Psychopathology of Eating Disorders - Research Paper Example

 Psychopathology of Eating Disorders The world is obsessed with beauty. It expects that American people will look a certain way and they promote this way of looking through the media. Many children grew up with the “Barbie” doll image, seeing a woman as someone who was unnaturally thin. There are many models who earn their living by making sure that they are thinner than any normal woman would be in real life. Unfortunately, many children find that they cannot meet the expectations of these ideas of beauty, but they think that they must remain thin. Eating disorders, such as anorexia and bulimia, are common in many Westerns societies. According to the National Association of Anorexia and Associated Disorders (2011) women are more likely to develop an eating disorder than men, although 5% to 15% of people with anorexia or bulimia are men. Also, 47% of girls in grades 5-12 want to lose weight because of the pictures they have seen in magazines. A question that comes to mind is, “Do young people throughout the world ( e.g. Japan, Australia, China, France, United States, and other countries) all strive to attain the ideal body image that the media portrays?” The answer to this question is “yes” because the media touches girls all over the world. This question will be explored further in this paper. Beauty in the Media The term media generally describes print and electronic newspapers, radio, magazines, television and the Internet. All of these venues promote beauty in one way or another. Media in most countries, women are the ones that carry most of the burden of what beauty should look like. Every tabloid such as The National Enquirer and The Star will have pictures on it of people who are famous and how good or bad they are looking. People Magazine constantly shows women on the front cover and they chastise those who are fat or those showing their age. Media generally means print or electronic media Recently, on the television program, Dancing With The Stars, Kirstie Alley was heavier than the rest of the women on the show, and there was constant conversation on the Internet about her weight, how people were afraid that her partner, Maks, would have a difficult time holding her. When they fell, it created more controversy. The message that this type of image in the media gives to young girls and young women is that they must look a certain way in order to be successful in life. According to the Media Awareness Network (2010), one of the reasons that this thin image is so prevalent in the world is because it supports the cosmetic and diet markets. For many women, this means that they will purchase beauty products to look younger, and they will purchase wrinkle creams or other types of beauty products to stop them from looking older. Other women do not care about looking older because they expect to grow older gracefully. For many women who do not have a positive body image already, these ads make them feel as if they are doing something wrong. According to the National Association of Anorexia and Associated Disorders (2011), one in four female college students use some form of unhealthy way to lose weight. These can include: fasting, using laxatives, skipping meals or vomiting. These types of behaviors can become serious eating disorders. Engelen-Maddox (2006) interviewed college women regarding how they thought their lives would change if their body image was more like one that the media glamorizes. They interviewed 109 undergraduate women in a small college in Ohio; the women were part of a voluntary participant pool in the psychology department. Women in this study imagined that there would be a variety of different rewards if they were to look like the media’s ideal woman. Some of those rewards included: positive (nonromantic) social attention, romantic success, less pressure about their appearance from other people, and positive psychological impact. In each of the cases, these college students felt that their lives would change positively if they looked like the media’s idea of beauty.. An interesting idea from this study was that the women did not talk about the fact that these images presented stereotypes or the fact that the media presented a fantasy image that did not reflect real life. This study showed how miserable many women are because they cannot measure up the media’s ideal woman. Television programs, especially sitcoms, reinforce this image and those women who already hate their bodies, have more to hate. Some researchers suggest that the evolution is responsible for the media’s idea of beauty and that female body dissatisfaction is actually an aspect of the culture that is natural and a part of how the species has evolved over time. Ferguson, Winegard and Winegard (2011) state that in Western societies, 40% to 50% of women have some aspect of body dissatisfaction. In fact, the American Psychological Association (2007 as cited in Winegard and Winegard 2011) and other experts suggest that the exposure to the media’s idea of thin contributes directly to eating disorders and women’s body dissatisfaction. Those who suggest this idea also suggest that media the is only one part of the equation because parents and peers also contribute to body dissatisfaction. According to these experts, body dissatisfaction develops into eating disorders is because it is “culturally bound” (p. 13). This argument seems to be very important to understanding eating disorders because it suggests that the media is not the only source to blame for eating behaviors. In other words, the media is one contributor and there