Women & Psychology

 

Learning Outcome 3

 

Eating Disorders Part I

 

 

 

Eating

 

Why do we eat? At the simplest level, we eat to ensure we stay healthy and ultimately survive. Humans can go without food for several days without lasting ill-effects, but frequent or prolonged fasting, or a long term lack of nutrients, can have a far greater effect on our health.

 

Think about what you've eaten today - and, if you can remember, yesterday as well. You don't need to write down your answers, but take a few minutes to think about it.

 

·         What made you decide to eat what you did?

·         Did you choose it from a range of foods, e.g. in a canteen?

·         What influenced your decision to eat at all, to eat a specific food, and to eat at that time?

·         If you chose not to eat something, why not?

 

 

From this simple exercise, we can see that when, where and what we eat can be about far more than simply being hungry. We live in a society where most people have access to plentiful food supplies, where we can be overwhelmed by choice in terms of what, where and when to eat. Yet we live in society where thousands of young women - and increasingly also young men - deliberately deprive themselves of food, and where an estimated 1 in 4 women and 1 in 5 men are obese.

 

This pattern exists alongside a booming diet industry, and for many women, eating is intrinsically linked to a desire to lose weight, in turn linked to a distorted body image. Research studies - which we shall examine in more detail next week - have demonstrated a widespread and cross-cultural failure distortion between actual and perceived body image, with women of different ages and cultures consistently believing that they are bigger than they actually are, regardless of whether they have been diagnosed with eating disorders. Susie Orbach, author of Fat is a Feminist Issue (1978), argues that:

 

"Since women are taught to see themselves from the outside as candidates for men, they become prey to the huge fashion and diet industries that first set up the ideal images and then exhort women to meet them. The message is loud and clear - the woman's body is not her own. The woman's body is not satisfactory as it is. It must be thin, free of "unwanted hair", deodorized, perfumed and clothed. It must conform to an ideal physical type. Family and school socialization teaches girls to groom themselves properly. Furthermore, the job is never-ending, for the image changes from year to year… Long and skinny one year, petit and demure the next, women are continually manipulated by images of proper womanhood, which are extremely powerful because they are presented as the only reality."

 

She goes on to argue that women are encouraged to behave in this way in order to "catch" a man for marriage, but that once married, they are considered to have "achieved the first step of womanhood".

 

 

Questions

 

1.      Is this your experience - social pressure to conform to a constantly-changing 'ideal'? If so, where does this pressure come from and how is it exerted?

 

2.      Do you feel this pressure is greater on adolescents than adult women? If it is, is this sufficient in itself to explain why so many young women are so concerned about their figures?

 

 

 

Eating Disorders

 

There are a number of eating disorders currently detailed in the DSM-IV (the Diagnostic and Statistical Manual, 4th Edition) - the main reference point by which psychological disorders are diagnosed and treatments recommended. Individuals with an eating disorder are likely to vary significantly from the 'normal' weight for their height and gender - calculated using the Body Mass Index. The BBC provide a BMI calculator which you can investigate if you wish - details are given at the end of this handout.

 

However, being under or over weight doesn't necessarily mean than a person has an eating disorder. Eating disorders usually cause the person ongoing distress and concern, and may be coupled with a range of other physical symptoms, as explained below:

 

 

Anorexia Nervosa

 

Of these, one of the longest established and possibly the best known is anorexia nervosa.

 

While treatment and attitudes towards eating disorders may have changed over time, the existence of such disorders is not new. Schwartz and Johnson (1985) quote a description of 'nervous atrophy' from 1694, in which two patients were described as being "skeletons clad only in skin". Interestingly, one of the patients was male.

 

Individuals with anorexia may express fear of gaining weight or becoming fat, despite having a BMI less than 17.5 (very underweight); they may have a distorted perception of their body weight and shape, and may experience other physical symptoms such as loss of menstrual periods. Abraham and Llewellyn-Jones (2001) identify two types of anorexia - restricting, where the individual eats very little food; and binge-eating/purging, where the person combines restricted food intake whilst bingeing and purging at other times, through vomiting or laxative abuse.

 

Bulimia nervosa

 

Despite being more common than anorexia, bulimia was recognised as an eating disorder much later - as late as 1979, in fact. Those with bulimia binge-eat regularly (twice a week or more) over an extended period of time. Individuals report a feeling of a 'lack of control' during secretive binges, following which they may vomit, abuse laxatives or take excessive exercise.

 

Binge Eating Disorder

 

This disorder is distinct to bulimia; sufferers do not 'purge' following binges, and are usually overweight rather than underweight. Binges are less frequent than those with bulimia, and no specific cause has been identified.

 

Atypical Eating Disorders

 

'Atypical eating disorders' or 'Eating disorder not otherwise specified' are terms used by psychologists to categorise those experiencing eating disorders, but whose symptoms do not match those specified in the DSM-IV. Such eating disorders by nature are much more common than disorders such as anorexia and bulimia - Abraham and Llewellyn-Jones estimate that as many as 1 in 10 young women may be affected at any given time.

 

Obesity

 

While most images associated with 'eating disorders' are those of emaciated young women, there has been much public concern in recent years that children and adults in Western countries are at increased risk of obesity. Obesity - being severely overweight to the point where one's health is affected - can stem from a number of factors, but has been connected to frequent dieting, low self-esteem and binge-eating.

 

Extent of eating disorders

 

The table below gives an indication of the prevalence of eating disorders in women aged 15 - 30:

 

Anorexia nervosa

0.5 - 1.0 %

Bulimia nervosa

2 %

EDNOS

12 %

Obesity

10%

 

While eating disorders are found in males, they are predominant in young women, with most instances developing before the age of 25, and occur across ethnic and social class backgrounds. The exception is obesity, which is most common in women and men aged 50 - 70.

