Pro-Anorexia - Impact on Body Image and Self-Esteem in Normal and Susceptible Individuals - Essay Example

Pro-Anorexia Websites: Assessing the Impact on Body Image and Self-Esteem in Normal and Susceptible Individuals 2007 To lose confidence in one's body is to lose confidence in oneself Simone De Beauvoir, 1949 INTRODUCTION Anorexia nervosa is an eating disorder that affects approximately one percent of female population in the U.K. and is often referred to as "the most fatal of psychiatric illnesses" (Lask and Bryant-Waugh, 2000: 97). This disorder turns people neurotically anxious to reduce body weight or maintain it at an abnormally low level. Excessively strict monitoring of calorie intake and distorted perception of physical appearance are reported to be the most common behavioural patterns observed in anorectic patients (DSM-IV-TR, 2000). Officially, anorexia is estimated to be the third most common chronic condition amongst adolescent girls though many scholars believe that official statistics does not show the true incidence of this disorder (Misra et al, 2004). The highest prevalence of anorexia is normally found in female population aged 15 - 30 girls (Goldman, 1996; Gordon, 2000). However, youth under 15 and women above age 30 may suffer from this disorder too: the oldest anorectic patient reported in the literature is a woman of 68 without any prior history of eating disorders (Dally, 1984). Anorexia also occurs in male population: estimated 10 to 15 percent of people with anorexia are men. The highest occurrence of anorexia among males is reported in the age group of young adolescents from 7 to 14 years: nearly 25 percent of anorexia cases in this age group are boys (Herman-Giddens et al., 1997). Anorexia nervosa negatively impacts mental and physiological health. Similarly to other eating disorders, anorexia frequently co-occurs with depression, substance abuse and anxiety disorders (APA, 2000). Physiologically anorexia nervosa causes a wide range of health complications some of which - cardiovascular conditions and kidney failure - are life threatening: this disorder is associated with a 5.6 percent mortality rate, which is "the highest among all psychiatric conditions" (Misra et al, 2004:1575). Anorexia nervosa typically causes "loss of subcutaneous fat tissue, orthostatic hypotension, bradycardia, impaired menstrual function, hair loss, and hypothermia" (Yager and Andersen, 2005: 1481), and stimulates serious changes in functioning of organism, namely in hematologic aspect and bone metabolism (Misra et al, 2004). The typical symptoms of anorexia nervosa have been well studied. The disorder is often associated with 'loss of appetite due to nerves' (Lask and Bryant-Waugh, 2000) though such association is not fully correct. Loss of appetite may occur only at the late stages of starvation, while at the early and middle stages people suppress their appetite. Anorexia nervosa is characterised by the following symptoms: Refusal to maintain body weight at or above a minimal normal weight for age and height (e.g., a weight loss resulting in maintenance of body weight at less than 85 percent of the expected weight or failure to make the expected weight gain during the period of growth, resulting in a body weight of less than 85 percent of the expected weight); Intense fear of gaining weight or becoming fat, even though underweight; Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight; Among postmenarchal girls and women, amenorrhoea (the absence of at least three consecutive menstrual cycles) (DSM-IV-TR, 2000: 46); The aetiology of anorexia nervosa has been studied less well than its symptoms and consequences: the origins of this disease are not fully understood at present (Tozzi et al, 2003). Destructive influence of family and society, genetic (inherited) factors, brain dysfunction, and neurotransmitter levels imbalances are reported to be on the list of the causes, yet none of these factors have been proved to play the key role in onset and development of the disease. Some twin studies suggest that anorexia nervosa is more than other eating disorders associated with a genetic predisposition (Paris, 1999). Considerable research links the disease predominantly to brain dysfunction (Tozzi et al, 2003). However, the increasingly popular stance points to a combination of social and biological factors (Lask and Bryant-Waugh, 2000). Low self-esteem plays an important role in the multifactorial theory of the aetiology of anorexia nervosa. The concept of self-esteem, first described by William James in 1890, relates to an individual's mental perception of his qualities; it one of the most frequently mentioned in psychological literature concepts (Rodewalt, and Tragakis, 2003). The first definitions of self-esteem described this concept as a ratio of successes and failures or pretensions (James, 1983). The social learning tradition represented by Albert Bandura and Maurice Rosenberg adopts a different view on self-esteem defining it in terms of a stable sense of personal worth or worthiness that can be measured by self-report testing (Rosenberg, 1965). Although this definition has been the most popular one in psychological research for decades, it is not without some serious flows, e.g. narcissism or arrogance is barely distinguishable from the actual self-esteem construct within the framework of this definition (Baumeister, Smart, & Boden, 1996). The two-factor definition of self-esteem proposed by Nathaniel Branden in the late 1960's is believed to be the most balanced one up to date (Mruk, 2006). Branden defines self-esteem as "the experience of being competent to cope with the basic challenges of life and being worthy of happiness" (Branden, 1994: 14). Branden lists major six