I mainly read “The Eating Disorder Sourcebook” (1996) by Carolyn Costin for the last two weeks. In this book, Carolyn describes the history of eating disorders, the types of eating disorders, and the internal and external factors that cause them. Meanwhile, Carolyn also lists the further treatments for eating disorders, which include professional treatment and family treatment, which includes treatment dialogue between herself and the patient.
In addition, Carolyn suffered eating disorder for a long time. So she clearly understands the feeling of being an eating disorder. Through reading, I can feel her. Her writing, full of empathy, also keeps a professional attitude. So I will document her valuable thoughts in this post.
The content with the following aspects discusses what affects eating disorders.
- Sociocultural: A look at the cultural preference for thinness, and the current epidemic of body dissatisfaction and dieting, with an emphasis not only on weight loss but also on the ability to control one’s body as a means of gaining approval, acceptance, and self-esteem.
- Psychological: The exploration of underlying psychological problems, developmental deficits, and traumatic experiences such as sexual abuse, which contribute to the development of disordered eating or exercise behaviors as coping mechanisms or adaptive functions.
- Biological: A review of the current information available on whether or not there is a genetic predisposition or biological status that is at least partly responsible for the development of an eating or activity disorder.
Chapter 4: Sociocultural Influences on Eating, Weight, and Shape
In today’s culture, thinness represents not only attractiveness but also self-sacrifice, virtue, success, and control. The pervasive attitude seems to be that the more fat one has on his or her body, the more unattractive, self-indulgent, lazy, and out of control one is.
With the slogan, “Just the Right Shape”, one wonders what is being sold, the body or the outfit? Media advertisements like these both reflect and shape our perceptions and standard of beauty.
It may be that the media pressure to diet is a major influence on the occurrence of eating disorders in otherwise vulnerable women and men.” Since the culturally prescribed body weight is so unrealistically low and since mountains of evidence show that diets don’t work (approximately 98 percent of those who lose weight gain it back), it follows that some individuals will resort to extreme measures such as starving or purging in order to deal with their dissatisfaction over their figures or sizes, striving to obtain “Just the Right Shape.”
Most ads and diet products are directed toward females, but males are no longer spared. Males are increasingly portrayed as ora-mental objects and targeted for the purchase of beauty and weight loss products, as women have been since advertising began. Is it a coincidence that the incidence of males with eating disorders is also increasing?) Still, eating disorders remain a predominantly female problem, with females accounting for approximately 90 to 95 percent of all known cases. In regard to this gender distribution, it may seem obvious, but cannot be minimized, that historically men are judged more for what they do and women for how they look. Of the many Life magazine covers that have featured women over the last fifty years, only nineteen featured women who were not actresses or models- that is, women who were not on the cover because of their beauty (Wolf 1991). Women have always been taught that their value is associated with their appearance and their bodies.
It is our society, not any particular woman’s psyche, which has brought about the undue influence that weight and shape play on self-esteem.
And now our wonderful technology can remove fat from our thighs and add it to our breasts. Plastic surgery for cosmetic reasons is being performed on children as young as twelve. It is interesting to note that although eating disorders are increasingly appearing in all cultures around the world, Westernized women seem to be at greater risk for developing them, and the degree of Westernization seems to increase the risk (Dolan 1991). Evidence suggests that anorexia and bulimia nervosa, although present, are uncommon outside the Western world and in less affluent Western countries. Furthermore, when immigrants move from less industrialized countries to more industrialized countries they are more likely to develop eating disorders.
My Though: With China's rapid economic development and increasing industrialisation, eating disorders are now becoming a common phenomenon among the Chinese population (mainly women), but due to the lack of widespread education in psychology and nutrition, as well as the lack of professional knowledge, not many people are aware of their eating disorders, which makes them ashamed of their behaviour and unable to seek help from the outside world in a timely manner. East Asian women are more introverted than their Western counterparts, and have been brought up with the social precept that they should "not express your feelings easily, and keep silent most of the time".
Women have gone through fundamental changes in their place in society, both economically and politically, and thinness has come to symbolise control, wealth, independence, and freedom. Whereas at one time, it was virtuous to abstain from sex, it has now become virtuous to abstain from food. Even thinness is no longer enough. The contemporary feminine ideal includes being thin and physically fit.
Eating disorders need to be understood within the context of the current culture, where the idea that thinness is attractive and desirable for females is so commonly accepted that it is rarely even questioned.
Starving, stuffing, and purging women are trying desperately to gain acceptance, approval, control, and love through external validation of their bodies. Eating disorders are not about food or weight but a disordered “sense of self” looking for approval and finding it, however temporarily, in the pursuit of thinness or the comfort of food.
