Eating Disorder Week Notes
Eating Disorder Week Notes PSYC 2250
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This 13 page Bundle was uploaded by AmberNicole on Saturday September 17, 2016. The Bundle belongs to PSYC 2250 at East Carolina University taught by Dr. Greg Neimeyet in Fall 2016. Since its upload, it has received 29 views. For similar materials see Eating Disorders in Psychology at East Carolina University.
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Date Created: 09/17/16
Cut to the Bone: The Influence of the Media and Cultural Attitudes on Eating Disorders Media actually is the overall way of which communication is spread Media is omnipresent Understood broadly Exposure is pervasive Most research is correlational (not causal) Illusory correlation: meaningless relationship; no actual cause between relationship Interchangeable with each other o A could cause B (depression could cause a poor GPA) o B could cause A (poor GPA causes depression) Another factor causes changes in both A and B o Getting a raise so spending more, therefore being more happy Correlation is association between two or more variables o Positive correlation (+1.0) o Negative (inverse) correlation (-1.0) o No correlation (0) Most research is correlational not causal The Media By 1991, 99% of Americans owned at least 1 television 65% had more than 1 television The average household spent 7 hours per day watching t.v. (49 hours per week) 72% owned a VCR to watch shows at their convenience – this is additional to the 7 hours of television per day. The average American sees 1500-1800 advertisements a day Jean Kilbourne in 1994 did media research on television and found individuals were exposed to 3,000 advertisements per day and in 2000 they now see 1500-1800 per day. Children and Television Children ages 2-5 watch an average of 28 hours per week of television (4 hours per day) Teens watch an average of 22 hours per week of television By adolescence, children will have seen over 150,000 commercials Research links the quantity of children's t.v. consumption with the strength of their gender stereotypes (the more t.v., the more traditional the stereotypes) o The more people watching t.v. the more traditional the stereotypes are o Clear link between attractiveness and success starts very early in life Children and Body Image 1986 Huon and Brown study showed that 80% of 10 year old girls in the sample were currently dieting 50% feared becoming fat or engaged in binge-eating 75% girls weighed themselves frequently compared to 41% of the boys 53% of the girls reported a desired weight of less than 10% of their expected norm compared to 13% of the boys The Thin-Ideal The average model weighs 23%-25% less than the average American woman Longitudinal Wiseman et al.'s 1992 study showed that between 1979 and 1988, 69% of Miss America contestants met weight criteria for anorexia Women's bodies in the media have become increasingly thinner over time Winners are far more below average than women who did not win Renaissance ideal had bigger women because people who were bigger were better fed showing money In 40s-50s Marilyn Monroe was plump and that was the ideal woman Anti-Fat Attitudes Not only is being thin equated with a multitude of positive characteristics (I.e., beautiful, popular, lovable, sexy, successful), but being overweight is associated with negative characteristics (I.e., ugly, lazy, not attractive to opposite sex, stupid, socially unpopular) Therefore, there are two distinct social pressures operating to influence people to be thing o Good pressure: thin o Bad pressure: fat Americans tend to have a "Self-made Man" or Protestant work ethnic perspective and tend to believe that overweight people are at fault for their weight, not genetics Study: over ½ of 18-25 year old women would rather get run over by a truck than be fat o 2/3 would choose to be stupid or mean than fat Children as young as 5 express anti-fat attitudes Overweight women (not men) earn $6,170 per lear less than average weight women and have higher rates of household poverty Study: 17% doctors said that they would not perform a pelvic exam on a fat patient, 83% of doctors would be reluctant to perform it Overweight people are less likely to be accepted into elite colleges, even when they have identical credentials as average weight people Overweight women are 20% less likely to be married than average weight or thin women Study: Most college students would rather marry an embezzler, drug user, or shop-lifter than marry an overweight person Study: 11% of parents would abort a fetus that was genetically programmed to be overweight A person's weight affects: evaluations from teachers, admissions to college, personnel decisions, landlord decisions about tenants, and assessments conducted by mental health and medical personnel The Impact on Women 80% of American females have dieted by 18 Study: 70% of young women in U.S. and England thought they were overweight even though they were normal