- A correspondence between the patient and the spouse with regard to psychiatric illness,
- A lack of marital satisfaction and intimacy,
- Deficient communication
- Inadequate conflict strategies.
(Eating Disorders and Marital Relationships)
In general, physical appearance has a very important impact in couples’ relationships. Many anorectics and bulimics want to please others including their partners. They are convinced that looking good is the best guarantee for an enduring relationship, to the point where appearing physically attractive becomes an obsession. In this way eating disorder helps them to cope with the fear of being deserted. (Eating Disorders and Marital Relationships, p.123).
Studies have also found a relationship between EDs and pregnancies. Many women perceive a pregnancy as a challenge, to their body image, to the control of their body weight and to their self-esteem. (Franko and Walton, 1993; Abraham and Llewellyn-Jones, 1995; Stewart and Robinson, 1993). Fairburn and Welsh(1990) found that about 40% of normal prigravida (first pregnancy mothers) worried that they might gain too much weight; 28% had negative attitudes to changes in body shape, and 72% reported a fear that they would be unable to return to their former weight after delivery.
Finally researchers are still examining potential biochemical or biological causes of eating disorders. It has been found that some eating disorder sufferers have imbalances in certain chemicals in the brain that control hunger, appetite and digestion. In February of 1998 scientists discovered two novel hormones that appear to modulate hunger and saity. This finding may well lead to better prevention programs and medications in the near future. (Scientific American: Explorations: Treating Eating Disorders).
All this factors of psychosomatic abuse, family problems, biological causes, marital status and women in pregnancy, can be either appeared in connection or independently and increase the probability someone to develop eating disorders. Although, the above factors could also be linked with psychological and sociocultural issues, which can explain why does anorexia nervosa in one person evolve to a chronic state or even death and in another to a mild and limited episode in adolescence only. Based in the above factor is worthwhile to examine the relationship between eating disorders and psychological factors.
Psychological factors in relation to eating disorders.
Research from Heinberg and Thompson (1995) explored the concept of awareness and acceptance of societal attitudes toward female attractiveness. They found that women with high cognitive distortions and awareness of societal attitudes were more depressed, angry and more dissatisfied with their bodies following viewing the commercials.
The problem of Individual Cognitions has been discussed widely from cognitive psychologists. Evidence has suggested that issues around control and self-control, in particular, may be critical variables in the aetiology of eating disorders (Jeffrey 1987). As an example various studies found that maternal overprotection is associated with dieting and eating disorders. So, many girls, especially in adolescence, try to establish their feeling of mature ness and their need of independence by rejecting the maternal overprotection in a “Secret” way of foot restriction.
Moreover cognitive-behavioural theorists suggested that the fear of fatness and body image disturbance are powerful reinforces for weight loss. (Abnormal Psychology, p.219). Body image dissatisfaction is so epidemic in certain societies that it’s almost normal. About half of the teens think they’re too fat and almost 50% are dieting. (Body image, Internet). The aim in this case is to have the “perfect” body. Hence, some sports that are pre-requiring a certain body type, can contribute to a negative body image. For example ballet dancers often suffer for anorexia nervosa, while thinness in ballet appears to be connected with the sensitive and vulnerably model that ballet tent to reinforce. So, often ballet dancers starve their selves in order to gain the ideal body, which will make them to succeed.
Low self-esteem can also cause the development of an unhealthy body image. As self-esteem reflects how much you respect your self physically (how happy you are with the way you look), intellectually (how well you feel you can accomplish your goals), emotionally (how much you feel loved) and morally (how you think of yourself as a person), low self-esteem appears to represent a significant risk factor for the development of eating disorder. (Internet)
In connection with the above findings, the role of personality in the development of eating disorders appears to be another important factor, which needs further explanation. A recent study estimated the prevalence of personality disorders prior to onset in 51 Swedish anorexics compared with 51 normal controls (Rastam, 1992). A strong association between anorexia nervosa and premorbid obsessional problems was apparent when interview notes were submitted to a blinded clinical researcher for assignment of diagnosis. The results showed that 35% of anorexics versus 4% of controls were given premorbid diagnoses of obsessive-compulsive personality. (Journal of abnormal psychology, 1994, vol. 103, p.139).
Furthermore, perfectionism in relation to obsessive ness with healthy eating could increase the risk of EDs. One objection that is typically raised is ‘why to I have to eat foot that is bad for me? This is a trick question as there is no such thing as perfect eating and is just a thin line dividing healthy from unhealthy eating. Hence, the fear of foot is one area that must be conquered in order to produce full recovery from an eating disorder. (Internet)
Mitchell et. Al (1991) estimated that 24%-88% of a clinical population experienced eating disorders in present with depression. In general researches showed that a high co-morbidity exits between anorexia and depression. From the other hand bulimic patients exhibited more diffuse and serious psychopathology. In these cases a proper differentiation with co-existing disorders is very important.
