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Eating Disorders
A vast
amount of research has been done on the subject of eating disorders and their causes. Many
eating disorders have been proven to emerge during adolescence and often serve as the
foundations to more serious problems like anorexia and bulimia. This essay will explore
the development of eating disorders in adolescent girls. It will show that these disorders
are closely connected to the biological and psychosocial changes that occur during the
adolescent period.
Many teen girls suffer with anorexia nervosa, an eating disorder in which girls use
starvation diets to try to lose weight. They starve themselves down to skeletal thinness
yet still think that they are overweight. Bulimia, meanwhile, is a disorder in which young
women binge on food and then force themselves to vomit. They also often use laxatives to
get food out of their system. All of these young women who suffer from this problem are
considered to suffer from a psychiatric disorder. While the causes are debatable, one
thing that is clear is that these young women have a distorted body image. (Wolf,
pp.214-216)
What is extremely alarming is that the current thin ideal for women in Western
society, which is unattainable for all but a very small percentage of the population, is
compounding this problem. It is a very serious issue when someone's body shape is
determined by genetic disposition and yet they try to alter it to fit some kind of
imaginary ideal of how a person should look.
Thus, one of the most serious problems is that female nature is not what society
says it should be. Some researchers theorize that anorexia is a young woman's way of
cancelling puberty. Since they lack body fat, anorexics don't get their periods and often
lose their sexual characteristics such as public hair. They remain, in other words, little
girls. There is also the complex issue of women feeling that by having an eating disorder
they are finally in control of something in their life. This may sound strange, but much
research has shown that women who have been abused or neglected in their childhoods
develop these problems of control. (Attie and Brooks-Gun, pp.70-71).
Studies suggest that eating disorders often begin in early to mid-adolescence. They
are directly connected to pubertal maturation and the increases in body fat that occurs
during this phase. These biological changes are associated with increased dieting and
unhealthy behaviours in early adolescence. This problem is aggravated by various problems,
including negative body image, which has a close association with weight, perfectionism
and depression. Family and socialization also play significant roles. It has been found,
for instance, that mothers with girls with eating disorders are often critical of their
daughters' weight and physical appearance. Families with adolescents who have eating
disorders are also often characterized by enmeshment, over protectiveness, rigidity and
lack of conflict resolution. This is connected to the "control" issue mentioned
previously. Interestingly enough, girls who are more involved in mixed-sex social
activities and dating boys are also more likely to exhibit disordered eating tendencies.
(Attie and Brooks-Gun, pp.70-71).
Thus, eating disorders must be studied in the context of what certain individuals
face during their developmental stage, or what they may have suffered in childhood. In
general, a combination of the pubertal phase of the female body, the loosening of the
individual's ties to parents, and the development of a stable and cohesive personality
structure play profound roles in this process. Psychologists Ilana Attie and J. Brooks-Gun
have done some work on this issue. They considered eating disorders within the so-called
"developmental" perspective, which examines the emergence of eating disorders in
adolescent girls as a function of pubertal growth, body image, personality development,
and family relationships. The two psychologists examined 193 white females and their
mothers during the formers' middle-schooled years (13.93 years) and then two years later.
They set out to see how much the development of eating problems represented a mode of
accommodation to pubertal change. Taking a "developmental" approach, the authors
studied the impact of the pubertal transition relative to other aspects of the female
adolescent experience. (Attie and Brooks-Gun).
These researchers emphasized one very significant fact: that as girls mature
sexually, they accumulate large quantities of fat. For adolescent girls, this growth in
fat tissue is one of the most dramatic physical changes associated with puberty, adding an
average of 11 kg of weight in the form of body fat. This increase in fat is, in turn,
directly connected to desires to be thinner. (Attie and Brooks-Gun, p.7O) This reality is
due to the fact that, as Attie and Brooks-Gun demonstrate, female body image is intimately
bound up with subjective perceptions of weight. Prepubescent girls who perceive themselves
as underweight are most satisfied while the opposite occurs for those who are overweight
or perceive themselves to be such. Thus, Attie and Brooks-Gun found that dieting emerged
as the female body developed, and that is was a function of the body image transformation
occurring at puberty. (Attie and Brooks-Gun, p.71)
Aside from the pubertal changes that the authors found significant in this issue,
family relationships were also detected to influence the emergence of eating disorders.
Families that set high standards for achievement, gave little support for autonomy, and
blurred interpersonal boundaries left adolescent girls with deficits in their self-esteem.
(Attie and Brooks-Gun, p.71) Once again, as mentioned earlier, it makes sense in a very
complex way that young girls who have been abused in this way end up
"controlling" things that are ultimately not good for them. For instance, a
young girl who was made to feel powerless in some ways in her family (i.e. sexual or
physical abuse) may end up feeling a sense of individual identity if she can
"control", for example, when she vomits and when she does not. Now, at least,
she can have control over something in her life.
