Eating Disorders Flashcards
1
Q
Historical perspective on Eating Disorders
A
- saints ‘holy anorexia’
- witches
- insane
- disease
- mental disorder
2
Q
Sir William Gull on anorexia
A
- British physician interested in the scientific study of dysfunction of the gastric system
- 1874- makes the first reference to anorexia nervosa
- no physical cause for loss of appetite and emaciation
- concluded that anorexia is a psychiatric phenomenon resulting from psychopathology
3
Q
Classification of eating disorders in DSM 3
A
- anorexia and bulimia appeared for the first time in the DSM
- classified as a subtype of disorders usually first diagnosed in infancy, childhood or adolescence
4
Q
Classification of eating disorders in DSM 4
A
a separate diagnostic category was created for eating disorders
5
Q
Classification of eating disorders in DSM 5
A
- binge-eating disorder added to the DSM
- Anorexia Nervosa- amenorrhea no longer a requirement for diagnosis
6
Q
Anorexia Nervosa prevalence
A
young females - 0.4%
10 times more common in women
7
Q
anorexia course and long-term outcomes
A
- average age of onset 14-18 yrs
- 50% weight in normal range
- 2-% significantly below normal body weight
- 5% death
- 50% still experience eating difficulties
- can develop new problems: depression, bulimia, social difficulties
8
Q
Bulimia Nervosa prevalence
A
- young females 1-1.5%
9
Q
Bulimia Nervosa course and long-term outcomes
A
70% symptom free
- 20% some improvement but still struggle
- 10% chronically ill
- rarely fatal but may be at increased risk for suicide
10
Q
binge eating disorder prevalence
A
females- 1.6%
males- 0.8%
11
Q
binge eating disorder course and long-term outcomes
A
- needs more research
- CBT results in remission rates of up to 50%
- interpersonal therapy- remission of 62%
- improvement in broader areas- depressive symptoms, psychosocial functioning and body dissatisfaction
12
Q
Reported Prevalence Rates in Non-Western Countries of eating disorders
A
AN- 0.002%-0.9%
BN- -.46% - 3.2%
- increase in prevalence is attributed to the influence of the media, adoption of Western values and acculturation stress
13
Q
Le Grange (1998)
A
university students in SA
- Black students scored significantly higher than white participants on the Eating Attitudes Test and Bulimic Investigatory Test
- An equal percentage of black and white participants scored above the cut-off on these measures
- The percentage of female participants who reported irregular menses and who were underweight was meaningful in all racial groups
- Concluded that eating disorders were present in both groups
14
Q
Wassenaar (2000)
A
- Eating Disorders Inventory administered
- White students had significantly higher scores for ‘body dissatisfaction’
- Black students had significantly higher scores for ‘drive for thinness’ and ‘perfectionism’
- No difference in scores indicating bulimia nervosa
- Concluded that significant eating disorder pathology exists in South African women across ethnic groups
15
Q
Edwards (2004)
A
- male and female university students
- Initial findings – bulimic pathology evident in 25% of white female students; 10% of black female students and 5% of the black male students
- After interviewing participants – no evidence of a high risk for bulimia nervosa in black female and male participants
- Measures are normed for North America
- Variations in the ease and familiarity with the discourse of eating disorders
- Need to explore the reasons people engage in particular eating behaviours – does it indicate the presence of an eating disorder?
16
Q
Morris and Szabo (2013) what was the meaning of thinness?