Although, the interpersonal and psychological factors have been discussed, someone may still ask: ‘ why eating disorders are so popular in our days? In this stage the sociocultural influence appears to play an important role. As far as society promotes the thin standard as ideal and necessary for being successful and as far as people learn by classical conditioning, (Pavlov’s theory of learning) sociocultural factors can not be exclude from the causes of EDs.
Sociocultural influence to the development of eating disorders.
Perhaps the most empirically supported approach is a Sociocultural model, which identifies social pressure as the impetus behind an individual’s need to conform to body shape standards (Fallon, 1990; Stormer & Thompson, 1996). Social endorsements of an ideal body shape, such as those found in print and film media formats have been related to body image disturbance( Altabe & Thompson, 1996; Heinberg & Thompson 1995) as well as implicated in the development of eating disorders( Fallon, 1990; Stice. Schupak-Neuberg, Shaw, & Stein,1994).
In 1980 the classic investigation of Garner, Garfinkel, Schwartz, and Thompson examined the changing body shape of Playboy centrefolds. Playboy magazine was selected for this study because its models were considered to epitomise the female body shape ideal. The researchers collected bust and hip measurements as well as weights of centrefolds for 20 years period (1959-1978). An initial examination of the mean weight for the centrefolds indicated a weight significantly lower than that of the average female for the same time period, as well as a significant decrease in the centerfolds’ bust and hip measurements over the 20 years. At the following 10 years a replication of Garner’s research from of Wiseman, Gray, Mosimann and Ahrens revealed that bust and hip measurements of Playboy’s centrefolds continued to decrease.
Andersen and DiDomenico (1992) compared body shape ideals in articles and advertisements in 10 popular women’s magazines from the fall of 1987. They based their selection of magazines on popularity statistics from Simmon’s study of media and markets, performing an analysis of the written text in the advertisements and articles to identify those that were diet related or shape related. Their findings revealed that diet advertisements and articles appeared ten times more frequently in women’s than in men’s magazines. (Job SR, Vol.37, article 203,p.702).
Druss and Henifin (1979) reported that 90% of anorexics are women. Women also make up the majority of those who participate in dieting organizations such as Weight Watchers. (Strunkard, Levine, & Fox, 1970). The reason way that women appearing to suffer significantly more than men from eating disorders, has been examined from Franzoi and Shields (1984) factor analysis of Body Esteem Scale (BES). The factor analysis revealed different dimensions of body satisfaction for men and women. While men appeared to be more worried about: physical attractiveness, upper body strength, and physical condition, women were comprising body-esteem as: sexual attractiveness, weight concern and physical condition.
The ideal image of female attractiveness currently presented in the media is rigid, with a particular emphasis on thinness (Cash& Henry, 1995; Freedman, 1984). Many authors have suggested that media images of attractiveness may be responsible for the normative discontent among younger women regarding their own body weight( Evans, Gilpin, Farkas,Shenassa etc.) So as current media images of ideal female beauty are narrowly defined, exaggerated, and emphasize thinness, exposure to media images may make salient the discrepancy between a female perceiver’s conception of her own weight and the standard accepted by society. Female’s social outcomes depend critically on their attractiveness (e.g., Buss, 1994; Feingold, 1990), and accordingly a perceived discrepancy is likely to be quite threatening, perhaps leading to increased concern with body weight.
However, eating disorders are comparatively rare and little reported in non-Western cultures (Dolan 1991). Bhadrinath (1990) and Khandelwal et. Al. (1995) pointed out that, because traditional Indian culture does not emphasise thinness as a mark of femine beauty, Indian women would not be under the same culture pressure to conform to a fin body ideal as their Western counterparts. (Psychiatry Epidemiol(2001)36,p.462).
Furthermore, it has been implied, that Black and British-Asia women living in the west are not under the same cultural pressure to conform to these body shape ideals (Hsu 1987), because of the values of their original culture.
Stunkard and colleagues in a large American survey found also a striking negative association between socio-economic status and the prevalence of obesity. The investigation revealed that 30% of women of lower socio-economic status were obese compared with 16% of women of middle status, and no more than 5% in the upper socio-economic group. Similar findings have been found in Britain (Silverstone, 1970; Silversone et. Al.1969; Baird et. al. 1874) and Sweden (Bjurulf & Lindgren) In contrary to the above findings, in less affluent countries there is a direct positive correlation between body weight and socio-economic status.(Powers, 1980). In fact, studies among adults in India (Mayer, 1955), Latin America and Puerto Rico (West,1974), American Indians(Garb et. Al. 1975), and children in South China(Chang et. Al 1963) and the Philippines (Stunkard, 1977) have demonstrated that an increasing standard of living is associated with an increasing mean body weight. (Psychological Medicine, 1983,13,p.829-830).
