The avoidance of the feared stimulus(eating) can perpetuate dieting as it negatively reinforces it- the individual has escaped an undesirable situation resulting in pleasure.
The media acts as a means of vicarious reinforcement, creating the idea that the social norm that to be thin is a good thing. Watching actors and musicians receive attention and admiration can lead an individual to imitate behaviour. This is supported by Becker’s 1999 study into Fiji, which was to see the effects of Westernised television which was only just being introduced to the island. When the TV was first introduced, 63 native Fijian girls were asked to complete questionnaires on their attitudes to eating and were also questioned on their television viewing habits. Three years later they were re-questioned. Becker found that from 1993 to 1995, there was a 12% increase in the number of girls who said that they were vomiting to control their weight (in 1993, 3%, in 1995, 15%). Also the percentage of girls at risk of disordered eating (as indicated by the questionnaire) had increased from 13% in 1993 up to 29% in 1995. This supports the approach as it suggests that the behaviour was learnt through imitating the Westernised ideals. However, although the behavioural model can account for gender differences and cultural differences in anorexia, it cannot explain individual differences, that is, all of the people in Western countries are exposed to thin models, yet we do not all develop anorexia. Many people diet and yet they also never develop anorexia. This suggests that the behavioural approach alone cannot account for anorexia.
The psychological explanation in terms of the cognitive approach suggests that anorexia may be related to disordered thinking, that is, by being preoccupied with the way an individual looks or thinks that they look. People who have anorexia often do perceive themselves differently, as unattractive and/or as overweight. The cognitive approach suggests that the reason why only some people develop anorexia is because only those with faulty belief systems are affected with anorexia as they do not “see” their excessive weight loss. Bemis- Vitousek and Orimoto (1993) pointed out some of the faulty cognitions that are typical of those with anorexia. A common cognition is that dieting is a means of the individual exerting control but at the same time many of the individuals who have anorexia are aware of the fact that they are out of control because they can’t stop dieting even when they are aware of the fact it is damaging their health and/or threatening their lives. This is a maladaptive way of thinking. However, criticising this approach, it is not clear whether the maladaptive thinking is a cause or an effect of the illness. Once an individual has developed faulty cognitions these can act as a means of perpetuating the disorder. Positively criticising this approach are Garner and Bermis (1982) who point out that whatever the cause, the end result appears to always be the desire to be thin. Therapies based on tackling self-defeating statements and of repairing the faulty cognitions could focus on this.
Psychological explanations of bulimia nervosa include the psychodynamic approach. McLelland et al (1991) found that 30% of those who had developed eating disorders had also been abused in their childhood. These experiences may have been repressed and expressed later through the symptoms of bulimia. Bulimia can act as a means of punishing the body and of expressing a degree of self-disgust. It may act as a coping mechanism which could explain the gender difference in the number of females compared to the number of males who develop it, females are taught to be more self-critical whereas men are taught to blame others, therefore a female who is abused is more likely to blame herself and to develop bulimia than an abused male who is more likely to become hostile towards others and is less likely to develop bulimia. Chassler(1998) suggests that bulimia develops as it represents the conflicting wishes for a merger and autonomy. The act of bingeing is an attempt for the individual to regain the momentary experience of the Mother and to merge with the engulfing maternal object. The anxiety of engulfment results in purging. Criticising this approach, not all individuals who develop bulimia have been abused, therefore this does not explain all cases of bulimia. Also, merger and autonomy issues are not apparent in all individuals who have bulimia. This suggests that this approach may only have relevance in certain cases to certain individuals.
The behavioural approach to bulimia nervosa suggests that the individual goes through direct and indirect conditioning. Bingeing is rewarding to the individual as it provides a means of self indulgence. However, as well as this, it also causes anxiety, which can be released by the act of purging which is therefore rewarding to the individual. This means that both purging and bingeing act as means of reinforcement. The media also acts as contributing factor to bulimia. Lee et al (1992) suggests that the reason why eating disorders were relatively rare in Hong Kong was the lack of specific information on how to do it. He also suggested that bulimia is a cultural bound syndrome, the Chinese value fatness and dieting is rare. Their diet is also low in fatty food and eating has no association with guilt. This suggests that socio-cultural factors may be the cause of bulimia rather than biological factors.
The cognitive approach to the psychological explanations of bulimia nervosa suggest the disinhibition hypothesis, Ruderman (1989) proposed that people differ in terms of the extent to which they restrain their eating. A 10 point restrain scale was developed in order to assess this. Restrained eaters have a rigid cognitive style, i.e. things are all or nothing. They also constantly monitor their weight. If restrained eaters feel they have overeaten they lose this sense of restraint and this may lead to bingeing. They no longer feel inhibited about eating and this leads to a massive eating binge. The individual will then feel both guilty and disgusted with themselves. This leads to the act of purging. Binge-purging may also be rewarding to the individual (the behavioural model) as the bingeing allows self indulgence and the purging offers a sense of relief. The individual may see this as a good way of dieting. Cooper and Taylor also found that individuals who had bulimia tended to have a distorted body image. This distorting then lead to the individual having a greater desire to lose weight. Vanderlinden et al (1992) suggested that individuals with bulimia tended to perceive events as more stressful than most people thus binge-purging acted as a means of gaining control over situations and of coping with the stress. However, this model does not suggest a cause or effect. On a more positive note, they may provide a means of treatment in order to break the binge-purge cycle.
However, to summarise, each of these psychological explanations of eating disorders can be criticised in some way, primarily as they ignore the degree to which genetics have a role within such disorders. Genetics may have a greater basis. Kendler et al (1991) suggests that bulimia nervosas’ heritability is 55% and Holland et al (1988) suggests an 80% heritability rate for anorexia nervosa. This would suggest that the psychological explanation is of less importance than the biological causes. However, it does not mean that the psychological explanation should be disregarded as unimportant in explaining the development of eating disorders. It is most likely that the diathesis-stress model explains the development of such disorders: the individual is born with a gene which makes them more vulnerable to such disorders and that a trigger (such as a stressor) sets off the disorder.