A
- physical illness and stress are reasons for getting too thin
- Schools A&B (HIV, TB, stress)
- Schools D&E (body dissatisfaction, pressure towards thinness, social comparison)
- sick skinny vs nice skinny
- Cultural identity confusion - thinness is a way to construct a more coherent sense of identity
17
Q
Morris & Szabo, 2013- Meanings of Thinness -Dysfunctional Eating Behaviour
A
- Skipping meals – stress, embarrassed to eat food brought from home; having no food
- A way to lose weight
- Zulu Culture – purging is a necessary form of ‘cleansing’ used to promote well-being and as a remedy for a range of physical and emotional maladies
- Laxatives used to get rid of toxins
- Binge-eating – not eating at school, social gatherings
18
Q
Morris & Szabo, 2013- Meanings of Thinness conclusion
A
- Typically western meanings of thinness were identified
- South African adolescents may be at risk for developing eating disorders during the period of rapid social-cultural transition that is occurring in post-apartheid South Africa
- Traditional forms of purging could provide a culturally sanctioned remedy for western body image concerns
- Western diagnostic measures may incorrectly identify the presence of an eating disorder
- Western diagnostic systems may not be able to identify dysfunctional eating patterns that may need treatment
19
Q
The three main themes in academic writing that emphasised the social and cultural dimensions of psychological disorders including anorexia nervosa
A
- Growing disenchantment with psychiatry
- Psychoanalytic theories of the socio-cultural dimension of anorexia nervosa
- Early feminist contributions to the explanation of anorexia nervosa
20
Q
Disenchantment with Psychiatry
A
- 1960s – anti-psychiatry movement
- Recognised that social factors play an important role in the development of psychological disorders
- The emergence of therapeutic communities
- Goffman (1968) –described the inhumane practices that were taking place in St Elizabeth’s Psychiatric Hospital in Washington
21
Q
Sigmund Freud’s psychoanalytic theories of eating disorders
A
- impairment in the nutritional instinct was related to the person’s inability to come to terms with sexual excitation
- hysteria (the refusal to eat is a hysterical symptom)
- Many client’s reported a history of sexual abuse but this was viewed as derived from fantasy
- The individual is pathologised and the problem is located within the person’s attitude towards their sexuality
22
Q
Hilde Bruch’s psychoanalytic theories of eating disorders
A
- relentless pursuit of thinness
- caused by abnormal family patterns of interaction
- controlling parents and over-compliant daughters
- a struggle for independence in the face of parental control
- uses starvation and domination of bodily desires to search for control, identity and competence
- food and her body is the only thing she can control
- highlights the influence of the media in the development of eating disorders
23
Q
Feminist perspectives on eating disorders background
A
- Emerged in the 1970s
- First major challenge to the medical model
- Introduced a conceptualisation of anorexia nervosa that drew directly on women’s experiences of themselves and their social relationships
- Explored the interrelationships between women’s experience of living in Western societies, the effects of a subordinate social position and the denial of food by women
- Anorexia viewed as a form of social protest and an expression of conflicting social roles and identities
24
Q
feminist perspective context in early 1900s-1960s
A
- Social roles changing
- Women’s Suffrage - the right to vote
- World War I and II – women entered the workforce
- Post-WWs – women expected to return to the domestic sphere
- Women’s Liberation Movements
25
Q
feminist perspectives- Susie Orbach, Hunger Strike (1986)
A
- food refusal (denial of emotional needs, gain control over body, form of protest)
- anorexia as a metaphor for our time (attempts to negotiate passions and desires at a time of great confusion, many social roles to choose from but women still enter world as guests, your needs vs others needs)
- changing social roles (defin of good mother keeps changing, idea of all-providing wife and mother, can work but responsible for child rearing, liberation vs guilt)
- mother-daughter relationship (daughter’s needs stir the mother’s unmet needs resulting in inconsistent parenting, separation vs individuation, anorexia is a way for the daughter to return to her mother)
26
Q
feminist perspectives- Kim Chernin (1986) = the changing social roles
A
- conflict between new social roles and traditional ones
- feeling of ambivalence and guilt about moving into the ‘male sphere’ of self development
- ‘terror of female development’
- women transform their bodies because of guilt over transforming their lives and personalities
- Life is consumed by the obsession with food in place of freedom
27
Q
feminist perspectives- Kim Chernin (1986) = the mother-daughter relationship
A
- Eating disorders are an expression of identity confusion
- The search for identity and self-hood
- The daughter’s struggle to separate from the mother
- Self-development = surpassing your mother
- Mother is ambivalent about her daughter’s opportunities (rage vs. guilt)
28
Q
Feminist Perspective- treatment of eating disorders
A
- shifting the focus of therapy from the individual onto the social context in which the symptoms emerged
- create an understanding of food refusal
- recognise that eating disorders are thre result of oppression of women within our culture
- explore contradictory social roles
- explore overidentification with caretaking roles
- explore identification with cultural ideal of thinness
- help clients to value their strengths in typically devalued areas
