries. Body dissatisfaction was found to be independent of self-esteem and BMI. The significant differences between cultures support behaviourist explanations of bulimia. More specifically, the disorder is due to the “idealised” body images portrayed in the media, which encourage distorted views and consequently body dissatisfaction and dieting behaviour. Western countries are more exposed to these images, and they do show higher body dissatisfaction than non-Western cultures. Perhaps even more significant is the increase in body dissatisfaction in cultures undergoing Westernisation, where exposure to idealised images is increasing. Implications are that explanations of the disorder must be considered at a macrolevel (society) rather than as originating solely within the individual (microlevel). Jaeger, B., Ruggiero, G.M., Gomez-Perretta, C., Lang, F., Mohammadkhani, P., Sahleen-Veasey, C., Schomer, H., & Lamprecht, F. (2002). Body dissatisfaction and its interrelations with other risk factors for bulimia in 12 countries. //Psychotherapy and Psychosomatics//, //71//, 54–61.
 * RESEARCH STUDY: Cross-cultural differences in body dissatisfaction **
 * Aims **
 * Procedure **
 * Findings **
 * Conclusions **
 * Criticisms **
 * The study ignores the role of genetic factors in causing bulimia, even though heredity certainly plays a part in the development of the disorder. It is not easy to separate out the influence of nature and nurture, but it is oversimplified and reductionist to consider only //one// explanation, behavioural, as a basis for eating disorders when there are many other possible explanations, e.g., biological, cognitive, and psychodynamic.
 * This is a natural rather than a true experiment. This means that the independent variable (culture) was not under the control of the experimenter. Causation cannot be inferred if the independent variable was not directly manipulated. As a result, it cannot be said that culture causes differences in body dissatisfaction and the subsequent risk for bulimia.
 * The participants in the study were all medical or nursing students. Such relatively well-educated groups do not form representative samples, and it is not at all clear that other groups in each country would have similar levels of body dissatisfaction.
 * Reference **

Holland, Sicotte, and Treasure (1988) studied genetic vulnerability in anorexics. Holland et al. aimed to investigate whether there was a higher concordance rate of anorexia nervosa for monozygotic (MZ) than dizygotic (DZ) twins (concordance rate being the extent to which the fact that one twin has a disorder predicts that the other twin will also have it). This study was based on previous research, which suggested that abnormality might have a genetic basis. A difference was sought between MZ and DZ twins, because MZ are 100% genetically identical whereas DZ have only 50% of their genes in common. Thus, there should be higher concordance for MZ than DZ if there is a genetic basis to anorexia nervosa. An opportunity sample of 34 pairs of twins (30 female and 4 male) and one set of triplets was selected because one of the pair (or triplets) had been diagnosed with anorexia. This was a natural experiment as the independent variable (genetic relatedness) is naturally occurring and cannot be controlled by the experimenter. A physical resemblance questionnaire established genetic relatedness, that is, whether the twins were MZ or DZ (16 were MZ and 14 were DZ). MZ twins typically have greater physical resemblance but if there was any uncertainty a blood test was carried out. This was a longitudinal study, with the researchers checking over time to establish whether the other twin went on to develop anorexia (the dependent variable). A clinical interview and standard criteria were used for diagnosis of anorexia. A significant difference was found, because there was a much higher concordance rate of anorexia for MZ (56%—9 out of 16) than DZ (7%—1 out of 14) twins. Further findings were that in three cases where the non-diagnosed twin did not have anorexia they were diagnosed with other psychiatric illnesses, and two had minor eating disorders. The results suggest a genetic basis for anorexia and general psychiatric illness. The fact that the percentage for MZ twins was well below 100% indicates that genes are not wholly responsible. Thus, genes can provide a predisposition, i.e., they make the individual vulnerable but do //not// directly trigger the disorder. Implications include the need to identify the precipitating factors, i.e., environmental triggers, which interact with the genetic predisposition. Holland, A.J., Sicotte, N., & Treasure, J., (1988). Anorexia nervosa: Evidence for a genetic basis. //Journal of Psychosomatic Research//, //32//, 561–572.
 * RESEARCH STUDY: Genetic vulnerability in anorexics **
 * Aims **
 * Procedure **
 * Findings **
 * Conclusions **
 * Criticisms **
 * The study ignores the role of environmental factors or nurture in causing anorexia. The environment certainly plays a role, because the concordance rate was only 56% for MZ twins. This would have to be 100% if anorexia were exclusively due to genetic factors. Furthermore, the 56% concordance may be due in part to environmental factors. MZ twins often experience a more similar environment and are treated more similarly than DZ twins, due to the fact that they look and behave more alike. This does //not// account for the considerable difference found between MZ and DZ twins, but it does show that it is hard to separate out the influence of nature and nurture or environment. Thus, it is oversimplified and reductionist to consider only one factor, genes, as a basis for anorexia.
 * The natural experiment lacks control of the variables. The IV, genetic relatedness, is not isolated, as multiple other factors (confounding variables) may be implicated, e.g., environmental factors (as identified above), individual-specific experiences, and socio-economic factors. Consequently, internal validity is low, as factors other than the IV may have resulted in anorexia. Also the IV is not controlled and so causation cannot be inferred. This means conclusions are limited as it cannot be said that genes cause anorexia; at best they are strongly implicated.
 * This study is limited in that it was carried out in a Western society. Anorexia is much more common in Western societies than in other parts of the world, presumably because of the emphasis on the desirability of thinness (especially in women) in Western societies. These cultural factors are very important, but were not considered by Holland et al.
 * Reference **