Eating Disorders in Adolescence - Term Paper Example

Eating Disorders and Self-Esteem: A Correlation and a Vicious Circle Eating disorders are often caused by a lack of self-esteem. The issue with eating disorders is also that they tend to be self-perpetuating – an adolescent or child who has low self-esteem may attempt to diet, in order to feel that he or she has control over his or her life. Dieting is difficult, and, if the child is not successful, then this leads to more negative thinking, and lower self-esteem, which might cause the child or adolescent to purge. Alternatively, with an anorexic child or adolescent, the issue is that starvation might cause physical and psychological changes which cause the cycle of starvation to perpetuate. One of the ways that a school or parent can counteract the cyclical nature of the eating disorder would be to focus on improving the child’s self-esteem through a concentrated program that encourages the child to see him or herself as unique, as well as encourages communication skills between the child and the child’s peers, parents, and teachers. Introduction Self-esteem is an issue to many of our children and adolescents in todays world, and self-esteem, or the lack thereof, may contribute to eating disorders. For instance, a child or adolescent may develop self-esteem issues because he or she has been teased for being overweight, and, if the child or adolescent is very sensitive to being called overweight, than that child may develop anorexia nervosa. This would mean that the adolescent stops eating. At the root of this disorder, in addition to being caused by a lack of self-esteem, is the feeling that the adolescent does not have control over what she eats, so, by starving herself, the adolescent can prove to herself and the world that she does have this control. The adolescent who is suffering from anorexia nervosa also has a need to control her emotions, and this is also what is at the root of anorexia (Anorexia Nervosa). Anorexia is also caused by a lack of self-esteem, in that the anorexic adolescent may not believe that he or she is entitled to pleasure, therefore eating is restricted, because eating is generally pleasurable. Or, the anorexic may believe that he or she is unworthy, therefore must be punished. The punishment may take the form of over exercising, and extreme counting of calories and fat grams (Anorexia Nervosa). Bulimia is another form of eating disorder, and bulimics also deprive themselves of food, but, unlike anorexics, bulimics will actually consume food. Often they consume mass quantities of food, known as binging, then they purge. Purging may be forced vomiting, and it may be excessively using laxatives (Halvorsen & Heyerdahl, 2006). Both bulimia and anorexia often have abuse at their core – the sufferer of the eating disorder has suffered emotional, physical or sexual abuse, and this is the reason for the low self-esteem, as well as the feeling that the person is not worthy of pleasure (Anorexia Nervosa). At the opposite end of the spectrum, but also having the same root cause as anorexia, is overeating. Overeating leads to obesity. These eating disorders are serious, and result in serious health implications. Anorexia leads to starvation, which means that the body is not getting proper nutrients. This may lead to death (Anorexia Nervosa). Bulimia may also lead to malnutrition, as the body is not receiving nutrients, because the nutrients are purged before they can be processed. Other problems with bulimia may be that the tooth enamel is eroded by the stomach acid that is expelled when the person purges food, as well as other health problems that might be associated with this constant purging of stomach acid, such as wearing out the lining of the esophagus (Fairburn et al., 1986). As for overeating, obesity is the result of this, and obesity carries with it health problems that might include an increased risk for diabetes, stroke, heart disease, cancer, and any number of other health problems (Decaluwe & Braet, 2005) . At the root of all of these issues is the lack of self-esteem. Method The method that was used for this essay was secondary research. PubMed, Google Scholar and JStor were perused to find articles that focused upon eating disorders and self-esteem, and how the two interact with one another. The articles that were searched were narrowed to articles that were written no earlier than the year 2000. The articles were also selected in that at least one article focused upon a particular type of eating disorder, whether it is bulimia, anorexia or overeating. One article was included because it detailed a solution to the issue of self-esteem and eating disorders, and how, in particular, a school might address the problem of eating disorders by addressing the issues surrounding self-esteem. Results Eating disorders are often caused by a lack of self-esteem. This is noted by Halvorsen & Heyerdahl (2006), who examined the traits that presage anorexia nervosa. They found that individuals with the disorder tend to be perfectionists. The individuals with this disorder also tend to have negative emotions that are restrained. They are high achievers, and are inclined to comply with norms and rules. Because of the stress of always having to achieve, coupled with the fact that any negative emotions they have are bottled up inside, individuals, when they hit puberty, and start to gain weight. The weight gain is a symbol of failure to these individuals, so anorexia is the end result of this mind-set. That said, there is also a question of cause and effect in anorexia. Halvorsen & Heyerdahl (2006) state that anorexia causes psychological and physiological symptoms. Because of this, it is difficult to sort out what psychological and physiological symptoms caused the anorexia, and