2. Anorexia causes a general physical
decline:
Symptoms……..
Cessation of menstruation (amenorrhoea)
Low blood pressure
Dry and cracking skin
Constipation
Insufficient sleep
Depression and low self-esteem
Up to 20% cases of Clinical AN are fatal
A BMI of below 18.5 is an indicator & 15
is clinical
3. Clinical characteristics of Anorexia Nervosa – DSM-IVTR
Weight loss that this considered
abnormal and drops below 85% of
what was previously considered
normal. Control of weight through
unusual eating habits.
Anxiety about being overweight – this
is an excessive fear. Not only
obsessed with weight but fearful of
weight gain.
Body image distortion – they do not see
their own thinness and deny the
seriousness of their low body weight.
Continue to see themselves as fat despite
the fact that bones can be seen. Thinness
is vital to their self esteem.
4. Explanations for this disorder:
• Psychological – psychodynamic, cognitive,
behaviourist.
• Biological explanations – Neural and
evolutionary
• Diathesis stress model – genetic
predisposition + environmental triggers
5. Psychological :
1) Behaviourist explanation
• Three strands:
• Classical conditioning
• Operant Conditioning
• Social Learning Theory
6.
7. Psychological explanations of AN
Behaviourist Explanations (AN as a
‘Learned’ behaviour)
Classical conditioning (Learning by
association)
• Eating can be associated with anxiety
since it can make people overweight
• Losing weight ensures that the individual
reduces these feelings of anxiety ∴ Feel
fat/ugly so diet and associate
happiness with weight loss and
unhappiness withPsychological explanations of AN
weight gain
8. Behaviourism
Operant conditioning
• AN is a learned behaviour which is maintained
by positive reinforcement. An individual who
diets and loses weight is encouraged by peers
and society.
• Those that remain overweight get criticised and
are disapproved of and sometimes face ridicule
because of their bodily appearance.
• Positive reinforcement for weight loss becomes
so powerful that the individual maintains the
anorexic behaviour despite threats to health
which could result in death.
9. What is the explanation for this?
MEDIA
INFLUENCES:
Portrayal of thin models on
TV and in magazines.
Drive for thinness by
adolescent girls.
10. • SLT: People imitate people they admire
(Media/Peers etc) – vicarious
reinforcement (later reward for gaining
the look)
They adjust behaviour to achieve the looks of others and gain the rewards
11. Behaviourist:
SLT - Media influences:
• Body image concern amongst adolescent girls
because of the portrayal of thin models
• People imitate and copy people they admire.
• Young women see female role models rewarded
for being slim and attractive.
• Association of being slim with being successful –
vicarious reinforcement
• Reward is being received indirectly by observing
another person being rewarded. When they slim
the reinforcement will be direct.
12. SLT – AO2 - support
• Goresz et al (2001) support the view that the mass
media portray a slender beauty ideal. Review of 25
studies showed that this ideal causes body
dissatisfaction and contributes to the development of
eating disorders. Effect most marked in girls under 19
years.
• Forehand (2001) found that women feel undue pressure
on their appearance and reported that 27% of girls felt
that the media pressure them to strive to have the
perfect body.
• Increase in eating disorders in Fiji (Fearn 1999) with the
introduction of American television programmes which
emphasise a westernised idealised body shape.
13. Evaluation of behaviourist explanation – AO2
Face validity in that in the Western society women are exposed to
images of thin women and have a complex relationship with food.
Helps to explain why so many women diet and why so many women
are dissatisfied with their body shape.
Problem in that this analysis cannot explain why only a minority of
women develop eating disorders.
Does not help explain why that so many anorexics continue to starve
themselves when they no longer receive praise and compliments
about their size – it could be about the attention that they receive
that’s reinforcing being anorexic.
Underplays the cognitive aspects of anorexia – eg it does not really
explain the faulty perceptions of body image that play such a large
part in eating disorders.