- emphasis on the need for social change
29
Q
A general critique of feminist perspectives
A
- First major challenge to the medical model
- Need to focus on social, cultural and political factors
- Gave women with anorexia a voice
- Drew attention to the distress women experience
- Highlighted the way in which the medical paradigm limited rather than facilitated recovery from anorexia
- Psychoanalytic-based analyses contributed to a failure to establish a shift away from a psychomedical epistemology
30
Q
a critique of feminist perspectives- medical discourse
A
- Use of medical language in feminist writings
- The meaning and utility of the term is not questioned
- Reproduced explanations of anorexia as a psychiatric category
- Something that you can ‘be’
- ‘anorectic woman’ – separates them from other women
31
Q
a critique of feminist perspectives- the centrality of the mother-daughter relationship
A
- father-daughter relationship excluded
- the relationship between eating disorders and sexual abuse not examined
- ‘family’ is equated with ‘mother’
- women still positioned as the centre of domestic life
- mothers still remain the central link in explaining pathology
32
Q
a critique of feminist perspectives- anorexia nervosa as a problem of identity
A
- locates the pathology within the individual
- reduces the explanation to an ‘identity crisis’
- ‘failure’ to cope with the transition into adulthood
- the individual is expected to change rather than society
33
Q
Post structuralist perspectives- Julie Hepworth (1999)
A
- focuses on power relations in society to examine the construction of knowledge through which AN emerged
- the dominant psychiatric definition of anorexia is socially constructed through discourse
- reproduces dominant ideas about the phenomenon
34
Q
Anorexia vs Bulimia (Burns 2004- eating like an ox)
A
discourse influences how we categorise the disorder, position women and regulate them- tied to assumptions about normative femininities
35
Q
(Burns 2004- eating like an ox) view of AN
A
- total control
- total denial
- perfection
- sense of achievement
36
Q
(Burns 2004- eating like an ox) view of BN
A
- out of control
- indulgent
- failure
- shameful
37
Q
dualistic logic of (Burns 2004- eating like an ox)
A
- control vs lack of control
- success vs failure
- greed vs abstinence
- sexuality
- Anorexia (practices) – success, control, strength, discipline (gendered male qualities).
- Bulimia (practices) – greed, promiscuity, compulsivity, weakness (pathologised notion of a negative type of femininity)
38
Q
Burns (2004) – Eating like an Ox
implications
A
- disorder is located within the individual
- the social and discursive context is over looked
- anorexia viewed as desirable and acceptable
- bulimia is viewed as deviant and shameful
- the person ‘becomes’ their diagnosis
- pro-anorexia websites
39
Q
AN in males prevalence
A
- 5-10% of people diagnosed with AN are male
- underreported and misdiagnosed so may be higher
- diagnostic bias (amenorrhea in DSM 4)
- viewed by professionals and society as a female disorder
- stigma and shame associated with the diagnosis
- reluctance to seek treatments
40
Q
Anorexia Nervosa in Males- clinical presentation
A
- onset in late adolescence to early adulthood
- fear of gaining weight
- body dissatisfaction (upper body)
- lean, muscular body ideal
- more emphasis placed on body shape than on achieving a low weight
- binging and exercising excessively is more common than restricting food intake
41
Q
Anorexia Nervosa in Males- reasons for dieting
A
- being overweight (rather than feeling fat)
- attain goals in sports
- feel more masculine
- gain respect from others
- higher prevalence of eating disorders in athletes
42
Q
Anorexia Nervosa in Males- aetiology (family dynamics)
A
- controlling mother
- distant/absent father
- enmeshment hypothesis
- struggle for autonomy
- parental conflict and divorce
- similar family dynamics seem to play a role for males and females
43
Q
Anorexia Nervosa in Males- aetiology (sociocultural factors)
A
- limited research
- hegemonic masculinity (courage, aggression, competitiveness, mastery, emotional detachment, autonomy, rationality, toughness of the mind and body)
- Pressure to conform to society’s views of masculinity
- The role of the media
- Changing role of men in society
44
Q
Anorexia as a female disorder
A
- Anorexia is viewed as a disorder that only affects females
- 1970s – development of gender identity scales
- ‘Scientific proof’ that femininity is a risk factor for anorexia and masculinity is a protective factor
- Led to the stereotype that men with anorexia are:
Homosexual
Asexual
Effeminate
More severely disordered
45
Q
Social construction of anorexia - Benveniste et al. (1999) and McVille (2003)
A
- Examined lay accounts of men with anorexia
- Participants asked how they would explain male anorexia
- Language used served to distance anorexia from hegemonic masculinities
- This sustained both the dominant masculine identities and the gender-specific construction of anorexia
- New age men – feminine, emotional, focused on appearance
- Mentally weak ; manifestation of psychopathology
- Reformulated the symptoms as depression
- Something wrong with the person; different to other men
- Intellectually inferior – have to depend on their looks
- Childhood – ‘swayed them from the norm’
- Socialised to be feminized; atypical men
46
Q
future research into eating disorders in males
A
- Explore the unique features of eating disorders in men
- Explore issues relating to the social construction of masculinities
- Address the gender bias inherent in the conceptualisation and diagnosis of eating disorders
- Change social stigma
- Developing treatments specific to men with eating disorders