which of these symptoms were caused by the anorexia (Halvorsen & Heyerdahl, 2006). That said, Halvorsen & Heyerdahl (2006) did attempt to skein out the traits of the anorexic, with regards to self-esteem. Their study was concerned with 55 girls with a DSM-IV diagnosis of AN in Norway who were treated between the years of 1986 and 1998. Each of the participants of this study were given what is known as the Rosenberg Self-Esteem Scale. Three experienced clinicians also interviewed each of the participants. Each of the participants, at the time of the study, were considered to be recovering anorexia patients, so they were referred to as “former AN patients.” As such, they were divided into three different groups. In group one were the patients who, at the time of the study, had a normal or relaxed attitudes towards food. In group two, were the former AN patients who experienced some stress regarding food. In the third group were the relapsers – these former AN patients had a present eating disorder at the time of the study, using DSM-IV criteria to assess this (Halvorsen & Heyerdahl, 2006). The researchers then cross-analyzed each group, with regards to self-esteem – which of these groups scored the highest on the Rosenberg scale, and which scored the lowest? The researchers found, perhaps not unsurprisingly, that the individuals who had the best outcome with regards to eating disorders, which means that patients who had the most normal relationship with food, also had the highest self-esteem of all the groups. The ones who were suffering an active relapse at the time of the study had the lowest self-esteem. The ones who had some stress regarding eating, although not in full-blown relapse mode, had self-esteem scores in between the two other groups. Therefore, it was found that there was a correlation between anorexia and self-esteem. Decaluwe & Braet (2005) looked at bulimia with the same eye. They took the Fairburn et al. (1986) model when doing their analysis of bulimia patients. What Fairburn et al. (1986) proposed regarding obesity, according to Decaluwe & Braet (2005), was that bulimia can be represented by a vicious circle, all of which is rooted in self-esteem problems. What happens with bulimia is that an individual starts out with low self-esteem, which might be caused by abuse, bullying, or any number of issues. Because this individual has low self-esteem, they get the mind-set of an anorexic - that is, that they want to be able to control their eating, to prove to themselves that they have the ability to control at least one aspect of their life. However, controlling eating is difficult, and the person ends up binging. This brings a sense of failure to the bulimic, and the sense that the binging means that they are not perfect. This leads them to binge more – if they cannot be perfect, then why try at all? However, the bulimic realizes that binge eating will bring weight gain, so, to make sure that this doesnt occur, they have to induce vomiting or take laxatives. This makes the individual feel that he or she is even more out of control, which leads, anew, to a resolve that he or she will control their eating. Thus, the cycle begins again from this point (Fairburn et al., 1986; Decaluwe & Braet, 2005). By using the Fairburn framework regarding binging and purging, Decaluwe & Braet (2005), were able to look at binge eating that does not include purging. In other words, the population studied by Decaluwe & Braet (2005) were children who were overweight because they were suffering from binge eating disorder (BED). After all, at the heart of both obesity and bulimia is binge eating – one population purges the food after eating it, and one does not, but both binge eat. In the researchers estimation, binge eating is caused by a self-evaluation that is negative. It is also associated with ones parents being depressed, or having issues with abuse or problems with ones parents. Being subjected to ridicule about ones weight and eating is another factor that causes binge eating, according to previous researchers that were studied by Decaluwe & Braet (2005). All of these factors might cause low self-esteem. And, indeed, Decaluwe & Braet (2005) found that low self-esteem was a predictor for overeating. What they also found was that people who overeat alternate with periods where they restrain their diet, especially if they were dissatisfied with their body. However, by the same mechanism found by Fairburn, dietary restraint led to more binge eating – the person tries to be perfect with their dietary restraint, but, when perfection doesnt happen, they feel that its not worth it. This leads to more binge eating, which leads to further dissatisfaction with ones body, which leads to more dietary restraint, which leads to the cycle continuing (Decaluwe & Braet, 2005). They looked at cognitive behavioral therapy, which is makes individuals more aware of their behavior and their eating habits, and found that CBT actually was a risk factor for more overeating, because CBT made the person even more obsessed with their eating habits (Decaluwe & Braet, 2005). CBT, then, was found to be a risk factor for binge-eating, as opposed to a model for the person to maintain ones restraint of binge eating behavior (Decaluwe & Braet, 2005). Bullying is another risk factor for low self-esteem – low self-esteem may cause one to be bullied, and people who are bullied often suffer low self-esteem because of the bullying. Fox & Farrow (2009) found a link between being overweight and being bullied – bullying causes kids to be overweight, and, because a kid is overweight, he or she is more likely to be bullied, therefore bullying is an issue with cause and effect. At any rate, bullying and being overweight are definitively linked. Fox & Farrow (2009) attempted to