11.6 PUTTING IT...together

A Standard for Integrating Perspectives

You have observed throughout this book that it is often useful to consider sociocultural, psychological, and biological factors jointly when trying to explain or treat various forms of abnormal functioning. Nowhere is the argument for combining these perspectives more powerful than in the case of eating disorders. According to the multidimensional risk perspective embraced by many theorists, varied factors act together to spark the development of eating disorders, particularly anorexia nervosa and bulimia nervosa. One case may result from societal pressures, autonomy issues, the physical and emotional changes of adolescence, and hypothalamic overactivity, while another case may result from family pressures, depression, and the effects of dieting. No wonder that the most helpful treatment programs for eating disorders combine sociocultural, psychological, and biological approaches. When the multidimensional risk perspective is applied to eating disorders, it demonstrates that scientists and practitioners who follow very different models can work together productively in an atmosphere of mutual respect.

CLINICAL CHOICES

Now that you’ve read about eating disorders, try the interactive case study for this chapter. See if you are able to identify Jenny’s symptoms and suggest a diagnosis based on her symptoms. What kind of treatment would be most effective for Jenny? Go to LaunchPad to access Clinical Choices.

Research on eating disorders keeps revealing new surprises that force clinicians to adjust their theories and treatment programs. For example, researchers have learned that people with eating disorders sometimes feel strangely positive about their symptoms (Williams & Reid, 2010; Serpell & Treasure, 2002). One recovered patient, for example, said, “I still miss my bulimia as I would an old friend who has died” (Cauwels, 1983, p. 173). Given such feelings, many therapists now help clients work through grief reactions over their lost symptoms, reactions that may emerge as the clients begin to overcome their eating disorders (Zerbe, 2008).

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While clinicians and researchers seek more answers about eating disorders, clients themselves have begun to take an active role in the identification and treatment of the disorders. A number of patient-run organizations now provide information, education, and support through Web sites, national telephone hot lines, schools, professional referrals, newsletters, workshops, and conferences (Musiat & Schmidt, 2010; Sinton & Taylor, 2010).

Wrong message Supermodel Kate Moss arrives at a New York City fashion gala. Asked during a 2009 online interview whether she had any life mottos, Moss set off a firestorm by replying, “Nothing tastes as good as skinny feels.” Noting that this phrase often appears on pro-anorexia Web sites, many critics accused the model of giving legitimacy to the pro-Ana movement. Moss countered that her answer had been misrepresented and clarified that she does not support self-starvation as a lifestyle choice.

BETWEEN THE LINES

In Their Words

“To be born woman is to know–Although they do not talk of it at school–Women must labour to be beautiful.”

W. B. Yeats, 1904

SUMMING UP

  • EATING DISORDERS Rates of eating disorders have increased dramatically as thinness has become a national obsession. Two leading disorders in this category, anorexia nervosa and bulimia nervosa, share many similarities, as well as key differences. A third eating disorder, binge-eating disorder, also seems to be on the rise. p. 350

  • ANOREXIA NERVOSA People with anorexia nervosa pursue extreme thinness and lose dangerous amounts of weight. They may follow a pattern of restricting-type anorexia nervosa or binge-eating/purging-type anorexia nervosa. The central features of anorexia nervosa are a drive for thinness, intense fear of weight gain, and disturbed body perception and other cognitive disturbances. People with this disorder develop various medical problems, particularly amenorrhea.

    Ninety to 95 percent of all cases of anorexia nervosa occur among females. Typically the disorder begins after a person who is slightly over-weight or of normal weight has been on a diet. pp. 350–352

  • BULIMIA NERVOSA People with bulimia nervosa go on frequent eating binges and then force themselves to vomit or perform other inappropriate compensatory behaviors. The binges are often in response to increasing tension and are followed by feelings of guilt and self-blame.

    Compensatory behavior is at first reinforced by the temporary relief from uncomfortable feelings of fullness or the reduction of feelings of anxiety, self-disgust, and loss of control attached to bingeing. Over time, however, sufferers generally feel disgusted with themselves, depressed, and guilty.

    People with bulimia nervosa may have mood swings or have difficulty controlling their impulses. Some display a personality disorder. Around half are amenorrheic, a number develop dental problems, and some develop a potassium deficiency. pp. 353–358

  • BINGE-EATING DISORDER People with binge-eating disorder have frequent binge eating episodes but do not display inappropriate compensatory behaviors. Although most overweight people do not have binge-eating disorder, two-thirds of those with binge-eating disorder become overweight. Between 2 and 7 percent of the population have binge-eating disorder. Unlike anorexia nervosa and bulimia nervosa, this disorder is more evenly distributed among males and females and people of different races. p. 358

  • EXPLANATIONS FOR EATING DISORDERS Most theorists now use a multidimensional risk perspective to explain eating disorders and to identify several key contributing factors. Principal among these are ego deficiencies; cognitive factors; depression; biological factors such as activity of the hypothalamus, biochemical activity, and the body’s weight set point; society’s emphasis on thinness and bias against obesity; family environment; racial and ethnic differences; and gender differences. pp. 358–369

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  • TREATMENTS FOR EATING DISORDERS The first step in treating anorexia nervosa is to increase calorie intake and quickly restore the person’s weight, using a strategy such as supportive nursing care. The second step is to deal with the underlying psychological and family problems, often using a combination of education, cognitive-behavioral approaches, and family therapy. As many as 90 percent of people who are successfully treated for anorexia nervosa continue to show full or partial improvements years later. However, some of them relapse along the way, many continue to worry about their weight and appearance, and half continue to have some emotional problems. Most menstruate again when they regain weight.

    Treatments for bulimia nervosa focus first on stopping the binge-purge pattern and then on addressing the underlying causes of the disorder. Often several treatment strategies are combined, including education, psychotherapy (particularly cognitive-behavioral therapy), and antidepressant medications. As many as 75 percent of those who receive treatment eventually improve either fully or partially. While relapse can be a problem and may be precipitated by a new stress, treatment leads to lasting improvements in psychological and social functioning for many people. Similar treatments are used to help people with binge-eating disorder. These individuals, however, may also require interventions to address their excessive weight. pp. 369–377

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