By: Kristine Wright, Care Tech

Eating disorders have been on the rise and a center of study since the 1980’s. They have been a serious concern for patients suffering from these disorders, their families, friends, and health care professionals. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD)(2004), eating disorders affect seven million women and one million men in the U.S., and have one of the highest mortality rates of all psychological disorders (anorexia has the highest). Unfortunately, eating disorders are very harmful to the body and very difficult to overcome. Treatment is expensive and not always effective. Anorexia alone is the number one cause of death among young women (ANAD).

Many factors influence the onset and continuation of these disorders. This article will focus on three main factors. The first factor is self-concept, which also includes self-esteem, body image, body satisfaction, and identity formation. The second factor is the impact of the media, which includes TV, magazines, advertisements, movies, and the internet. And lastly, gender differences and their influence on eating and exercise disorders.

Self-Concept

Research suggests that female problem eaters have low physical and personal self-esteem which includes a negative perception of their appearance, physical and personal competence, sexuality, and self-worth (Nelson & Hughes, 1999). It has been reported that the transition from high school to college can be a very emotionally draining and vulnerable time for young women in this area. It is speculated that because of women’s socialization, eating problems are very much connected to one’s self-concept. During this transition, self-concept tends to deteriorate and therefore the risk for disordered eating patterns increases (Hesse-Biber & Marino, 1991).

One research study conducted on patients with eating disorders has characterized them as lacking self-affirmation, having high levels of self-hate and self-blame, and as having an overall negative self-image and interpersonal style (Bjorck, Clinton, Sohlberg, Hallstrom, & Norring, 2003). This particular study found that patients with anorexia are more prone to have higher levels of self-control, self-blame, self-hate and less selfemancipation as compared to other categories of eating disordered patients. Other research suggests that patients with more severe eating disorder pathology lack interoceptive awareness (knowledge of inner life), are characterized with high levels of somatization, bulimic behaviors, muscle tension, anxiety, and low self-concept (Faldt & Johnsson, 2002). It was found that with more severe psycho pathology there was lower self-concept and poorer self-image.

How people strive to achieve self-worth differs from person to person. Each person bases their self-worth on different dimensions. For some, having love and support from their family makes them feel worthwhile, and for others it may be doing well academically or winning a competition. In a study of college students, it was found that when self-esteem was based on appearance, students experienced more symptoms of disordered eating and spent more time exercising than those who based their self-esteem on other domains (Crocker, 2002).

People with eating disorders have been widely labeled as “perfectionists.” In a study comparing female aerobic exercisers and college athletes it was found that athletes were characterized as having higher levels of perfectionism than exercisers, but that exercisers showed a positive relationship between perfectionism and drive for thinness that wasn’t shown with the athletes (Krane, Stiles-Shipley,Waldron, & Michalenok, 2001). In this particular study, most of the women did not seem to suffer from eating disorders or social physique anxiety, but some were categorized as excessive exercisers. It was noted that possibly body dissatisfaction may be combated through participation in physical activity.

Not all people who suffer from eating disorders fall into the categories of anorexia nervosa and bulimia nervosa. Many people – especially women – suffer from Eating Disorders Not Otherwise Specified (EDNOS) as outlined in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). These disorders vary widely and are basically defined as not meeting the specific criteria for the other eating disorders. In one particular study it was found that college women suffering from EDNOS experienced high levels of body dissatisfaction, attention to body image, and drive for thinness (Schwitzer, Rodriguez, Thomas, & Salimi, 2001). An overall theme of perfectionism was found and related to higher levels of stress, anxiety, decreased self-esteem, and episodes of depression. Other characteristics found were maturity fears, self-sufficiency concerns, and struggles with parents and family for young-adult autonomy. From the above research it seems there is a pattern of low self esteem and self concept, poor body image and high body dissatisfaction among those who suffer from eating disorders. There also appears to be high levels of perfectionism, self-hate, and self-blame which are all interrelated. There seems to be more similarities of individual characteristics between eating disorders than differentiating characteristics. An underlying theme of poor self-concept displayed through many diverse arenas, is a very powerful factor contributing to eating disorders.

