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  1. 1. Eating disorders Anorexia Nervosa
  2. 2. Video clips
  3. 3. Clinical characteristics of Anorexia Nervosa – DSM-IV- TR 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. Cessation of menstrual periods – Amenorrhoea. Absence of periods for more than 3 months. Lack of menstrual cycle caused by inadequate nutrition – become very child like.
  4. 4. Anorexia causes a general physical decline 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
  5. 5. Explanations for this disorder: • Sociocultural – SLT – media influences, Ethnicity and peer influences • Psychological – psychodynamic, personality • Biological explanations – Neural and evolutionary • Diathesis stress model – genetic predisposition + environmental triggers
  6. 6. What is the explanation for this? MEDIA INFLUENCES: Portrayal of thin models on TV and in magazines. Drive for thinness by adolescent girls.
  7. 7. 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. • AN a learned behaviour through observation 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 (Susan Boyle) • Positive reinforcement for weight loss becomes so powerful that the individual maintains the anorexic behaviour despite threats to health which could result in death.
  8. 8. SLT – media - research • Practical learning activity – go the website: • http://clearinghouse.missouriwestern.edu/ manuscripts/355.asp • Summarise the findings in fewer than 500 words.
  9. 9. SLT – media - 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. • Hofschire 2002 – media have a preoccupation with a thin body shape particularly in the case of girls and younger women, this pressure encourages women to become more and more dissatisfied with their own body shape and physical appearance (Thompson 1999). • Done in an explicit way with slim models and articles on achieving the ideal (thin) body shape however implicitly peers voice admiration of certain role models they see as being successful. Slim ideal is equated with success and health whereas average weight or overweight becomes synonymous with failure. This view slowly becomes the dominant belief in society (Harrison 2001). • 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. • High incidence of AN in ballet dancing and modelling - great pressure to be thin (Alberge 1999). • Further support for it being a western ideal in that eating disorders are not so prevalent in non western societies (eg China) – fewer role models exist. • Increase in eating disorders in Fiji (Fearn 1999) with the introduction of American television programmes which emphasise a westernised idealised body shape.
  10. 10. Sociocultural – ethnicity and peer influences Ethnicity • Value of thinness in women not the same in non western society and in black population in western society. • Meta analysis of 98 studies (Grabe and Hyde 2006) found a difference between African-American and Caucasian and Hispanic females. African- Americans reported significantly less body dissatisfaction than other 2 groups. • Positive attitudes toward large body sizes in non-Western cultures such as Fiji and Caribbean – associated with attractiveness, fertility and nurturance (Pollack 1995) • 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.
  11. 11. Sociocultural – peer influences • Peer acceptance during adolescence • Peers susceptible to peers influence in disordered patterns of eating • US study – dieting among friends was significantly related to unhealthy weight control behaviours such as diet pills or purging (Eisenberg et al 2005) • Jones and Crawford (2006) – teasing – mechanism on overweight girls and underweight boys (most likely) – enforces gender based ideals. • AO2 – Shroff and Thompson (2006) found no correlation among friends on measures of disordered eating in an adolescent sample. However the gender differences in teasing do not emerge until adolescence. • Study of 10 year olds found positive correlation between body mass index (BMI) and teasing for both boys and girls (Lunde et al 2006).
  12. 12. Evaluation – 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. • Other synoptic points:
  13. 13. Diathesis stress model • 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
  14. 14. Psychological factors – psychodynamic and personality 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) • Inadequate parenting by ineffective parent – might feed child when the child is crying and anxious as well as not feeding the child when they are actually hungry. • Children will grow up confused about their internal needs becoming overly reliant on their parents. • 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. 15. Bruch’s AO2 • Supported by observations in that parents of adolescents with AN define 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).
  16. 16. Personality • Perfectionism • Impulsiveness
  17. 17. Thinking synoptically • Ethics • Reductionist • Determinist • Research methods used • Gender bias • Cultural bias • Other approaches
  18. 18. Exam question • Discuss two or more psychological explanations of anorexia nervosa (25 marks). 9 + 16 marks.

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