 

 

What causes eating disorders?

 

What do you believe causes eating disorders? Think back to Learning Outcome 2, and some of the psychological perspectives considered. How might psychology attempt to explain eating disorders? Take a few minutes to consider this, and discuss in small groups.

 

 

Biological and Evolutionary explanations

 

Our bodies are wired to experience hunger - we look around, and our senses have developed to tell us what is edible, and what is tasty - and our bodies also tell us when we are full. On this level, it would be logical then to assume that if our physiology dictates how often we eat and what we like to eat, then it may also play an important role in eating disorders.

 

Although much of the research in this area is still at an early stage, scientists have identified a number of physiological factors, relating to substances found in the bloodstream and to activities in the brain, which may be relevant. Eating carbohydrates, for example, increases the presence of tryptophan in the bloodstream – an amino acid thought to affect mood. Dieters may therefore feel ‘flat’ or ‘down’ as a result of not eating carbohydrates.

 

Other physiological factors are thought to influence binge eating and obesity. Neuropeptides – chemicals found in our brains – have a strong influence on appetite. Scientists believe that an oversensitivity to certain chemicals may induce binge eating, while the act of bingeing – eating a large amount of food in a short time – leaves neuropeptides unable to respond appropriately and make the person feel ‘full’. Hormones such as leptin, produced by fat cells in our bodies, also influence our appetite. Obese people have more fat cells and therefore higher levels of leptin, yet the hormone doesn’t act efficiently (people may continue to overeat), leading researchers to suggest that long term obesity may cause immunity, with those affected less able to feel ‘full’.

 

Evolutionary arguments have also been used to attempt to explain obesity, with scientists arguing that we prefer sweet, sugary (and often fattening) foods as sweetness suggests that a food is safe to eat, while bitterness suggests that a food will be indigestible or even dangerous.

 

Social Explanation

 

Social constructionists argue that food and eating are socially constructed and given meaning at all stages in an individual’s life; food has an important role in our culture, and may be given significance through traditions (e.g. the Sunday roast) or particular religious festivals (e.g. eating certain foods at Christmas). These messages are created and reinforced through language at all levels in our society, but particularly through the media.

 

Feminist psychologists argue that appetite and eating are constructed differently for women than men; a large appetite is seen as ‘greedy’ in females but as ‘healthy’ in males. In addition, girls and women are bombarded throughout their lives – but particularly during adolescence – with varied and conflicting messages about health, diet and appearance, through the media and social institutions such as the family. Fursland (1987) argues that eating disorders develop as a result of these conflicting societal pressures, inducing feelings of shame and guilt in women about their bodies, their appetites and their sexuality.

 

 

 

 

Magazine Exercise

 

Working in pairs, look through the magazine you have been given.

 

·         Who would you consider to be the 'target audience' of this magazine (gender, age, ethnicity, sexual orientation etc)?

·         Do any of the feature articles directly deal with issues around weight, eating or dieting?

·         What messages do you feel are given out to potential readers of the magazine via the fashion, health/beauty, food and problem pages?

·         Do these messages conflict, and if so, in what way?

 

 

Developmental Explanation

 

The majority of eating disorders occur in adolescent girls, so could the developmental process – and puberty in particular – hold the key to understanding the causes of eating disorders?

 

As babies and children, a healthy appetite is seen as key to healthy growth and development. Along with its gender, a baby’s weight is by far its most commented on feature. Puberty signals a time of rapid physiological change for both girls and boys; in girls, the menarché, the start of menstruation, causes a reduction in the body’s energy requirements and may in turn lead to an increase in weight, coupled with the girl’s increased awareness of her body.

 

While this may explain why teenage girls are more likely to develop eating disorders than women in their twenties and thirties, it doesn’t explain why some girls develop eating disorders and others do not. Developmental psychologists point to the strong influence of the family – in particular, a girl’s sisters and mother’s experiences of puberty, and the family’s general attitude to food.

 

Psychological explanation

 

Can eating disorders be attributed to certain personality traits or disorders? Research in this field is controversial – there are conflicting debates on how personality can be accurately measured, and how it may predispose us to certain types of behaviour. ‘Personality disorders’ cover a broad range of behaviour, described by Abraham and Llewellyn-Jones (2001) as featuring ‘significant social or occupational functioning or subjective distress’.

 

More controversial is the diagnosis of ‘borderline personality disorders’, where symptoms may include impulsive behaviours such as shoplifting and drug-taking, moodiness, persistent boredom, anger, unstable relationships and suicidal feelings and/or behaviour. Many adolescents exhibit some or all of these symptoms without developing a personality disorder, and it is difficult to establish cause and effect with eating disorders – a person might exhibit such symptoms as a result of an eating disorder, while others might experience personality disorders without any signs of an eating disorder.

 

References

 

The BBC has a number of articles on its website regarding Eating Disorders. The 'Health' section has articles and useful links under 'Women's Health', and information targeted at young people can be found on the OneLife pages.

 

The BBC's BMI calculator and other information on healthy eating can be found here:

 

http://www.bbc.co.uk/health/healthy_living/your_weight/

 

 

There are lots of other books that may prove useful as background reading:

 

S. Orbach, 1988, Fat is a Feminist Issue (2nd ed), Random House: London

 

This is a classic feminist text on dieting and body image - there is one copy in the library, and second hand copies seem to be plentiful.

 

S. Abraham and D. Llewellyn-Jones, 2001, Eating Disorders: the facts (5th ed), OUP: Oxford

 

This is a useful and up-to-date book detailing the causes and treatments of eating disorders. While the college don't currently have a copy, Ch 3 has been placed in the Offprints section of the library.