weight Study: 55% of college women thought that they were overweight, though only 6% were Up to 2/3 of women feel dissatisfaction with some part of their bodies 39% expressed moderate to strong negative feelings about their body as a whole, 44% more about some body part 94% strongly desired to be smaller in size 96% felt that they were larger than the current societal ideal Women often perceive discrepancies between their current weight and what they perceive as attractive, attractive to the opposite sex, and what they personally want to weigh (ideal) In other words, women (but not men) tend to believe that they are heavier than what is considered to be attractive and express a desire to weigh less than their current weight Silencing-the-self theory Self-silencing theory was proposed by Dana Crowley Jack (1991) Women are socialized to find a great deal of their worth and identity in external attributes such as their ability to create and maintain relationships (especially romantic ones) and their appearance Because so much of women's identity is tied to finding a mate, they feel more pressure than men to act and appear in ways that are attractive to the opposite sex (including downplaying parts of them to be more attractive) 4 components o Silencing the self: suppressing their own needs and wants to avoid creating conflict and possibly losing the relationship o Externalized self-perception: seeing themselves as others see them (self-objectifying) o The divided self: outwardly conforming to gender stereotypes, but inwardly becoming angry and hostile at how they look o Care as self-sacrifice: believing that in order to show caring, they need to sacrifice their own needs/wants - put other people first There are many parallels between self-silencing and those with eating disorders: having a strong desire to please others, ignoring or suppressing their needs and wants, having greatly difficulty expressing negative emotion, fearing conflict, objectifying themselves, and often having unexpressed anger Studies by UF psychology graduate students directly link self-silencing and eating-disordered attitudes and behaviors Higher Media exposure studies: media consumption directly linked to Lower self-esteem Frustration with weight Weighing themselves 1+ times a week Exercising only to lose weight Feeling guilty during and after eating Preoccupation with desire to be thinner Fear of becoming fat ** Predicted eating disorder symptoms Sexist ads and body image Laven et al looking at sex differences in ads: Women exposed to sexist ads judged their current body size as larger than the societal ideal and expressed a desire for a thinner body Men exposed to sexist ads judged their current body size as smaller than the ideal and expressed a preference for a larger body Feminists and non-feminists were equally affected Both men and women rated the sexist ads less favorably than the nonsexist ads Cultural Attitudes As a culture, we are becoming more body and weight conscious – the number of weight-loss and exercise ads have increased dramatically over the past decade There are an increasing number of products geared toward women for "preserving" appearance (anti-aging) Women tend to engage in "fat talk" when in groups: talking about fat, calories, exercise, and their bodies: reinforcing the normacy of talking about and being worried about being fat This "fat talk" normalizes obsessing over appearance Men are engaging in more carb and bodybuilding talk New trends in fashion for women – the tighter and lower, the better Clothing that shows more of the body increases one's awareness of one's own body weight/shape and increases comparisons with others Society tends to emphasize external attributes for women (appearance, relationships), and more internal for men (intelligence, talent) There are more muscular male icons in the media There are more exercise and diet commercials on TV Control how you eat and how you feel – media Barbie and Ken study Yale Study: the average woman who wants to look like Barbie has to grow 2 feet taller, gain 5 inches in her chest, lose 6 inches in her waist, and lengthen her neck by slightly more than 3 inches If Barbie were real, she'd be over 7 feet tall and have a 40" bust, 22" waist, and 36" hips The average man who wants to look like Ken has to grow 20 inches taller, increase his chest by 11 inches, and increase his neck circumference by about 8 inches and this is a lot better than superheroes and action figures Toxic food environment Fast-food nation: there is more and more fast food that is cheap and readily available Conflicting media messages: thin people shown eating fast food on T.V. Fast food ads placed next to diet ads in magazines Eating Disorders Chapter 5: Body Image, Dieting, and Eating Disorders: Is the Media to Blame? Cultural context shapes beliefs and values, and beliefs and values influence behaviors Cultural values can be communicated by families, religions, schools, and, in modern Western culture, the media A recent