tease out this circle of bullying, being overweight, and self-esteem issues. They found that there is the circle that is noted above - kids who are bullied suffer lowered self-esteem because of their bullying. This lowered self-esteem invites more bullying, and also results in depression, anxiety and loneliness. In turn, because the kids self-esteem has been lowered by the bullying, the kid was more likely to accept peer aggression and bullying than other kids who have high self-esteem. This lowered self-esteem might lead to binge eating, which makes the kid even more of a target for the bullies, because there is a link between obesity, body dissatisfaction, and bullying, in that kids will bully the overweight kids more than the kids who have a normal weight (Fox & Farrow, 2009). Fox & Farrow (2009) thus confirm the vicious circle between bullying, low self-esteem, and obesity. The essential conclusion is that obesity self-perpetuates through bullying, because of the vicious circle that occurs when a child is overweight. Because self-esteem is such a critical component of eating disorders, ODea & Abraham (2000) state that solving the issues of eating disorders should focus upon this component. They state that traditional approaches to solving eating disorder issues have been ineffective – for instance, they looked at the efficacy of solutions which attempt to resolve eating disorders by giving information to students. Information interventions might include giving information regarding calorie restriction and what starvation does to ones body, as well as giving information about the proper amount of nutrients a person needs to exist in daily life, and what optimal nutrition might entail. These information campaigns were ineffective, according to ODea & Abraham (2000), because these information campaigns treated the symptoms, while neglecting to treat the root of the problem. This might be akin to treating cancer by trying to only stop internal bleeding, pain, or vomiting that might be caused by the cancer, as opposed to attempting to treat the cancer itself. To this end, ODea & Abraham (2001), devised a program for secondary students that focused upon building self-esteem. They called their program “Everybodys Different,” and the learning of the lessons took place cooperatively, and in groups. The program also featured games, plays and dramas that were focused around this theme. The students first learned how to deal with stress, which means that they were taught relaxation exercises and other methods that they could use for when they felt stressed out. They then learned how to develop a positive sense of self – they learned that they have unique features, and learned to focus on them in a positive way. They also learned that there are ways that their self-image may be destroyed, and ways to counteract this when it starts to happen. The next step was learning about stereotypes, both male and female, and how they are individuals, not stereotypes. Next, they learned how to have a more positive evaluation about themselves, focusing on their own uniqueness, and found ways to value their own individuality. After this, they learned how to involve significant others – they learned how to seek positive evaluations from others. Relationship skills were the next lesson, and, in this lesson, they learned how relationships might define their self-esteem. Therefore they were taught how to negotiate relationships with others, so that the relationships gave them a positive outlook on themselves, as opposed to a negative one. Last, they learned communication skills, which means that they learned how to communicate with others, and they learned this through playing games. What ODea and Abraham (2000) found was that the students who participated in this intervention had positive body satisfaction when compared to the students who did not go through the intervention. They also had higher ratings with regards to perceived physical appearance rating than the students who did not go through the intervention. The students also found that social acceptance was less important than they did before the intervention. Moreover, there were students who were classified as being high risk for developing an eating disorder – the high risk students were identified as such because they had low self-esteem and high anxiety. ODea and Abraham (2000) found that, in the population of students who were identified as “high risk,” these students experienced significant gains in how they perceived their body satisfaction. They found that this increase in body satisfaction in the high risk group was present even at the 12 month mark after the intervention. The kids in the program did not believe that the program was focused upon preventing eating disorders – most of them just thought that the program was aimed at producing better self-esteem, and the kids who went through the program reported that they felt more positive about themselves, while valuing social acceptance less, than before they went through the intervention. The researchers found that the students who went through the program were less likely to begin dieting than the control group of students, thus the beginning of the destructive cycles – the restriction in dieting, which leads to either anorexia or overeating and binging – did not begin in these students. While females benefited from the program more than males did, the researchers did find that both sexes benefited from the program. Another good effect is that the students who went through the intervention reported that the intervention helped them with their relationship with their parents, as part of the intervention focused upon communication skills and relationships with others. This, too, was a positive for preventing eating disorders, as the researchers noted