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Clinical 2 > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Historical perspective on Eating Disorders

A
  • saints ‘holy anorexia’
  • witches
  • insane
  • disease
  • mental disorder
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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
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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
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4
Q

Classification of eating disorders in DSM 4

A

a separate diagnostic category was created for eating disorders

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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

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6
Q

Anorexia Nervosa prevalence

A

young females - 0.4%

10 times more common in women

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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
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8
Q

Bulimia Nervosa prevalence

A
  • young females 1-1.5%
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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
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10
Q

binge eating disorder prevalence

A

females- 1.6%

males- 0.8%

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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
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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

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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
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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
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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?
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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
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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
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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
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19
Q

The three main themes in academic writing that emphasised the social and cultural dimensions of psychological disorders including anorexia nervosa

A
  1. Growing disenchantment with psychiatry
  2. Psychoanalytic theories of the socio-cultural dimension of anorexia nervosa
  3. 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
  1. food refusal (denial of emotional needs, gain control over body, form of protest)
  2. 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)
  3. 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)
  4. 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

Clinical 2 (8 decks)

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