study examined the influence of Western television on the beliefs, values, and behaviors of adolescent girls in Fiji o Girls reported low levels of body dissatisfaction, dieting, or purging and low endorsement of the importance of being thin o Consistent with a cultural context that celebrated feeding as an expression of familial care o In Fijian culture, thinness has been associated with lacking love and the care of family o New cohort of adolescent Fijian girls endorsed a desire to be thin This study provides strong evidence that the exportation of Western culture values may be accompanied by the exportation of Western psychiatric conditions Provides strong evidence for the role of cultural factors in the emergence of eating pathology Cultural ideal of thinness The desire for a thinner body leads to dieting o If dieting leads to significant and medically dangerous weight loss, then AN has developed o If dieting leads to binge eating, purging may emerge in an effor to avoid weight gain, and then BN has developed o Media play a causal role in the development of body image disturbance – a core feature of eating disorders as defined by the DSM o Alarming ideal for feminine beauty considering that weighing less than 85% of that expected for height is the threshold at which AN might be diagnosed Why is thin beautiful? Joan Jacobs Brumber (1989) noted an association between thinness as an aesthetic ideal and periods in which women are encouraged to adopt responsibilities outside of the home and beyond their roles as wives and mothers The ideal of feminine beauty during the Great Depression was thing (e.g., Katherine Hepburn) Next phase of the revolution for women's independence came during the 1960's with the development of birth control pills, the sexual revolution, and the emergence of the feminist movement This theory explains the slight U shape in the curve of rates of AN Lowest rates of AN were observed in 1950-1954, not 1934-1939 Financial prosperity following the Industrial Revolution led to an abundance of food that disrupted the traditional positive correlation between wealth and weight This theory may explain the increased prevalence of eating disorders (particularly BN) in industrialized compared to non industrialized nations and why rates of eating pathology increase as cultures become more Westernized Kilbourn (1987) has argued that a consumer-driven economy requires the constant invigoration of buying By establishing an unattainable ideal, a constant market for products is created According to Kilbourn (1987), the presence of body dissatisfaction in the majority of adolescent girls and young adult women is a necessary evil to turn those same women into good consumers Why thin is beautiful emerges from the health risks associated with obesity The extent to which overweight is denigration appears to go far beyond concerns about the health consequences associated with overweight and may reflect an elaboration of the idealization of thinness- the denigration of fatness A comparison of action figures for GI Joe and characters from the Star Wars movies revealed significant increases in the chest-to-waist ratio This line of investigation suggests that the media may play a more proactive role in the conception of aesthetic ideals because it is difficult to believe that preadolescent boys would refuse to purchase action toys on the basis of normal waist-to-hip ratios Societal denigration of overweight/obesity In addition to valuing thinness, Western culture denigrates fatness The belief that people can control their weight contributes to a tendency to blame overweight individuals for being overweight Longitudinal research suggests that the association between obesity and socioeconomic status may be attributable to an anti fat bias and discrimination against individuals o It is also possible that being overweight contributes to lower socioeconomic status and that lower socioeconomic status contributes to the risk of obesity Anti fat prejudice can be found in children as young as 5 years of age Body Image Cash and Deagle (1997) have characterized body image as comprising facets of perception, cognition, and affect o Perception involves both seeing and feeling bodily dimensions such as weight and shape Perceptual disturbance is included as a possible symptom of AN but not BN even though perceptual disturbances have not been found to differ between the two disorders o Cognition involves evaluations and thoughts related to body size Women with BN report greater body dissatisfaction compared to women with AN The undue influence of weight and shape on self-evaluation is included as a possible symptom for AN and as a required symptom for BN o Effect involves emotions related to weight or shape Tiggemann and Pickering (1996) found a significant association between body dissatisfaction and time spent watching music videos, soap operas, and movies among adolescent girls o One possible explanation for the difference in findings is differences in the age of