that a good relationships with ones parents is a factor in preventing eating disorders. The researchers state that their approach might have been successful in preventing eating disorders, where other programs have failed, if those other programs focused upon changing eating habits, without reaching the underlying issues – the values, attitudes and beliefs that were the underpinning of the eating disorders. In this way, the researchers were able to reach the root of the disorder, as opposed to merely attempting stop-gap measures that focused strictly on preventing disordered eating habits without addressing why the eating disorders happen in the first place (ODea & Abraham, 2000). Moreover, as the study found that both males and females were positively affected by this intervention, it found that girls were even more positively affected than boys. This is significant because, as Furnham et al. (2002) note, girls are more likely than boys to have low self-esteem, and that their low self-esteem was a risk factor for eating disorders. They found that boys wanted to be heavier, and girls wanted to be lighter. They also found that body image dissatisfaction did not correlate with eating disorders in men, but that body image dissatisfaction did have this correlation in women. Girls were more likely than boys, according to these researchers, to describe themselves as fat, weigh themselves often, and diet. The researchers did find that both sexes tend to have skewed body images – the girls were more likely to state that they were fat, when they were not, by objective measures. The boys, on the other hand, were more likely than girls to complain that they were underweight, when, by objective measures, they were not. These researchers thus found that there were more eating disorders in girls than in boys, because girls wanted to be thinner, whereas boys want to be bigger. They also note that the eating disorders are perpetuated by society, with the image of thinness being the ideal that is reinforced through advertisements and other sources of media. Men, on the other hand, see that their ideal body type is not thin, but V-Shaped – large chests, biceps and shoulders, tapering down to a small waist. Because their ideal body shape is represented by being large and muscular, instead of excessively thin, they were less likely to starve themselves or engage in binging and purging activities than were the girls in the study (Furnham et al., 2002). Conclusion Eating disorders are caused by a variety of factors, but there is a clear link between self-esteem and these disorders. It seems as if low self-esteem and eating disorders also have a kind of circular pattern. That is that low self-esteem may cause the person to diet to try to lose weight. Low self-esteem may cause the dieting behavior because girls who have low self-esteem may perceive themselves to be fat, even when they are not fat by objective measurements. Girls who try to diet find that dieting is difficult, however, which gives them a feeling of failure instead of success. This makes them have even lower self-esteem. This is the cause of binging behavior – the girls feel that they should be perfect in their weight-loss endeavors, and every failure in losing weight makes them feel even lower about themselves. Therefore, they purge because they feel this sense of failure, which makes them feel even more of a failure, which leads to overeating and purging more. Anorexia has a similar mechanism – the girls start to starve themselves because of low self-esteem. When they starve themselves, there are psychological and physiological changes in the body that are adverse, and may lead to further starving. In this way, anorexia has a circular cause, much like bulimia. What may prevent eating disorders is a program that focuses upon self-esteem enhancement. Similar to the program advocated by ODea and Abraham (2000), programs should focus upon the fact that everybody is unique, and everybodys uniqueness should be celebrated. The program also focused upon enhancing relationships with ones parents and peers by seeking validation from them, as well as teaching them to enhance communication with their parents and peers. They found that there were positive effects that fed one upon the other from this program. The students in the program felt better about themselves, and were less likely to think that social approval was important than the students who did not participate in this program. This, in turn, would affect bullying, as bullying is one aspect of social approval. Moreover, because the students learned how to communicate with others, they found that these more positive relationships with their parents and peers further enhanced their self-esteem and further prevented them from wanting to engage in destructive eating patterns. Overall, the students had better body images than the students who did not participate in this program, and the high risk students were less likely to develop an eating disorder than the high risk students who didnt go through this program. Therefore, this type of program might be the way to prevent eating disorders in adolescents. -Bibliography Anorexia Nervosa – Topic Overview. Web MD. Available at: http://www.webmd.com/mental- health/anorexia-nervosa/anorexia-nervosa-topic- overviewhttp://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa- topic-overview Decaluwe, V. & Braet, C. (2005). The cognitive behavioural model for eating disorders: A direct evaluation in children and adolescents with obesity. Eating Behaviors, 6, 211- 220. Fairburn, C., Kirk, J., OConnor, M. & Cooper, P. (1986) A comparison of two psychological treatments for bulimia nervosa. Behavioral Research and Therapy, 24, 629-643. Fox,C. & Farrow, C. (2009). 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