elements of self-esteem (living consciously, self-acceptance, self-responsibility, self-assertiveness, living purposefully, and personal integrity), and his definition allows for high flexibility depending on the purposes of research. The contention that low self-esteem is a major trait of eating disorders, including anorexia, has been confirmed by many credible studies. Schupak-Neuberg (1993), Rosen and Button (1993) employed various strategies and questionnaires to show that low self-esteem occurs very commonly in patients with eating disorders. Some theorists believe the evidence for this relationship is sufficient to consider low self-esteem a necessary prerequisite for disordered eating (Silverstone, 1992). The core features of low self-esteem - insecurity, excessive concern over weight, negative mood, feelings of inadequacy, negative attitudes about self-control and discipline, social and personal withdrawal, poor adaptation skills, and unrealistically high aspirations - are reported to be consistently present in patients with disordered eating (Steinhausen, 1993; Button 1997). Concerns with body image, which have been linked to a decrease in self-esteem, are also reported to relate to anorexia nervosa (Thompson, 1990; Grogan, 2006; Steinhausen, 1993). A popular definition of body image has been proposed by Slade (1994): "The picture we have in our mind of the size, shape and form of our body; and the feelings we have concerning these characteristics and our constituent body parts" (p.498). There are several core elements in the concept of body image, namely: cognitive (thoughts and beliefs about the body), perceptual (tactile, kinaesthetic, proprioceptive, visual, olfactory, auditory), affective (feelings about one's own body), behavioural, and social. Consequently, the development and transformation of body image is influenced by events affecting the body, relationships with others, self-esteem and socialization (Espina et al, 2002). Multiple and barely quantifiable elements of body image make this construct extremely difficult to measure. Nonetheless, dissatisfaction with one's body (the discrepancy between self-perceived image of physical appearance and conception of the ideal physical beauty) is reported to link consistently to eating disorders (Jacobi and Cash, 1994; Strauman and Glenberg, 1994; Cash and Szymanski, 1995; DSM-IV, 2002; Slade, 1988). The social nature of self-esteem and body image constructs suggests that the standards of physical attractiveness promoted in the media influences them seriously (Groesz, Levine, and Murnen, 2002). Previous research indicates media influences as one explanatory factor for low self-esteem and negative body image eating disorders. Some studies "have begun to test multiple factors and suggest integrative models" (Thompson et al, 1999: 331), with the central influences being peers, parents, and media. Media pressure and dieting talk and behaviours have been found to exert the greatest influences on thinness awareness, thinness internalisation, and social comparison, which in turn influenced body dissatisfaction, drive for thinness, and eating disordered behaviours (Goodman, 2005; Field et al, 1999; Tiggerman and Slater 2004; Irving, 1990; Halmi, 1997). Pro-Anorexia Websites (PAW) is the most recent form of media that have emerged in the cyberspace. As the name implies, anorectic individuals use such websites to create support networks or redefine the concept of anorexia as a lifestyle rather than a serious disorder (Davies and Lipsey, 2003). The public concern that PAWs may stimulate susceptible individuals to become anorectic has been voiced in numerous news broadcasts, newspapers, discussion boards, and popular TV talk shows such as Oprah (Payne 2004; Doward and Reilly 2003). In the same vein, clinicians have also expressed concern that the individuals visiting these sites will become entrenched in disordered eating behaviours and attitudes (Dias, 2003, Bardone-Cone and Cass, 2006). A spokeswoman for the National Eating Disorders Association stated: "[visiting PAWs] is like putting a loaded gun into the hands of someone who is suicidal" (Brase, 2006, cited in Tennen 2006). The emergence of PAWs highlights some highly essential issues associated with the relationship between media influences, body image and/or self-esteem, and eating disorders. Some of these issues have been addressed (Field et al, 1999; Groesz, Levine, and Murnen, 2002; Tiggermann and Slater, 2004). These studies add considerably to our understanding of the aetiology of anorexia nervosa, but only a few of them set out to tackle the issue of PAWs. The thinspiration-related items (e.g. the images of thin women) are reported to negatively impact the body image of viewers. Groesz, Levine and Murnen (2002) conducted a review of 25 studies that assessed immediate influence of IOTW on body dissatisfaction and negative mood and discovered that negative effect on participants' mood and increased body dissatisfaction had been confirmed by a majority of the studies under review. Martin and Kennedy (1993) staged an experiment involving girls that read fashion magazines containing IOTWs. The result was that participants felt less satisfied with their bodies and exhibited disordered eating more expressly than before. Another study conducted by Stice, Maxfield and Wells (2002) found out that involvement of thin women in discussion of dieting efforts negatively affected the body image of participants. Bardone-Cone and Cass (2006) pointed out the similarity between the situation studied by Stice, Maxfield and Wells (2002) and communication via forum sections of PAWs. Although the research exploring the effects of pro-anorexia websites is scarce, the existing evidence suggests they may