are many other factors. Social and Cultural Causes of Eating Disorders Because many societies are fixated on the idea of thin as an ideal image, the fact that there is more than enough food to eat in Western society, and because many people react negatively to obese people, most people do not want to become obese. These social and cultural causes make women feel that they are abnormal if they have even small amounts of extra weight. The challenge is that these issues can create psychological and physiological problems that add to the difficulties. These social attitudes create a variety of issues for young women and young men because they are not able to understand that these ideas of beauty are just that – ideas. They are a vulnerable population because most are adolescents who are already in an emotional state about their body image, their friends, and most things in their lives. This is a time when self-criticism becomes standard and children compare themselves to others. Often adolescents will feel shame because they are not thin enough and then suffer shame because they are overeating or vomiting to control their weight. Many researchers have studied the relationship between society’s ideas of beauty and the reaction of adolescents to these ideas. Gilbert, McEwan, Irons, Bhundia, Christie, Broomhead and Rockliff (2010) studied the relationship between “self-criticism, shame, and social rank variables to self-harm, depression, and anxiety” (p. 563). The researchers gave questionnaires to 73 patients between the ages of 20 and 69 with a mean age of about 42 years old. The group was a “non-psychotic” group. In other words, there were no people in the group who had psychotic disorders, but they had other issues along with their eating disorder. These other issues included emotional issues such as depression, anxiety, alcohol abuse, and bipolar disorder as well as eating disorders. The researchers wanted to use a wide group of participants because the issues of self-harm, shame and self-criticism are not significant to any one group. They were also interested in understanding how “self-criticism and put-down, and internal criticism and put-down” (p. 572) were able to activate negative feelings and making the group feel inadequate towards the others who were criticizing them. The researchers found that there were many forms of self-criticism that lead to self-harm and mood. Also, different types of societies will increase the likelihood of self-harm. As an example, in a competitive society, individuals may be more prone to treat themselves as objects and to compare themselves with others. In a society that is both competitive and materialistic, individuals may feel a need to perform and when they cannot do what they would like, they can become frustrated and turn to self-harm. These results indicate that many people are vulnerable to the way the media treats beauty and that there are many unhealthy issues that happen when someone has eating disorders. Society can create negative circumstances for those who are the most vulnerable in the way of difficulties with moods and anxiety. Waller, Corstrphine, and Mountford (2007) studied the role of emotional abuse in eating disorders. They concluded that emotional can be a factor as to why an individual would begin an eating disorder. When someone has a history of emotional abuse, they are also more at risk for increasing certain behaviors that go with eating disorders such as vomiting, obsessive-compulsive behavior and a higher level of impulsiveness. A major factor when someone starts an eating disorders is when the emotional abuser makes them feel like they do not matter. In other words, that their voicing their experiences do not matter. Waller, Corstrphine and Mountford suggested that there are three environments that create the idea that the individual’s experience does not matter: the perfect environment, the chaotic environment and the typical environment. In the chaotic environment, parents are often unavailable and when their child asks for something, the parents react in anger. In the perfect environment, parents will react with anger when the child reacts in fear or uses any other emotions because the parent perceives that the child is saying that something is wrong. In the typical environment a child is not allowed to act as a child, but is expected to act as an adult. The child is taught to keep control over their emotions and success becomes more important than anything else. These environments seem to be created by the stress and difficulties that parents have with finances, substance abuse or mental health issues. Children who grow up in these homes have difficulty establishing their own sense of who they are and where they fit in the family. When children are afraid and anxious, food may be comforting which can create the eating disorder. Psychopathology of Eating Disorders Although both men and women can have eating disorders, statistics show that women are more susceptible to them because the emphasis for dieting is aimed at them. The psychological aspects of eating disorders will depend on which disorder the individual has and how they are expressing the issue. As an example, anorexia nervosa in young girls, the disorder where the individual has a fear of gaining weight so they starve themselves, is often brought on by the fear of growing up, the need to be liked, the need to please the family or the need to control and be a perfectionist. Bulimia nervosa in young girls will include binge eating and then vomiting and purging. Bulimic individuals will deny that they are hungry, abuse laxatives and diuretics and they will often have health issues such as swollen salivary glands and broken blood vessels in the eyes (National Association of Anorexia and Associated Disorders, 2011). Many people with these challenges will also have other psychological issues such as anxiety and depression. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) both bulimia nervosa and anorexia nervosa are classified as mental disorders. According to the specific culture information for anorexia, the DSM-IV states that: Anorexia Nervosa appears to be far more prevalent in industrialized societies, in which there is an abundance of food and in which, especially for females, being considered attractive is linked to being thin. (p. 542). Generally, this means that anorexia nervosa is most prevalent in the United States, New Zealand, South Africa, Canada, Europe and Australia. The same is true for bulimia nervosa and for this disorder, the age group is usually adolescents and young adults (DSM-IV, 1999). Predictors of Eating Disorders Kong and Bernstein (2009) studied the effects of trauma on eating psychopathologies to understand whether childhood trauma would predict that a child would have an eating disorder later in life and whether obsessive compulsiveness or depression added to eating disorders. They created a survey that interviewed 73 Korean patients who had eating disorders. Patients were asked to complete four different survey instruments: The Childhood Trauma Questionnaire, Eating Disorder Inventory-2, Beck Depression Inventory and Maudsley Obsessional-Compulsive Inventory, and these survey instruments were used to study five domains that included emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. The researchers used a correlative and cross-sectional design for their study. The results showed that the most common predictors were emotional abuse, sexual abuse and physical neglect. They also found that depression was the major mental challenge that created eating disorders. The authors concluded that early intervention for childhood trauma should be instituted especially in cases where treatment was unsuccessful. In another study by Herpertz-Dahlmann, Wille, Holling, Vloet, and Ravens-Sieberer (2008) children ages 11-17 were randomly selected for a telephone interview to understand the psychopathology of eating disorders in Germany. A total of 1,895 children were enrolled in the study and 1,850 were selected to participate. The researchers found that one third of girls and 15% of boys were participating in disordered eating. They found that girls and older adolescents engaged in more disordered eating than other children in the group. The highest rates were in children who were obese and depression was part of the psychopathology in this group; it was also the same after they brought their Body Mass Index (BMI) under control. They also found that these children had large amounts of stress and low self-esteem. These issues seem to be prevalent across the board in groups of children who have eating disorders. There is debate about whether children have eating disorders because they have low self-esteem and depression or whether it happens because of the media. Harpertz-Dahlmann et al. briefly touched on the controversy but did not go into detail about it. In another study by Tanofsky-Kraff et al. (2011) a longitudinal study was conducted with children between the ages of six and 13 to understand eating behavior in these children. The researchers wanted to understand how early loss of controlled eating was related to future problems with eating disorders. Several notices about the study were mailed to people’s homes, doctor’s offices and pediatricians. Children did not receive treatment but they were tested to understand the effects of their eating on the body. All children received several blood draws during the course of the study (July 1999 through August 2009) along with imaging assessments and other medical examinations that were specific to males or females. They provided a stipend of $70 to $170 per visit, depending on the level of participation per child (e.g. some children only had a few panels of medical exams while others received full panels). The children were also drug free and medication-free for two weeks prior to the study. Initially, 119 children came to the first baseline visit and the Eating Disorder Examination was used as a way of detecting eating disorders. The results of this study showed that children who have a loss of control in eating early on in life are prone to eating disorders later in life. This is also an indication of psychological stress that is persistent. The researchers found that if children change their eating habits earlier, they may be able to stop obesity, later but they could not be sure that these interventions would work to stop eating disorders. This study indicates that eating disorders can be well ingrained into an individual at an early age. Children who are in distress and who are allowed to eat more food at times of stress may be more susceptible to eating disorders. Tanofsky-Kraff et al. (2011) observed this to be true in their study. To these researchers, it would seem that if they were able to help children early in life to change their eating habits that they would be able to stop childhood obesity. However, the researchers did not know whether these interventions would work. It would seem that reducing the psychological distress may be the answer along with appropriate eating habits. The studies that have been quoted thus far are American studies, but eating disorders are not limited to the United States. Isomaa, Marttunen, Kaltiala-Heino, and