the participants o This study found that measures of awareness of the societal ideal of thinness and internalization of this ideal were significantly associated with disordered eating attitudes and behaviors A drawback of these correlational studies is their inability to determine the direction of association between media images and body dissatisfaction Experimental studies in which participants can be randomly assigned to media images and body dissatisfaction Joiner (1999) stated disorders and body image influence perceptions of societal messages and stated that individuals with BN may seek confirming evidence that their bodies are unacceptable College women selected photographs of heavy celebrities showing heavier than actual bodies Dieting Percentage of college students desiring weight loss exceeds the percentage describing themselves as overweight The physiology of weight control is a balance between energy intake (eating) and energy expenditure (resting metabolic rate + activity level) Across different weight loss programs, initial weight loss appears to be attainable but maintaining the weight loss is much more difficult Decreased BMR was associated with slowed pulse, decreased respiration, lowered blood pressure, and decreased temperature, among other physical changes (all noted physiological consequences of AN) Set-point theory emerged to explain why organisms resist weight change o Our bodies have evolved weight-defending mechanisms in order to withstand periods of famine An association between dieting and disordered eating attitudes and behaviors has been demonstrated in prospective longitudinal studies Girls who dieted were eight times more likely to develop an eating disorder than girls who were not drinking Presnell and Stice (2003) found that individuals placed on diets lost weight in conjunction with a decrease in bulimic symptoms Lowe and colleagues (1998( found that greater dietary restraint was associated with lower rates of binge eating among patients with BN Women with ANR demonstrate high levels of dietary restraint without experiencing binge- eating episodes Conclusion The increasing idealization of thinness provides one explanation for the increasing rates of eating disorders in Western cultures in the second half of the 20 century Evidence of AN outside of the modern cult of thinness, suggesting that this explanation may be less relevant for AN than for BN Evidence that in a small but reliable percentage of women with BN, binge eating precedes the first diet Extent that the thin ideal has led to body dissatisfaction and attempts at weight loss in a majority of American women, eating disorders affect only a very small minority Cultural ideals provide an important part of the explanation for the emergence of eating disorders, but they are only part of the picture Eating Disorders Review March/April 2014, Volume 25, Issue 2 Scott Crow, Editor-in-Chief Highlights from the 2014 iaedp Symposium Talked about well known treatment models, including Structural, Systematic, Maudsley and FBT Behavioral family therapy adolescent patients had lower treatment dropout rates, lower rates of relapse, and patient and parent satisfaction with treatment was good Overall, FBT was superior to comparison interventions at the end of therapy and follow up Four positive predictors for successful FBT o Younger teens (15 years or younger) o Shorter duration of illness (less than 13 months) o Mild to moderate weight loss (89% of ideal body weight, or IBW) o Parental expressions of warmth Negative predictors for FBT o History of low weight (<80% of IBW) o Older teens with a longer duration of illness and psychiatric comorbidity o High levels of parental criticism and patients' failure to increase their weight by about 3% shortly after the beginning of therapy o Patients with obsessive compulsive disorder and those from non-intact families need more treatment Eating disorders pose challenging legal and ethical issues Clinicians treating clients with eating disoders must deal with unique legal and ethical issues surrounding confidentiality, informed consent, protection of medical records, and multiple relationships with other medical professionals Some practice pointers for inter-professional relationship ethics include: obtaining releases for all procedures, contacting each department to obtain records, discussing the diagnostic impression, and developing a treatment plan Dr. Dolores also touched upon the Omnibus Rule involving the Health Insurance Portability and Accountability Act (HIPAA) and the Code of Federal Regulations (CRF) 42 CFR, for Substance Abuse and Confidentiality o The Omnibus Rule, which went into effect in late September 2013, prohibits selling patient health information unless authorized, expands reporting duties, and allows stricter penalties for violating patient confidentiality Important to use an evidence based approach for informed consent Process of terminating treatment is a challenging area Abandonment occurs when needed