CONCLUSION
However, eating disorders can only be adequately understood when all relevant factors are taken into account. Psychological and Interpersonal factors need to be combined with the Socio-cultural values of our time in order to gain a clear picture of what causes eating disorders. However, Silverstein, Peterson and Perdue (1986), found that the popularity of a thin standard of bodily attractiveness for women leads to eating disorders. (Sex Roles, vol.14, 1986, p. 532). As far as the society and media reinforce the thin standard of bodily attractiveness among women while unconsciously could effect people’s thoughts and desires, eating disorders will keep growing parallel with other psychological problems as stress, anxiety and obsessive perfectionism caused by the high expectations of western countries in different aspects of life.
“ An interesting question for future research is to understand the cognitive processes of women who do not experience increased weight concern following exposure to media images. Such an investigation may provide beneficial information for use in clinical interventions with clients with body image disturbance. By studying the psychological components of a body-satisfied person, or the cognitive responses such a person has when exposed to images of media attractiveness, interventions may be developed to buffer vulnerable women from the effects of media exposure”. (Sex-Roles, vol.38, 1998).
REFFERENCES
BOOKS:
1)Stephan Van den Broucke, Walter Vandereycken and Jan Norre,‘Eating disorders and Marital Relationships’,ed.1997.
2)Zimbardo-Weber, ‘Psychology’,ed. 1994.
3)Gerald C. Davison, John M. Neale, ‘Abnormal Psychology’, seventh edition.
4)Helen Malson, ‘The Thin Woman’, ed. 1998.
5) Karen Ciclitira, Kendra Gilbert, Fiona Starr, “Psychology of mental Health Handbook”, Feb. 2002, Middlesex University.
JOURNALS
Sex Roles, Vol. 14, Nos. 9/10,1986, “The role of the Mass media in promoting a thin Standard of Bodily Attractiveness for Women”. Brett Silverstein, Lauren Perdue, Barbara Peterson and Eileen Kelly.
Journal of Abnormal Psychology, 1994, Vol. 103, No. 1, “Personality Variables and Disorders in Anorexia Nervosa and Bulimia Nervosa”. Kelly Vitousek and Frederic Manke.
Psychological Medicine, 1983, 13, “Gross-cultural differences in the perception of female body shapes”. Adrian Furnham and Naznin Alibhai.
International Journal of Eating Disorders, Vol. 18, No. 2, 1995, “Ethic/Racial and Socio-economic Differences in Dieting Behaviours and Body Image Perceptions in Adolescents”. Mary Story, Simone A. French, Michael D. Resnick Robert W. blum.
Sex Roles, Vol. 37, 1997, “Body Image and Body Shape Ideals in Magazines: Exposure, Awareness, and Internalization ”. Dale L. Cusumano and J. Kevin Thompson.
Sex Roles, Vol. 19, Nos.3/4, 1988, “Behavioral and Psychological Implications of Body Dissatisfaction: Do men and women differ?” Lisa R. Silberstein, Ruth H. Strigel-Moore, Christine Timko and Judith Rodin.
Soc Psychiatry Psychiatr Epidemiol (2001), 36, “Abnormal eating attitudes and behaviours and perceived parental control: a study of white British and British-Asian schoolgirls”. A. Furnham-S. Adam-Saib.
INTERNET WEPSIDES
International Eating Disorder Referral and Information Center.
.edreferral.com/causes.Htm
Introducing Bulimia Nervosa and Bulimia Nervosa
Scientific American: Explorations: Treating Eating disorders: March 2, 1998
. Sciam.com/explorations/1998/030298eating/index.html
FURTHER READING
Journal of clinical psychology, Vol. 53(2), 167-175(1997) “Perception of Body Shapes by Anorexics and Mature and Teenage Females”. Bahman Baluch, Adrian Furnham, Anna Huszcza.
Springer-Verlag (1992), p.273-303, “The Course of Eating Disorders”. W. Herzog H. - C. Deter, W. Vandereycken (eds.)
Journal of Social and Clinical Psychology, Vol.14, No. 4, 1995, p.325-338, “Body Image and Televised Images of Thinness and Attractiveness: a Controlled Laboratory Investigation”. Leslie J. Heinberg, J. Kevin Thompson.
Hilde Bruch, “Conversations with Anorexics”, 1994.
Gabriella Ripa di Meana, “Figures of Lightness”, 1995.