Psychological explanations

Psychodynamic

A number of different explanations have been produced, but all have the telltale influence of Freud et al.

Hilde Bruch has suggested a couple of ways in which eating disorders may have originated:

Oral impregnation:

Freud saw eating and sex as symbolically related.  Girls may link the fattening stomach caused by eating with that of pregnancy at an unconscious level.  Refusing to eat, therefore, could be seen as a refusal to accept developing sexuality.  The girl wants to remain immature so she doesn’t have to adopt the responsibilities of the adult role.  One way to achieve this is to stop eating which helps to maintain the pre-pubescent shape and as we’ve seen, can stop periods.

Bruch believes that this is a two way process, since the daughter can continue to rely on the mother for security and the mother in turn is able to keep their daughter safe and in the home.

However, as with all psychodynamic theories, Bruch’s ideas on oral impregnation are unscientific and untestable.  The unconscious forces involved are hypothetical constructs that cannot be observed or measured by any objective means. 

Ineffective parenting

Effective parents, according to Bruch, feed their children when they’re hungry and comfort them when they’re anxious.

Ineffective parents, may mis-read the cues.  When the anxious child cries the mother might feed it, believing it to be hungry and when it cries due to hunger she may comfort it believing it to be anxious.   This confuses the child about their own internal state and their needs.  It makes them dependent on others, for example to tell tem when they’re hungry.

As it reaches adolescence it is expected to become increasingly independent, but their uncertainty makes them fearful.  This results in a feeling of helplessness and not being in control of their own body.  The one thing they can control with certainty is their eating.

Bruch (1975) found that many mothers of anorexic children had admitted to anticipating the child’s hunger when they were young.  As a result the children had never experienced hunger.  There is also evidence that anorexics do rely too heavily on the views of others, perhaps suggesting a perceived lack of self-control. 

Enmeshment

Minuchin believes that anorexics are products of enmeshment.  This is the tendency by some families to be over-protective of their children and prevent any sort of independence.  Families like this tend to do everything together and as a result the child has no sense of its own identity.  One way the child can rebel is to stop eating. 

Another feature of this kind of family is an inability to resolve conflicts.  This causes anxiety, (classic psychodynamic concept).  In order to deal with their anxiety, parents of the anorexic are able to take on the role of caring for their ‘sick’ child. 

Evidence

Kalucy et al (1977) found that the families of anorexics tend to be unable to resolve conflicts and blame others for their problems (external locus of control). 

However, whilst it is true that there is a lot of conflict within the families of anorexic children we can’t be certain that there is a cause and effect relationship.  It is certainly true that having an anorexic living in the house will cause tension and conflict.

Since families like the ones described above have presumably always existed how can we use this model to explain the recent increases in the incidence of eating disorders?

Behaviourist explanation

The approach is based on the portrayal of women in the media, particularly over the past thirty years.  In this time, the ideal shape has shifted from the rounded size 12/14 of the Sixties, as exemplified by Marilyn Monroe, to the emaciated, twig like form of today, for example Kate Moss and Posh Becks.  (probably best not to quote the last bit, but you get the idea!).  This has led to women, particularly teenagers, dieting, and the lay-persons idea of anorexia is the slimmers’ disease. 

When using the behaviourist model to explain any behaviour it is useful to adopt Mowrer’s Two Stage Approach.  This explains how a behaviour is acquired and how it is later maintained. 

Acquisition

Classical conditioning (or learning by association). 

People are told they look good when they lose a little weight.  Dieting therefore becomes associated with feeling good about yourself.  Eating causes weight gain and as a result anxiety.  As a result eating becomes associated with anxiety.  Or

Social Learning Theory (neo-behaviourist)

We see others on television and in the media being rewarded for their thin build.  Successful women tend to be thin!  Think of television presenters, newsreaders, pop stars, actresses, celebrities, WAGS….  Girls, particularly are exposed to this vicarious reinforcement (the rewarding of others) and imitate in order to be rewarded themselves. 

Maintenance

Operant conditioning

Admiring glances and compliments following weight loss, act to reinforce the dieting behaviour, so the weight loss continues.  This is an example of Thorndike’s Law of Effect which put into simple terms predicts that of all behaviours performed, those that are rewarded are more likely to be repeated. 

It is worth mentioning that severe weight loss and abstinence from food also punishes parents, which to the adolescent can be very rewarding in itself.