treatment is inappropriately halted Eating disorders, self-harm, and trauma When a patient has an eating disorder combined with a history of trauma and self-harm, clinicians have to work with the "darker side" of a patient's profile, including dissociation, intense self-loathing, anger, and hatred Key is to use a treatment approach that is both flexible yet structured enough to guide cliical decision making because it will be necessary to treat both the eating disorder behaviors and the darker and more challenging emotional states Structural Process Model empowers such patients to learn ways to take control and to eventually discover their own healthy power and control Empowerment is not something the therapist does to the patient; instead, it is the result of repeatedly observed, discussed, and enacted interactions that lead to the patient discovering his or her own power and capabilities o In this way the patient becomes the "expert" in his or her recovery The focus is also on the role emotions may be playing because emotions directly or indirectly impact our relationship with ourselves, our environment, and with others Therapy also is focused on helping patients learn to self-regulate and to use self-care Update: Changes Needed in Treatment of Patients with Eating Disorders and Substance Use Disorders Most publically and privately funded substance abuse treatment facilities neither provide nor include multidisciplinary evidence-based treatment for patients with eating disorders Integrated treatment is similarly lacking in eating disorders inpatient, residential, partial hospitalizations and intensive outpatient programs Integrated treatment is necessary to combat the high rates of comorbidity in these patients Avoidant/Restrictive Food Intake Disorder (ARFID) This new DSM-5 category involves younger, significantly underweight patients who are distinctly different from those with AN and BN Adults with AFRID lose weight; younger children may not lose weight but can't gain weight and may not grow as expected The problems caused by ARFID go far beyond issues with food (extends to social) Excessive Consumption of Diet Soda and Eating Disorders Consumption is particularly high among bulimic patients Americans drink 4 billion gallons of diet soda a year and many studies are now underway to investigate possible unhealthy side effects of these diet drinks Possible elevated risk of bone loss, fractures, and dental caries, and the possibility that the drinks' phosphate and artificial sweeteners and coloring may exacerbate preexisting conditions Individuals with eating disorders are among the groups that drink the most diet soda per day Three possible explanations for excessive intake of diet soda among persons with eating disorders are increased appetitive drive, increased concern about gaining weight, and overvaluation of weight and shape The Bulimia scale on the EDI reflects the behavioral portion of appetitive drive, or tendency toward over consumption of food Those with eating disorders drank more diet soda than did controls Individuals with a lifetime eating disorder, specifically those with BN, consumed more diet soda per day than did controls Individuals with BN drank an average of 6.9 cans of diet soda per day Symptoms associated with appetitive drive or weight concerns were associated with increased intake of diet soda; fear of gaining weight or becoming fat had a medium-sized effect Patients with BN may use diet sodas as a way to satiate their appetite drive or to "fill up" without adding calories A combination of high appetitive drive and high weight concern among patients with BN may indeed underlie excessive consumption of diet sodas Offsprings BMI is related to parental eating behavior Data from participants in the Quebec Family Study showed two key risk factors o Obesity, usually defined as body mass index (BMI) greater than 30 kg/m22, affects 600 million adults and from 40 to 50 million children around the world o BMIs of older offspring could be traced to family environmental factors, such as parental eating behaviors Such changing such factors may help prevent transmission of obesity within families Parental eating behavior traits, especially rigid control and disinhibition, are associated with the BMIs of A offispring and mediate the relationship between parents and offsprings' BMI Relationship was examined both in offspring living at home and outside the home Rigid control by parents and disinhibition, but not hunger scores, were positively related to offsprings' BMI after controlling for the ages of the children, sex and physical activity, parental BMI, parent age, and gender and number of offspring per family Rigid control is actually a "pseudo control" because it is not planned effectively "and takes an all or nothing approach to eating that leaves little room for versatility Authors hypothesize that simultaneous high rigid control and high disinhibition lead parents to alternate between "strict self regulated eating" and periods