These women are all expressing a deeper struggle than thin versus fat. In essence, they are describing a struggle for power, success, and control. The issue becomes mind over matter. We look up to people who can lose weight and keep it off even if they are unhealthy and unhappy. The ultimate power felt by anorexics is that they do without, punish their bodies, and make them obey. The increased incidence of eating disorders in certain subgroups of our population that stress these ideals along with thinness, such as ballerinas, models, gymnasts, and jockeys, lends even further credence to the cultural factor in the causes of eating disorders.
Eating disorders are highly complex and are the manifestation not only of our culture but also of various underlying struggles in the core of the personality and even the biochemistry of each individual afflicted.
Chapter 5: Eating Disorder Behaviors Are Adaptive Function
A struggling will, an insecure feeling, and despair may manifest themselves in problems with the care and feeding of the body but are fundamentally a problem with the care and feeding of the soul. In her aptly titled book The Obsession, Kim Chernin has wit ten, The body holds meaning . .. when we probe beneath the surface of our obsession with weight, we will find that a woman obsessed with her body is also obsessed with the limitations of her emotional life. Through her concern with her body, she is expressing serious concern about the state of her soul.”
What are the emotional limitations commonly seen in individuals with eating disorders? What is the state of their souls?
Common State of Being for The Eating Disordered Individual:
- Low self-esteem
- Diminished self-worth
- Belief in the thinness myth
- Need for distraction
- Dichotomous (black or white) thinking
- Feeling of emptiness
- Quest for perfection
- Desire to be special/unique
- Need to be in control
- Need for power
- Desire ffor respect and admiration
- Diffuculty expressing feeling
- Need for escape or a safe place to go
- Lack of coping skills
- Lace of trust in self and others
- Terrified of not measuring up
Eating disorder symptoms serve some purpose that goes beyond weight loss, food as comfort, or an addiction, and beyond a need to be special or in control. Eating disorder symptoms can be seen as behavioural manifestations of a disordered self, and the purpose or meaning of the behavioural symptoms can be discovered through understanding and working with this disordered self.
The development of an eating disorder can begin early in life when childhood needs and mental states are not properly responded to by caregivers and thus get disowned, repressed, and shunted off into a separate part of a person’s psyche. The child develops deficits in his or her capacities for self-cohesion and self-esteem regulation.
At some point in time, the individual learns to create a system whereby disordered eating patterns, rather than people, are used to meet needs because previous attempts with caregivers have brought about disappointment, frustration, or even abuse.
The development of an eating disorder can begin early in life when childhood needs and mental states are not properly responded to by caregivers and thus get disowned, repressed, and shunted off into a separate part of a person’s psyche. The child develops deficits in his or her capacities for self-cohesion and self-esteem regulation. At some point in time, the individual learns to create a system whereby disordered eating patterns, rather than people, are used to meet needs because previous attempts with caregivers have brought about disappointment, frustration, or even abuse.
- a distorted self-image (I am selfish, bad, stupid)
- no self-image ( I don’t deserve to be heard or seen, I don’t exist)
Adaptive Function of Eating Disorders
- Comfort, soothing, nurturance
- Numbing, sedation, distraction
- Attention, cry for help
- Discharge tension, anger, rebellion
- Predictability, structure, identity
- Self-punishment or punishment of “the body”
- Cleanse or purify self
- Create small or large body for protection/safety
- Avoidance of intimacy
- Symptoms prove “I am bad” instead of blaming others (for example, abusers)
Sexual Abuse
Although researchers have used varying definitions of sexual abuse and methodologies in their studies, the above figures show that sexual trauma or abuse in childhood is a risk factor for developing eating disorders. Furthermore, clinicians nationwide have experienced countless women who describe and interpret their eating disorders as connected to early sexual abuse. Anorexics have described starvation and weight loss as trying to avoid sexual alit and thus evade or escape sexual drive, feelings, or potential perpetrators. Bulimics have described their symptoms as a way of purging the perpetrator, raging at the violator or oneself, and getting rid of the filth or dirtiness inside of them. Binge eaters have suggested that overeating numbs their feelings, distracts them from other bodily sensations, and results in weight gain that “armours” them and keeps them unattractive to potential sexual partners or perpetrators.
Chapter 7: Assessing The Sotuation
Checklist of Observable and Nonobervable Sighs of an Eating Disorder
Chapter 8 :Guidelines for Significant Others
Friends and Family members are often the forgotten victim of eating disorders.
- Pick a time and place where there will be no interruptions and no need to hurry
- Be empathetic and Understanding
- Express your concern about what you have observed and speak from your own experience
- Provide information about resources for treatment
- Do not argue oof get into a power struggle
- Accept your limitaions
Recovery from anorexia and bulimia takes approximately four-and-a-half to six-and-a-half years.
Chapter 9: Treatment Philosophy and Approaches
Three main philosophical approaches to the treatment of eating disorders.
- Psychodynamic
- Cognitive behavioural
- Disease/ addiction