Personality factors were also found to contribute to the development of eating
disorders. Characteristics such as perfectionist strivings, feelings of ineffectiveness,
depressive symptoms and self-regulatory deficits were seen frequently in patients with eating disorders. (Attie and
Brooks-Gun, p.71)
The authors found, for instance,
that girls who early in adolescence felt most negatively about their bodies were more
likely to develop eating problems two years later. (Attie and Brooks-Gun, p.76).
Thus, overall, Attie and Brooks-Gun found that eating problems emerged in response
to physical changes of the pubertal period. Personality variables entered this problem,
but only at a later stage. Attie's and Brooks-Gun's findings suggest that body shape
becomes a primary focus and that efforts to control weight intensify during the
middle-school years. In other words, the rapid accumulation of body fat that is part of
the female experience of puberty often functions as a triggering effect, in the sense that
it starts the attempt of weight-loss diets.
Attie's and Brooks-Gun's study did, of course, have its limitations. The authors
themselves admitted that their investigation focused only on a sample of white girls from
upper-middle-class families. Yet most evidence has suggested that bulimia nervosa is more
prevalent in middle-and-upper middle class white girls, although there is evidence
suggesting that eating disorders are increasing in other ethnic and social class groups,
especially for girls who experience more pressure to acculturate to white, middle-class
standards. (Graber, Brooks-Gun, Paikoff and Warren, p.823) In other words, what we see
here is that the values and ideals held by the dominant society are an important issue as
well. Recent studies have shown us that adolescent girls in competitive environments that
emphasize weight and appearance experience increased social pressures to meet the thin
ideal. (Attie and Brooks-Gun, p.7O)
Another study that very much confirmed the findings of Attie and Brooks-Gunn
examined 116 adolescent girls drawn from a normal population of students enrolled in
private schools in a major metropolitan area. These girls were followed over an 8-year
period from young adolescence to young adulthood. Over a quarter of the sample scored
above the level identifying a serious eating problem at each of the 3 times of assessment
(14, 16, and 22 years of age.) (Graber, Brooks-Gunn, Paikoff, and Warren). Like Attie's
and Brooks-Gunn's study, this project also found that eating disorders were triggered
during the pubertal stage of girls. This is why the researchers recommended, among all
else, that primary prevention be indicated for all girls in early adolescence. (Graber,
Brooks-Gun, Paikoff, and Warren, pp.831-832).
Together with pubertal causes, there has also been evidence suggesting that dating
is an ingredient to this phenomenon. Psychologists Elizabeth Cauffman and Laurence
Steinberg examined 89 12-13 year old girls and examined their dating and other
heterosexual activities in relation to their dieting behaviours and attitudes. The two
researchers found that girls who were more involved in mixed-sex social activities and
dating boys were more likely to exhibit disordered eating tendencies. (Cauffman and
Steinberg.) The authors made the intriguing finding that sexual activity is correlated
with more symptoms of disordered eating. This is especially interesting in as much as
adults with eating disorders tend to be less sexually active. It thus appears that
physical involvement in early adolescence leads to increased concern about appearance and
attractiveness, but that when this concern becomes so great that it leads to disordered
eating, the end result is often a decrease of the activities that contributed to the
disorder in the first place. (Cauffman and Steinberg, p.634)
Eating disorders, therefore, have some common denominators but also remain complex.
The causes range from everything from sexual abuse to the social forces that construct
certain female ideals that most women can simply not live up to. Then, of course, there is
a blending of causes. Overall, of course, while we must emphasize personal problems, it is
necessary to keep an eye on social messages. Feminist-writer Naomi Wolf has discussed how
cultural ideals for beauty emphasize a slender body shape typical of pre-pubertal
development that is unattainable for most adolescents and women after puberty. Thus,
adolescent girls may engage in excessive dieting in an attempt to meet these unattainable
cultural ideals even though they are not over-weight. In a chapter entitled
"Hunger" in The Beauty Myth, Wolf writes:
...female fat is the subject of
public passion, and women feel guilty
about female fat, because we implicitly recognize that under the myth, women's bodies are
not our own but society's, and that thinness
is not a private aesthetic, but hunger a social
concession exacted by the community. A cultural
fixation of female thinness is not an obsession about female beauty but an
obsession about female obedience. (Wolf, p.187)
In light of all of these factors, it is possible to make some generalizations
regarding a significant portion of eating disorders. We know that they can be, and are,
compounded by the social messages that Wolf describes. But the causes obviously also run
deeper into the personal realm. It appears that problem eating develops during early to
middle adolescence, and that these early patterns influence later eating behaviour. Body
image becomes crucial in this development, as does the social and familial setting. We
have learned this from the "developmental" perspective, which crystallizes the
significance of changes in girls during their adolescent years. The potential remedy,
therefore, exists in the understanding of these changes and how they affect self-image.
Women with eating disorders are often in severe denial. The control of their body
weight serves an important purpose in their lives, for one dysfunctional reason or
another. It is a way they can cope with their problems. Many women, as we have learned,
use food to repress their emotions. They are out of touch with their feelings and use food
as a form of escapism. They need psychotherapy.
In order to help women suffering from eating disorders, it would first be important
to follow the advice given by David Burns in Feeling Good. The New Mood Therapy.