Björkqvist (2009) studied children in Finland in order to understand the onset of anorexia nervosa and bulimia. In Finland, to find eating disorders in the general population is rare, but adolescent girls have a high level of anorexia nervosa. As an example, one study quoted in this study showed that 270 adolescent girls out of 100,000 had a DSM-IV category of anorexia nervosa and 490 of 100,000 had broad anorexia behavior. The researchers used a survey that they distributed in one region of Finland which they gave to 606 boys and girls (288 girls and 318 boys) during the course of a school day. The questionnaire contained questions about eating behaviors, mental health issues and life circumstances. The study consisted of a baseline study and then a follow-up with the same children. The study found that one in five adolescent girls had either a DSM-IV classification of anorexia nervosa or a subclinical disorder of anorexia nervosa. Within this group girls ages 15-18 had higher incidences of anorexia than younger girls. Isomaa, Marttunen, Kaltiala-Heino, and Björkqvist (2009) also suggested that more research needs to be done in Finland in order to create far reaching conclusions. Conclusion There were several studies quoted in this research and the one issue all the research seemed to have in common was that they used questionnaires and asked young children or adults to self-report about their eating habits. This did not seem to be a very reliable way of gaining information. It would seem that using interviews with healthcare providers, psychiatrists or other medical professionals would have allowed the researchers delve deeper into why eating disorders happen and how parents and people in the community could help these children better. Anorexia nervosa and bulimia nervosa are two eating disorders that seem to be the result of society’s idea of beauty. When a young girl is already feeling vulnerable, telling her that she is not beautiful unless she is very, very thin creates a variety of psychological and emotional problems. When young girls and young boys do not have images that look like them, they tend to think something is wrong with them. Although many adults understand that this is not the case, many parents will tell their children that they must lose weight or they will make their child stay on some sort of diet. This type of behavior from parents can reinforce eating disorders. Unfortunately, our society may not change their idea of beauty because it is tied into commerce, but television programs like Glee, where all types of children are shown who are very productive and very happy, may be one way to reach those children who would otherwise feel ashamed and anxious because they do not look like other children. The media will always do what they can to make everyone think that there is a set way that beauty should look because this image sells products, but there are things that can be done to help young girls move away from eating disorders into a healthier lifestyle. References American Psychiatric Association. (1994). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). DC: American Psychiatric Association. Engelen-Maddox, R. (2006). Buying a beauty standard or dreaming of a new life? expectations associated with media ideals. Psychology of Women Quarterly, 30, (3), 258-266, doi: 10.1111/j.1471-6402.2006.00294.x Ferguson, C., Winegard, B., and Winegard, Bo M. (2011). Who is the fairest one of all? How evolution guides peer and media influences on female body dissatisfaction.. Review of General Psychology, 15, (1). 11-28, doi: 10.1037/a0022607 Gilbert, P., McEwan, K., Irons, C., Bhundia, R., Christie, R., Broomhead, C., and Rockliff, H. (2010). Self-harm in a mixed clinical population: The roles of self-criticism, shame, and social rank. British Journal of Clinical Psychology, 49, (4). 563-76. doi: 10.1348/014466509X479771 Herpertz-Dahlmann B, Wille N, Holling H, Vloet TD, Ravens-Sieberer U. (2008). Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: results of the BELLA study. European Child & Adolescent Psychiatry Supplement 1: 82-91. DOI 10.1007/s00787-008-1009-9 Isomaa, A-L, Marttunen, M., Kaltiala-Heino, R., and Björkqvist, K. (2009). The prevalence, incidence and development of eating disorders in Finnish adolescents—a two-step 3-year follow- European Eating Disorders Review, 17, (3). 199-207 doi: 10.1002/erv.919 Kong, S. and Bernstein, K. (2009). Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders. Journal of Clinical Nursing, 18 (3), 1987-1907. Doi: 10.1111/j.1365-2702.2008.02740.x Media Awareness Network. (2010). Beauty and body image in the media. Retrieved from http://www.media-awareness.ca/english/issues/stereotyping/women_and_girls/ women_beauty.cfm National Association of Anorexia and Associated Disorders. (2011). General information eating disorders. Retrieved from http://www.anad.org/get-information/about-eating-disorders/general-information/ Tanofsky-Kraff, M., Shoemaker, L.B., Olsen, C., Roza, C.A., Wolkoff, L.E., Columbo, K.M., … Yanovski, J.A. (2011). A prospective study of pediatric loss of control eating and psychological outcomes. Journal of Abnormal Psychology, 120 (1), 108-118. doi: 10.1037/a0021406 Waller, G., Corstrphine, E. and Mountford, V. (2007). The role of emotional abuse in the eating disorders: implications for treatment Eating Disorders,15 (4) 317-31. Retrieved from CINAHL database. All changes are highlighted in green so you can see them quickly. Page 1 – the question – it was the question that your teacher asked…I added “the media image” because different countries may have different body images. Not body type – body image. There is a difference.  