Psychology 101: The 101 Ideas, Concepts and Theories that Have Shaped Our World - Adrian Furnham 2021

Eating Disorders

We each day dig our graves with our teeth. (Samuel Smiles, Duty, 1880)

Tell me what you eat and I will tell you what you are. (Anthelme Brillat-Savarin, Physiologie du Gout, 1810)

There are various types of eating disorders of which two are most well-known.

Anorexia Nervosa (AN) is a condition that exhibits persistent restriction of energy intake which leads to significantly low body weight. Individuals experience a consistent and irrational fear of gaining weight and becoming fat. Their view of their body weight and shape is distorted, which leads to an undue influence of body shape and weight on their self-evaluation.

Bulimia Nervosa (BN) is recurrent episodes of binge eating. Binge eating can be characterized by the following: eating, in a discrete period of time (e.g. within any two-hour period), an amount of food that is significantly larger than what most people would eat during a similar period of time and under similar circumstances. A sense of a lack of control over eating during the episode (e.g. feeling as if you cannot stop eating or control what or how much you eat).

BN is also characterized by recurrent inappropriate compensatory behaviour to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting or excessive exercise. This behaviour is displayed on average, at least once a week for three months. Self-evaluation is unduly influenced by body shape and weight. However, BN does not occur exclusively during episodes of Anorexia Nervosa.

The psychiatric manual DSM-IV’s criteria for anorexia nervosa has highlighted four main factors in diagnosing the eating disorder: First, is the refusal to maintain a minimal normal body weight for age and weight causing weight loss of at least 15 per cent below minimum healthy body weight. Second, despite being underweight, to have an intense fear of weight gain. Third, having a distortion in the perception of one’s own body in shape and weight, as well as denying the seriousness of current low body weight. Fourth, applying only to females, is an absence of at least three consecutive menstrual cycles also known as amenorrhea.

Despite having a death rate of 5—8 per cent, people with anorexia feel their behaviour brings with it the appearance and feeling of total control. It stimulates pride, a sense of achievement, perfectionism and being different or even being better than others. Among the 1 per cent of people who develop the disorder, 90 to 95 per cent of people diagnosed are female. However, the disorder has begun to affect people of a younger demographic in comparison to the initial ages of 15 and 19. It seems more common in richer countries where slim body shapes are valued.

Various major academic theories can be found in academic literature to try to explain the eating disorders.

1 Family systems theory: The ’anorectic family’ is one in which the mother is the strong-willed, dominant parent, while the father is either meek and inoffensive or distant and aloof. The family is apparently close and tight-knit, with few outside friends. Often the mother and father demonstrate some form of psychological disturbance like addiction or depression. The mother often is described as controlling, overprotective and the major family disciplinarian; she occupies the central, dominant position in the family. The anorexic challenges her mother. The mother may try to compensate for any feelings of inadequacy in her role by feeding her child excessively as assurance of her love and affection. It can also be a substitute, particularly if she is prone to unrecognized feelings of hostility or rejection towards her child. This child may grow up prising food more than human relationships and be very unsure of herself in a social context.

2 Biological theory: At puberty, young girls (and indeed their families) become aware of their developing bodies. The potential anorexic responds with embarrassment, while the well-adjusted adolescent may experience pride or satisfaction. The anorexic’s embarrassment at such growth is linked with fear that this growth will necessitate moving out of comfortable family relationships and into more mature, possibly insecure, peer relationships. This fear may often be the realization that it is time to develop relationships with those of the opposite sex. Coupled with this is a dislike or disgust of what the adolescent sees as ’fatness’ and an inability to accept the new developing body as his or her own.

3 Socio-cultural theory: this tends to apply mainly to female anorexics because it is dependent on the promotion of a standard of thinness. A woman is faced with a widening discrepancy between her actual weight and the weight that she has been persuaded to believe is attractive. Anorexia nervosa is particularly prevalent among those women who are in professions that place an emphasis on physical beauty and thin appearance. However, the media select thin models to portray sophistication and glamour to the general female population as well, to the extent that ordinary women are so bombarded with an unrealistic standard of thinness that they are indoctrinated into believing it is desirable as an end in itself.

4 Feminist theory suggests females are encouraged to seek equal status with men and try to compete more with men than with other women. There is heightened competitiveness and the over-evaluation of achievement are also personality characteristics found among anorexics. However, women are still expected to spend time on their personal appearance, and so these two conflicting values will generate increasing uncertainty as to their roles and self-expectations. The result is that the woman experiences social uncertainty that conflicts with her attempts at embracing her autonomy and she refuses to submit responsibility for her actions or her appearance to any other party. In the case of the anorexic, this attempt at autonomy is thought to be further conflict with her symbiotic relationship to her mother.

5 The fifth theory is one based on the physiology of the adolescent, particularly the role of puberty. The latency period precedes adolescence and one feature of the latency period is that of physical similarity between the two sexes. In pre-adolescence, boys and girls resemble each other in physical appearance and size (same percentage of muscle and fat) and are similar in their fat distribution and skeletal shape. During the dramatic adolescent growth, girls begin to notice an increase in fat distribution around their hips; the development of their bust; and rapid changes in their height, weight and general body shape. They find themselves bigger than their male classmates, at a time when they are preoccupied and self-conscious about their body image as well as growing in self-awareness and awareness of the opposite sex. Thus the adolescent girl, aware of her ’fatter’ figure, seeks to minimize her shape by dieting, at a time in her development when her nutritional needs are increased markedly.

There are different versions of these theories and very mixed evidence for them.

REFERENCES

Crisp, A.H. (1980) Anorexia nervosa: let me be. London: academic process.

Furnham, A. & Hume-Wright, A. (1992) Lay theories of anorexia nervosa. Journal of Clinical Psychology, 48, 20—36.

Polivy, J. & Herman, C.P. (2002) Causes of eating disorders. Annual Review of Psychology, 53, 187—203