(Burns) Burns teaches certain steps in psychotherapy practise that teach people to make
charts of tables charted "cognitive distortion" and "rational
response". This entails a person writing down what is bothering them and then
honestly answering the questions. (Burns, pp.62-69) This might seem too simple, but it is
incredible what healing can reside in a person honestly facing their personal secret pain
and working through it. The key here, of course, is that many young women who having
eating disorders would simply not do this because of their denial. The crucial aspect,
therefore, is to make them reconcile themselves with their pain. Though this is the most
difficult process, it simply has to be done. Burns shows throughout the book that the only
way out of the pain is through the pain. After that, different treatments can be applied,
but the first step is for a person to be honest with themselves.
For instance, a young girl with an eating disorder who wants to get better must
write down whatever is haunting her: "I ate a hot dog today." After this, under
the heading "Cognitive distortion" she should answer why this would bother her.
Let us suppose she writes: "Well, because now I will get fat." Then she must ask
why this would bother her. It is here that we begin getting to the dark recesses of the
psyche and where many people who are in denial would not be able to continue. But this
girl must continue if she wants to get better. Suppose she writes: "Well, because
then I would be worthless and no one would like me." Then she must ask again why this
would bother her. She answers: "Then I would be alone and would have no reason to
live." But ultimately, there might be even darker things at the bottom of the list,
perhaps something like: "I'll prove I can stay fat, then men wouldn't like me and
then they would not sexually violate me anymore." The point here is that the dark
reasons for distorted thoughts would have to be faced. The person must recognize the root
of their dysfunctional behaviour, no matter how painful it is.
After this exercise, as Burns teaches, the person would make a parallel chart of
"rational response" in which they would answer every distorted thought. To
"I ate a hot dog today" the person would write, alongside it: "That is ok,
it is good and healthy to eat." To "now I will get fat", she would write:
"Well, not necessarily because I am already underweight and even if I was, I only ate
one hot dog." The next step would be the hardest ground to start working one, since
the problem of this person is rooted in distorted thinking. To "Well, because then I
would be worthless and no one would like me" she would have to start considering the
issues of whether her weight was connected to her self-worth. She would have to start
understanding that self-worth was based on something intrinsic, not on something external.
In this step and process lurks the greatest healing process, for so many of these
illnesses are based on illogical thought patterns. To "Then I would be alone and
would have no reason to live" she could start seeing the ridiculous nature of this
underlying belief. She could write down all the friends she has that would not care less
how much she weighed. She could write down how she would never be alone anyway and that
being alone might not be the end of the world.
This is just an example of course, and it is not to suggest that this writing
process of "cognitive distortion" and "positive response" is the
solution to all these serious problems. But what is important in dealing with eating
disorders, and this is the point, is that the person who is suffering must be made to
start thinking properly before anything else is done. Medication is not going to help a
young girl who is convinced that looking like a skeleton is the only way to get men to
like her, and that her life would not be worth living if men did not find her sexually
attractive. Obviously these ideas and beliefs would have to be dealt with before any other
approach is taken. The point here is that many young girls suffering from eating disorders
are fighting something and it is connected to a distortion in the process of thinking.
David Burns argues, with much success, that this thinking pattern must change before
anything else. He also shows the tremendous success that it can provide in healing all
kind of psychological disorders. (Burns, pp.383-405)
To be sure, eating disorders are very serious illnesses; they do not have easily
detectable causes and they do not have easily related cures. But we do know several things
that can be done. Along with making a young girl aware of her thinking, and making her be
honest with herself and about her past, it is also important to clarify to her the social
pressures that are sending her false messages. Education, therefore, is a must in the
context of teaching that the social ideal of thinness perpetuated in Western society is
distorted and flawed. It is not connected to human nature and it is not connected to
reality. Once young women become aware that there is nothing wrong with their own personal
body image, a significant amount can be done on this issue.
More than anything else, we need to find compassion and understanding for the
victims of eating disorders. While we work on helping these individuals, we must also
fight the social forces that objectify and exploit female body image to the disadvantage
of not only women, but of all humanity. No one profits if one half of the human race is
being held under attack by socially constructed body images that are rooted in morbid
intent and infantile fantasy.
Bibliography
Attie,
Ilana and Brooks-Gunn, J. "Development of Eating Problems in Adolescent Girls: A
Longitudinal Study," Developmental Psychology, 1989,
vol. 25, no.1, 7O-79.
Burns,
David. Feeling Good. The New Mood Therapy (New York: Avon Books, 1980)
Cauffman,
Elizabeth, and Steinberg, Laurence. "Interactive Effects of Menarcheal Status and
Dating on Dieting and Disordered Eating Among Adolescent Girls," Developmental
Psychology, 1996, vol. 32, no.4, 631-635.
Graber,
Julia, Brooks-Gunn, J., Paikoff, Roberta, and Warren, Michelle. "Prediction of Eating
Problems: An 8-Year Study of Adolescent Girls," Developmental Psychology,
1994, vol.3O, No.6, 823-834.
Wolf,
Naomi. The Beauty Myth (Toronto: Random House, 1991) |