p. 3 – defining the media. The journal articles do not define specific media. Media’s definition is newspapers, radio, television, electronic and print. Anyone reading should know what it means. Most of the articles do not specify. (Did you mean to include TV in the world media?). Yes, this was not a reference to any specific country. It was something that I read and paraphrased it to use it. Did you want the study only to be on America or other countries? You did not say that in the instructions. p.4 -- ( what society? you mean America? please be specific) Why? You’re confusing me here. Are societies different on this topic? I don’t’ think so. Also, some of your questions would have been answered if you read the entire paper (or paragraphs) before you asked the questions. As an example, social cultural, vs. social and cultural. I was talking about the socio-cultural aspects but your instructions used them as social cultural – not socio-cultural – so I used them the way the instructions said. Also social attitudes of young men and young women. You did not in the instructions say to specify one or the other. Many of the articles talked about young men and young women as anyone from the ages of 17 to 35. So, they are young men and young women. When you are talking about this topic, it is one that normally affects young people. When I talked about the study, I was more specific, but generally, research papers tend to go from the general to the specific. (Do you mean most adolescents?) – no, reading the entire paragraph, it states people between the ages of 20 and 69 with a mean of 49. “nonpsychotic” in quotes – is defined in the next sentence. Again, this is all from the study. (I don’t understand this part. Can you please explain this in simple words?) – this was in the sentence above. If you read the entire sentence, you’ll see that the study said that people in their study had no psychosis (no schizophrenia, etc. ) but they had depression and other types of problems along with the bulimia or anorexia. This is an academic paper…was it not to be? I’m just wondering because I thought it was described simply, from the study. I clarified it a bit more. (what is the difference?) – when you’re looking at putdowns and self-criticism, it is what the study said exactly (in quotes. They did not define a difference so I would not put a difference there because the study did not define them. p.5 – different types of societies – they were not country specific…only the TYPES of society. This means that they were looking at competitive vs. noncompetitive societies etc. This is defined in the next paragraph. p.6 – not other negative emotions…any kind of emotions. In these situations, parents tell the child to bury all emotions whether they are positive or negative. Not keep in control – it was supposed to be keep control – the sentence reads, they are taught to keep control over their emotions. In other words, they are taught not to show any emotion. In terms of getting that part – it’s what the study said. When a child doesn’t show emotion, they are taught that success is more important than showing emotion. p. 6 -- (haven’t you specified eating disorders?) Yes, but depending on which eating disorder the person uses….there is no reason to define anorexia nervosa in this case. We’ve been talking about eating disorders. People know what these two are. The DSM-IV definition—this is a direct quote. That is all that it is. It does not go deeper than that. Under the DSM quote you asked, ( Sound Africa?Europe? What countries? Please be specific) – I did define it if you read on. Korea and eating disorders – this was a study that was done using Korean patients. Whether it is prevalent in that area or not, the study is relevant to your topic. p. 8 -- (“Should be”? Do you mean, should have been?) No, it means what I said. That’s what they author said in the conclusion of the study. (You suggested earlier that the image from the media create low esteem and depression?) – yes, but there is an ongoing debate about whether this is true or not. Some studies say it does, others say something different p. 9 -- (Imaging assessments? What are these?) – the study did several but if I listed them, the paper would be longer. Someone wanting to know more about these assessments could go to the article and read it more in depth. This again is a study where the most important part was the results of the study. The conclusion – it is just that, a conclusion. It is a summary of what has already been stated. What other ways? I don’t know. I was concluding and thinking that there should be other ways. I’m not a researcher so I don’t know what other ways would be appropriate. Images of beauty vs. images – I am saying IMAGES that look like themselves. As an example, on the television program GLEE they have fat kids, skinny kids, a kid in a wheelchair, gay kids, lesbian kids etc. There is some kid on that show that another child in the audience can relate to. That’s what I am saying. Not all children are looking for beauty…they are looking for another kid to relate to who has the same skin color, hair, etc… Remember that this is your paper and you can change the conclusion if you want. I just was concluding it based on my own ideas. Remember your topic. This is YOUR topic so you can change anything the way you want. I wrote what was in my head in the conclusion. So, you can change it if you would like. Note: These are just comments from a teachers’ point of view actually, and it will help to explain what I wrote I hope, and what I did not change and why. Read More