14. 2) Psychodynamic approach
Hilde Bruch (1973) – Psychodynamic
• Origins in early childhood
• Effective parents (responding to child’s needs
when hungry) vs ineffective parents (who fail to
respond to child’s needs)
• During adolescence they try to exert control and
autonomy (more prevalent at this time) but they
may be unable to do so as they do not own their
own bodies.
• To overcome this they can take excessive
control over the body shape and size by
developing abnormal eating habits.
15. Bruch’s AO2
• Supported by observations in that parents of
adolescents with AN insist of defining their
children’s physical needs rather than letting the
child define their own (Steiner et al 1991).
• They never let the child feel hungry instead they
anticipate their child’s needs (Bruch 1973)
• Supports the claim that people with AN rely
excessively on the opinions of others, worry
about how others view them and feel lack of
control over their lives (Button and Warren
2001).
17. Psychodynamic explanations (Freud)
– Adolescents don’t want to grow up and
separate from their parents
– They become fixated at the oral stage when
they were completely dependent on their
parents
– Anorexics lose weight, lose secondary
sexual characteristics, become childlike
again (asexual) and return to the safety of
being a ‘little girl’ again (AO2: Gender Bias)
– In Freudian terms, eating and sex are
symbolically related
• A refusal to eat (the only control, they
feel they have) represents a refusal of
1. Stages of
sexuality
Psychosexual
development
17
2. Eating as manifest
representation of sex
(ego-defence)
18. • Survey of 1099 American women
– Sexual experiences during childhood
– Eating disorder symptoms
• Women with a history of sexual abuse had
elevated risk of ED symptoms
• Some issues surrounding retrospective data, but
has been confirmed in other studies
www.psychlotron.org.uk
A02 PD Support: Wonderlich et
al (1996)
20. A02:
Evaluation of PD model
Supported by observations that parents of
adolescents with AN don’t allow their
children to define their own needs. (Bruch)
Explains why the disorder affects more
women and often starts as puberty begins
21.
22.
23. •
McKenzie et al (1993)
– Female ED patients overestimated their own body size in
relation to other women
– They judged their ideal weight to be lower than comparable nonED patients
– Following a sugary snack, they judged their body size to have
increased. Controls did not.
www.psychlotron.org.uk
Support: Cognitive Errors
24. AO2 Evaluation- Cognitive
AN is certainly associated with biases and
distortions in thinking
However, most women are dissatisfied
with their bodies, not all of them develop
Eds
A good account of what helps to maintain
EDS, but not of what causes them in the first
place.
25. IDA – Cultural bias of explanations
• Value of thinness in women not the same in non western
society and in black population in western society.
• Positive attitudes toward large body sizes in nonWestern cultures such as Fiji and Caribbean –
associated with attractiveness, fertility and nurturance
(Pollack 1995)
BUT – mixed findings/views
• AO2 – Cachelin and Regan (2006) found no signficant
differences in prevalence of disordered eating between
African Americans and white caucasian participants.
Roberts et al (2006) report that it is only in older
adolescents that white populations have a higher
incidence of Anorexia than black populations.
26. Commentary
What about the biological approach?
Halmi (2002):
Perfectionism related to AN:
Found that is ‘runs in family’
- Suggests a genetic vulnerability
(biopsychosocial disease??)
27. Could be a personality type…
•
•
•
•
•
•
Perfectionism as a personality trait appears to run in families – suggests a
genetic vulnerability for the development of AN
Patients in a study by Halmi et al 2000 included patients with relatives who
suffered from AN.
Investigated the relationship between perfectionism and anorexia.
322 women with a history of AN across Europe and USA.
Individuals who had a history of AN scored significantly higher on the
Multidimensional Perfectionism Scale when compared to a comparison
group of healthy women.
Extent of perfectionism directly related to the severity of AN experienced by
women.
The diathesis model
Genetic Predisposition + Environmental Trigger = Disorder
28. Exam question
• Discuss two or more psychological
explanations of anorexia nervosa (25
marks). 8 + 16 marks.