negatively impact self-esteem and self-efficacy. Thus, a study investigating the effect of pro-anorexia websites found that young females who viewed a pro-anorexia website decreased in self-esteem, appearance, self-efficacy, and perceived attractiveness, and increased in negative affect and perception of being overweight. This pattern was not found among women who viewed a fashion website using average-sized models (Bardone-Cone and Cass, 2006). The ongoing study by Richardson and Cherry (2004-) employs quantitative and qualitative methods to show how young women share influential rhetoric, "trigger" images, and dieting tips, and thereby reconceptualize their experience of anorexia. A strong correlation between self-esteem and body weight in anorectic individuals is, in its turn, reported as one of the core symptoms associated with anorexia nervosa (DSM-IV-TR, 2000). Such relationship implies that eating disorders can ensue when self-esteem is contingent on thinness. Cooper (1997) and Vitousek and Hollon (1990) have found processing biases toward body related information in individuals with eating disorders. This information activates a dysfunctional 'body schema' or belief system. The schema defines body related information preference causing positively biased information to be accessed, processed, and remembered prior to neutral or negative information. The selective processing of body related information reinforces the dysfunctional schema which may result in the progression from dysfunctional attitudes to disordered eating patterns. Irving's (1990) study provides credible support to this assumption by reporting that history of dysfunctional body attitudes increases susceptibility to the negative effects of body related information, such as exposure to images of thin women (IOTW), which constitute an important feature of PAWs. The existing body of evidence strongly suggests there is a relationship between anorexia nervosa and low self-esteem and negative body image. Such relationship, though not fully understood at present, provides a good starting point for improving our understanding of the aetiology of anorexia nervosa: insufficient knowledge of the aetiology of anorexia seriously undermines our potential in treating and preventing this eating disorder. This study seeks to contribute to the broad body of knowledge about the aetiology of eating disorders by studying the impact of modern media on self-esteem and body image. The lack of research exploring the effects of pro-anorexia websites on body image and self-esteem of the viewers, coupled with the growing popularity of the Internet as the new form of media suggests such study is appropriate and up to date. Although the hypothesis to be tested does not imply any new aspects of investigation and relies upon the existing body of scholarly evidence, the study does offer some new insight in the application of theories and concepts designed for traditional media in the new environments. Thus, the study will explore whether the effects of face to face 'fat talk' (Stice, Maxfield and Wells, 2002: 108) extends to virtual discussions in the cyberspace. To certain extent, the study also represents an improvement of Bardone-Cone and Cass' (2004) research that does employ any statistical analysis and does not view PAWs as mediators of susceptibility. The data collected within the framework of this study is supposed to improve our understanding of the major constituents of the PAWs' impact on self-esteem and body image. The data may be used to design a risk model to predict how various groups of population are likely to change the eating patterns after visiting PAWs. The basic hypothesis to be tested in this study is that self-esteem of individuals with dysfunctional body schema (or individuals with disordered attitudes, as they will be referred to henceforth) is contingent on thinness. Therefore it is assumed that the disordered individuals will experience a drop in self-esteem and body image measured on the body image states scale and self-esteem states scale as a result of viewing pro-anorexia websites while the individuals without disordered attitudes (or normal individuals as they will be referred to hence forth) will only experience a drop in body image. The study relies upon the assumption that the impact of different sections of PAWs on body image and self-esteem of viewers is different. Three main components of a typical PAW have been selected for comparison in terms of their influence within the framework of this study: Thinspiration: a portmanteau of the words 'thin' and 'inspiration' that refers to a role model used by individuals to inspire them to lose weight. Forum: an open discussion board used by individuals to discuss eating patterns and build affinity networks. Tips and tricks: provides the visitors with pieces of advice about how to deceive the diagnostic instruments, description of techniques to kill the appetite, unique exercise advice, etc. The following subhypotheses will be tested to focus the research and provide an overarching objective for the study: 1. The control condition will not have a significant effect on the self-esteem and body image of the normal population and the disordered population. 2. The "Thinspiration" condition will have a non-significant effect on the self-esteem of the normal population. 3. The "Thinspiration" condition will have a significant negative effect on the body image of the normal population. 4. The "Thinspiration" condition will have a significant negative effect on the self-esteem and body image of the disordered population. 5. The "Forum" condition will have a non-significant effect on the self-esteem of the normal population. 6. 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