Evidence

Girls with interests in areas with the most reward for weight loss are the most likely to develop an eating disorder, for example dancers, gymnasts etc.  Garner et al (1987) found that 25% of a group of 11 to 14 year old ballet dancers developed anorexia during a 2 year course.

As the model would predict, anorexia is most common in Western Society where slim is portrayed by the media as being attractive.

When immigrants from societies where anorexia is rare settle in Western society their chances of developing an eating disorder increases significantly.  For example Nasser (1986) compared the following:

·         50 Egyptian women at University in London with

·         60 Egyptian women at University in Cairo.

Findings.  12% of the London group developed an eating disorder during their course.  None of the Cairo group did!

In some countries, particularly SE Asia, there are positive attitudes to women being a larger shape.  Here, there is an association of large with health, attractiveness and fertility.  As behaviourists would predict, anorexia is rare, almost unheard of, in these cultures. 

Similarly in China, where girls tend to be slimmer, there is an association of thin and ill!  Obesity is seen as a sign of prosperity rather than in the West where it is seen as a sign of lack of self-discipline.  Again eating disorders are very rare. 

Evaluation

Anorexia is a rare success story for the behaviourists.  Their model can explain some of the patterns that we see:

·         Why it has become so prevalent in recent years (as the portrayal of women in the media has changed).

·         Why it is becoming increasingly prevalent in men (as the portrayal of the ideal body shape for men becomes increasingly thinner).

·         Why there are cross-cultural differences such as its greater prevalence in Western Society where the emphasis is on ‘thin is beautiful.’

But

Does not explain why anorexics continue to diet even after they stop receiving compliments and are even told how awful they look.

Does not explain individual differences, i.e. why some people develop the disorder and others with the same media pressures do not.

Cognitive explanation

This has obvious face validity as an explanation since we know from research that anorexics typically have a distorted body image. The cognitive approach to abnormal behaviour is based on distorted thinking and perception.

Evidence for distorted body image

Bemis-Vitouesk & Orimoto (1993) (no I didn't make it up, that is their real names) found that anorexics consistently have a distorted body image and believe that they must continually lose weight in order to be in control of their bodies.  Typical thoughts included: 'I must lose more weight I am not yet thin.'  Similarly, Garfinkel and Garner (1982) found that anorexics overestimate their weight and body size. 

Lovell et al (1997) found that people who had recovered from anorexia nervosa two years earlier still had distorted body images and odd views about food and other 'adolescent issues.'

However, yet again we have the issue of cause and effect.  Do the distorted ideas pre-date the onset of anorexia, so offer a possible causal explanation, or do the distortions arise because of the anorexia?

Perfectionist personality

Fairburn et al (1999) identified perfectionism and negative self-image as the greatest risk factors in developing an eating disorder.  It seems likely that a combination of these two factors, distorted self-image and desire to be perfect are the risk factors.

Evidence

Halmi et al (2000) tested 322 anorexics on the Multidimensional Perfectionism Scale and found that they scored significantly higher than a control group.  Furthermore it was found that as levels of perfectionism increased so did the severity of the anorexia.

However, the same study reported that perfectionism of this sort tends to run in families, again providing support for the view of a genetic component.  Perhaps genes aren’t causing the anorexia directly, merely increasing the risk of developing a personality type that is a risk factor in anorexics. 

Stroeber et al (2006) investigated the cases of anorexic boys and girls being treated for eating disorders and found high levels of perfectionism in their past (73% in girls and 50% of boys).  But this study by its nature is retrospective, with the patients and presumably parents having to recall childhood events.  However, if this were the case it would suggest the perfectionism pre-dating the anorexia and provide stronger evidence for a cause and effect relationship. 

Diathesis stress

A suitable conclusion for an essay on explanations of eating disorders requires a multi-perspective approach. 

Diathesis refers to the genetic predisposition of some people to develop the disorder.  The medical model for anorexia, though generally weak, clearly suggests a genetic element to the condition.  Evidence suggests that this may however, be indirect. 

Much research has centred on the psychodynamic models which emphasises family issues.  A combination of behaviourist and cognitive seem to offer a reasonable compromise with behaviourist explaining how the pressures to be thin arise and the cognitive accounting for individual differences that pre-dispose some to eating disorders but not others. 

This behaviourist-cognitive model also offers an explanation of depression.