Media

Adolescence is a risky time for many young girls, and acts as the foundation for most eating disorders. Hoskins (2002) focuses on the relationship between identity development and cultural symbols and images, and how they influence an adolescent girl’s onset of an eating disorder. By the 1980’s the ideal body size for women had decreased 10 pounds since the 1960’s (Hoskins, 2002). Today’s media portrays women’s sexuality as very graphic and unrealistic. A young girl growing up in this type of atmosphere is prone to feelings of inadequacy and low self esteem when comparing herself to the unrealistic body sizes and standards of thinness. Hoskins states that many girls buffer these negative feelings towards themselves, by using their bodies as self improvement projects. This type of behavior is further reinforced by society’s beliefs which according to Furnham, Badmin, and Sneade (2002, p.587), “.encourage and reward the pursuit of the perfect body because it is an ideal that symbolizes the attainment of numerous personal virtues and achievements.”

It is important to note that eating disorders are a learned behavior (Hoskins, 2002). This is illustrated by a study done by Anne Becker (1999) in Fiji emphasizing the impact of television on eating behaviors and body dissatisfaction. She reported that once adolescent Fijian females were introduced to Western ideals through exposure to television, levels of dieting and body dissatisfaction increased.

Media can not be limited simply to exposure to television. In a study done on the relationship between media consumption and eating disorders in women, results showed that magazine reading had a positive, significant relationship to eating disorder symptoms (Harrison & Cantor, 1997). Magazine reading significantly predicted drive for thinness and behaviors of both anorexia and bulimia. Comparatively, television watching only significantly predicted body dissatisfaction. In this particular study, men were also studied. They found that magazine reading for men not only was significantly and positively related to dieting and endorsement of thinness for themselves, but also that the transition from high school to college can be a very emotionally draining and vulnerable time for young women in this area. It is speculated that because of women’s socialization, eating problems are very much connected to one’s self-concept. During this transition, self-concept tends to deteriorate and therefore the risk for disordered eating patterns increases (Hesse-Biber & Marino, 1991). One research study conducted on patients with eating disorders has characterized them as lacking self-affirmation, having high levels of self-hate and self-blame, and as having an overall negative self-image and interpersonal style (Bjorck, Clinton, Sohlberg, Hallstrom, & Norring, 2003). This particular study found that patients with anorexia are more prone to have higher levels of self-control, self-blame, self-hate and less self emancipation as compared to other categories of eating disordered patients. Other research suggests that patients with more severe eating disorder pathology lack interoceptive awareness (knowledge of inner life), are characterized with high levels of somatization, bulimic behaviors, muscle tension, anxiety, and low self-concept (Faldt & Johnsson, 2002). It was found that with more severe psycho pathology there was lower self-concept and poorer self-image. How people strive to achieve self-worth differs from person to person. Each person bases their self-worth on different dimensions. For some, having love and support from their family makes them feel worthwhile, and for others it may be doing well academically or winning a competition. In a study of college students, it was found that when self-esteem was based on appearance, students experienced more symptoms of disordered eating and spent more time exercising than those who based their self-esteem on other domains (Crocker, 2002). People with eating disorders have been widely labeled as “perfectionists.” In a study comparing female aerobic exercisers and college athletes it was found that athletes were characterized as having higher levels of perfectionism than exercisers, but that exercisers showed a positive relationship between perfectionism and drive for thinness that wasn’t shown with the athletes (Krane, Stiles-Shipley,Waldron, & Michalenok, 2001). In this particular study, most of the women did not seem to suffer from eating disorders or social physique anxiety, but some were categorized as excessive exercisers. It was noted that possibly body dissatisfaction may be combated through participation in physical activity. Not all people who suffer from eating disorders fall into the categories of anorexia nervosa and bulimia nervosa. Many people – especially women – suffer from Eating Disorders Not Otherwise Specified (EDNOS) as outlined in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). These disorders vary widely and are basically defined as not meeting the specific criteria for the other eating disorders. In one particular study it was found that college women suffering from EDNOS experienced high levels of body dissatisfaction, attention to body image, and drive for thinness (Schwitzer, Rodriguez, Thomas, & Salimi, 2001). An overall theme of perfectionism was found and the endorsement of thinness and dieting for women. They also found that watching television with only thin people being portrayed, significantly predicted the importance of thinness and dieting for men once more.

A study of college women was conducted looking at internalization of the thin ideal transmitted primarily through media (Low, Charanasomboon, Brown, Hiltunen, Long, Reinhalter, & Jones, 2003). They found that awareness and high internalization of the thin ideal was correlated with fear of maturity (growing up), body dissatisfaction, greater drive for thinness, and an increase of weight and shape concerns. Additionally, women with a body further away from the sociocultural ideal (having a higher body mass index) experienced higher body dissatisfaction, drive for thinness, and increased risk for eating and body image concerns.