of overeating Parents displaying rigid control and disinhibition have the heaviest offspring, independent of parental weight, and that these very traits are impactful in older offspring Assessment of unhealthy eating behavior traits, specifically rigid control and disinhibition in families, may be important for prevention and treatment of childhood obesity may be reduced Some facts about obesity in the US By state, obesity prevalence ranged from 20.5% in Colorado to 34.7% in Louisiana in 2012 o No state had a prevalence of obesity less than 20% o Nine states and the District of Columbia had obesity prevalence rates between 20%-25% o Thirteen states (Alabama, Arkansas, Indiana, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia) had an obesity prevalence rate equal to or greater than 30% Higher prevalence of adult obesity were found in the Midwest (29.5%) and the South (29.4%) Lower prevalences were observed in the Northeast (25.3%) and the West (25.1%)- CDC Taking stock of care for eating disorder patients in Canada Budgetary restraints limit day treatment, and the average waiting time to be seen is 6.5 weeks Treatment practices differ and program structures throughout Canada differ, and there still is no consensus on best practices for medical and/or psychological treatment of adolescents with severe eating disorders The questionnaire responses showed that all 11 programs treat patients with AN, BN, and eating disorders not otherwise specified (EDNOS), all offer inpatient and outpatient treatment, and all use a multidisciplinary, team-based approach to treating adolescents with eating disorders Family-based therapy, CBT, are most commonly offered Most use family based therapy or formalized family-based therapy for patients with AN Other approaches include cognitive behavioral therapy, readiness motivational models, narrative therapy, interpersonal and psychodynamic approaches, and multi-family therapy Areas of improvement Disordered eating behaviors identified in adults with celiac disease Disordered eating behaviors were more common among those with untreated celiac disease Used case control study to investigate a possible relationship between emotional-psychological factors in untreated celiac disease and the presence of an eating disorder Lower BMI's, higher EAT-26 scores o Patients with celiac disease had significantly lower BMIs and more frequent gastrointestinal symptoms than did the healthy controls Findings may support the hypothesis that high gluten intake occurs before the onset of celiac disease among persons who are genetically predisposed to the disease Results of this study reinforce the importance of testing for disordered eating in people with celiac disease Students of dietetics and nutrition: at increased risk of eating disorders? A Portuguese study found one area of concern Students of dietetics and nutrition may be particularly vulnerable to developing eating disorders Observational cross-sectional study to assess eating behavior, food habits and physical activity among three groups of women Concern about body weight An upswing in eating disorders is noted in Great Britain Some important implications for provision of health care Eating disorders not otherwise specified (EDNOS) was the most common eating disorder in males and females, and there was a significant increase in the incidence of eating disorders in both males and females during that decade Used data from the General Practice Research Database (GPRD), a large ananymous medical general practice database Incidence was age specific, and the incidience of AN, BN, and EDNOS was highest in girls aged 15-19 In nearly ¼ of these girls, the onset of AN occurred between 15 and 19 years of age The authors estimated that in Great Britain, 2 of 1,000 girls between 15 and 19 years of age were likely to be newly diagnosed with an eating disorders Among females 10 to 49 years old, EDNOS was the most common diagnosis Predicting recovery from an eating disorder Helpful clues may lie in measures of temperament Outcome is primarily assessed in physical and behavioral domains, while emotional and cognitive symptoms are often not taken into account Many original diagnoses changed by the end of follow-up o By the end of the study, a high percentage of the patients had migrated from their original diagnosis to a diagnosis of EDNOS What increases the risk of eating disorders in male athletes? Participants in weight-class sports had the highest rate of eating disorders For some elite athletes, disordered eating behavior helps lose and then maintain lower weights Ratio of men to women with eating disorders can reach 1:4 in the general population and 1:2 among athletes More than a fourth had disordered eating behaviors Athletes with a higher percentage of body fat were more likely to be dissatisfied with their body image, but there was no difference in eating behavior and body image between athletes from different sports categories
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