Not only do the media constantly portray an extremely thin body size; but it also portrays women as having a trivial role in society, as being objects of male dominance, and sends out contradictory messages to young girls. These messages promote independence and strength while promoting compliance and vulnerability simultaneously. These different cultural messages and images become very complex and confusing for an adolescent girl who is searching to find her identity (Hoskins, 2002).

Hoskins suggests that eating disorders begin as an attempt to relieve oneself from the complex and confusing demands of creating a self, or identity. For example, by taking on an “anorectic identity” the adolescent girl is relieved from this task, and now has rules and norms to guide her behavior. The catch is that once an eating disorder begins it is very difficult to reverse (Hoskins, 2002).

In addition to the challenges already discussed, the advertisement of and increasing popularity of plastic surgery has created a whole new realm of unattainable standards of body size and shape, and a narrowing of society’s beauty standards. Consequently, the more rigid the standards become the more drastic and harmful the attempts will be to reach them.

Gender Differences

In the past the majority of eating disorder patients have been women. Recent research has shown that the male population may have been overlooked (O’Dea & Abraham, 2002). It seems that problem eating attitudes and behaviors are not solely experienced by women, but a relatively large portion of men also experience such problems. In one particular study 20% of college men displayed problem eating attitudes and behaviors and 8% displayed and exercise disorder (O’Dea & Abraham, 2002). Of concern to health care professionals is that most men do not feel they have a problem or are hesitant to seek help even when they feel they do have a problem. The profile of a male problem eater tends to differ from a female in several ways. The strongest differential factor for men is current psychological distress, followed by high levels of patriarchal psychological control and dealing with single family relationships (Nelson & Hughes, 1999).

Men and women also differ in their quest for the ideal body. In a study conducted of adolescent’s ages 13 and 14, gender differences about body dissatisfaction were compared (Furnham, Badmin, & Sneade, 2002). It was revealed that 29.4% of boys and 10.2% of girls wanted to be heavier; compared to 35% of boys and 69% of girls wanting to be thinner. They also found that 73% of the boys wanted to increase the size of their upper body, whereas 63% of girls wanted to decrease the size of their lower body. It seems then that because there are different ideals for men and women, the sources of body weight and concern are also different. Men are more pressured to have a muscular and V-Shaped body figure which is achieved through exercise, weight training, and not necessarily through diet restrictions and weight loss. It was also found that body image dissatisfaction was only significantly correlated with girls’ self-esteem and not boys’. Therefore, in girls where body satisfaction is a central factor of their self-esteem, there tends to be more concern about weight and a higher chance of having negative attitudes toward eating.

Summary

Eating disorders are very complex and multidimensional with many causes and many outcomes. Researchers and healthcare professionals are now being faced with a broader range of disorders and patient profiles. Much of the research conducted in this area of study is focused on a small range of disorders, focuses mainly on young females, and is mostly corralational data.

Eating and exercise disorders are very difficult to study because the information gathered for most research is based on self reports, questionnaires, interviews, and case studies, which are easily biased and unreliable. Not much true experimental research has been done due to the unique and personal nature of these disorders. They can also be difficult to diagnose (especially in the early stages) and many sufferers don’t even recognize they have them.

From the studies that have been explored, it seems there is definitely a relationship between self-concept, media, and gender on eating disorders. The American culture is very media oriented and is largely influenced by its messages, images, and portrayals. This influence is further complicated by sex and gender issues, identity formation, and individual perceptions of the self.

References

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Crocker, J. (Fall, 2002). The cost of seeking self-esteem. Journal of Social Issues, 58 (3), 601-605.

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Funrham, A., Badmin, N., Sneade I. (Nov, 2002). Body Image Dissatisfaction: Gender Differences in Eating Attitudes, Self- Esteem, and Reason for Exercise. Journal of Psychology, 136 (6), 581.

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National Association of Anorexia Nervosa and Associated Disorders: ANAD (2004). Facts about eating disorders. Retrieved March 3, 2004, from http://anad.org

Nelson, W. L., Hughes, H. M. (Fall, 1999) Anorexic Eating Attitudes and Behaviors of Male and Female College Students. Adolescence, 34(135), 625-626.

O’Dea, J., Abraham, S. (2002). Eating and Exercise Disorders in Young College Men. Journal of American College Health, 50(6), 274-277.

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