Readings

Wenar, C. & Kerig, P. (2000) Wenar, C. & Kerig, P. (2000) “Psychopathologies of the adolescent “Psychopathologies of the adolescent transition” in C. Wenar and P.Kerig transition” in C. Wenar and P.Kerig Developmental Psychopathology.Developmental Psychopathology. Singapore: McGraw-HillSingapore: McGraw-Hill

Lecture Questions

What are the features and effects of What are the features and effects of anorexia?anorexia?

Why are some of the DSM criteria Why are some of the DSM criteria problematic?problematic?

Why are adolescent girls vulnerable to Why are adolescent girls vulnerable to developing anorexia?developing anorexia?

How might social values relating to How might social values relating to femininity and sexuality influence the femininity and sexuality influence the prevalence of anorexia in Western societies?prevalence of anorexia in Western societies?

I’m here to write my sob story. I went to see Dr Burnett today. Everything went fine. My eating is a chaotic mess. All I eat is chocolate, chips, biscuits, cereal and that is all. Tomorrow I’m going on a fast for two days. I’m allowed five sips of tea. I’ve just taken some Senakot laxatives. I feel god-awful. I’m going to raise my exercise as well.

Extract from Sasha Picks: Skin and Bones

Anorexia- formally recognised 1870sAnorexia- formally recognised 1870s

Late 1970s still seen as rareLate 1970s still seen as rare

Hilde Bruch- The Golden Cage, 1978Hilde Bruch- The Golden Cage, 1978

THE psychiatric disorder of the 1980sTHE psychiatric disorder of the 1980s

No sign of abatement 1990s- nowNo sign of abatement 1990s- now

Bulimia- first diagnosed Bulimia- first diagnosed

< 25 years ago< 25 years ago

Eating Disorders:History

Prevalence

Prior to 1980s relatively rarePrior to 1980s relatively rare Estimates vary along with methodology- NZ Estimates vary along with methodology- NZ

epidemiology (anorexia) 3 women per 1000 epidemiology (anorexia) 3 women per 1000 50 year retrospective study (50 year retrospective study (Lucas, Beard, O’Fallon & Lucas, Beard, O’Fallon &

Kurland) Kurland) : 25.7/100 000 females, 3.7/100 000 males, : 25.7/100 000 females, 3.7/100 000 males, 15-19 69.4/100 000 females, 7.3/100 000 males15-19 69.4/100 000 females, 7.3/100 000 males

Bulimia- 1.2% to 16% among high school Bulimia- 1.2% to 16% among high school females, .79 to 19% university students: NZ, 1 in females, .79 to 19% university students: NZ, 1 in 20 18-2420 18-24

Gender,age & culture

Age of greatest risk 15-19Age of greatest risk 15-19 Increasing number of pre-adolescent girlsIncreasing number of pre-adolescent girls Gender ratio estimates of 9:1 across Western Gender ratio estimates of 9:1 across Western

culturescultures A problem of the Western world- as influence A problem of the Western world- as influence

spreads to other cultures, rise in rates of eating spreads to other cultures, rise in rates of eating disordersdisorders

In NZ- Eating Disorders Service, Auckland- 1 in 5 In NZ- Eating Disorders Service, Auckland- 1 in 5 Maori or Pacific Nations, 3 in 5 EuropeanMaori or Pacific Nations, 3 in 5 European

Wellington- higher SES tertiary students, higher Wellington- higher SES tertiary students, higher rate of bulimia than general communityrate of bulimia than general community

DSM Criteria Refusal to maintain body weight at or above a Refusal to maintain body weight at or above a

minimally normal weight for age and height (<85% minimally normal weight for age and height (<85% expected)expected)

Intense fear of gaining weight or becoming fat even Intense fear of gaining weight or becoming fat even though underweightthough underweight

Disturbed evaluation of body weight and shape, undue Disturbed evaluation of body weight and shape, undue influence of body weight or shape on self-evaluation, influence of body weight or shape on self-evaluation, denial of seriousness of current low body weightdenial of seriousness of current low body weight

Menstruation cessationMenstruation cessation Restricting (no binge-ing, purging) type or Binge Restricting (no binge-ing, purging) type or Binge

eating/purging typeeating/purging type

Other eating disorders

Likely to be substantial increase in prevalence if Likely to be substantial increase in prevalence if take into account eating disorders that have some take into account eating disorders that have some but not all of the features listed in DSM or ICD but not all of the features listed in DSM or ICD criteria (called Eating Disorders Not Otherwise criteria (called Eating Disorders Not Otherwise Specified (EDNOS) in DSM IV)Specified (EDNOS) in DSM IV)

Clinical population studies unlikely to tap EDNOS Clinical population studies unlikely to tap EDNOS figures because must meet DSM criteria to access figures because must meet DSM criteria to access mental health/eating disorders servicesmental health/eating disorders services

Challenges to Body Image Distortion

Historically- faulty brain functioning, defective Historically- faulty brain functioning, defective processingprocessing

Research- 95% of women Research- 95% of women

overestimate body size asoverestimate body size as

25% bigger than it is25% bigger than it is Do 95% of women have a Do 95% of women have a

perceptual defect?perceptual defect?

‘‘Undue influence of body weight or shape on self Undue influence of body weight or shape on self evaluation’evaluation’

Prognosis

Contradictory research dataContradictory research data Strober, Freeman & Morrell, 1997- 86% Strober, Freeman & Morrell, 1997- 86%

good outcome over 10-15 years, 76% when good outcome over 10-15 years, 76% when well-being measuredwell-being measured

Other studies- 32-68%Other studies- 32-68% Recovery is slowRecovery is slow Highest mortality rate of any Highest mortality rate of any

psychiatric disorder- APA 20%psychiatric disorder- APA 20%

Bodily Effects

Anorexia ravages the physicalAnorexia ravages the physical

body as a consequence of body as a consequence of starvation and laxative abuse:starvation and laxative abuse:

Hair falls outHair falls out Brittle nailsBrittle nails Growth of fine body hair (lanugo)Growth of fine body hair (lanugo) Loss of bone massLoss of bone mass Dry flaky skinDry flaky skin

Psychological Effects

Depression common Depression common Low self-esteemLow self-esteem Feelings of worthlessnessFeelings of worthlessness Self-injurious behavioursSelf-injurious behaviours Drug abuseDrug abuse Suicidal thoughts and Suicidal thoughts and

attemptsattempts

Medical effects:

Blood pressureBlood pressure Starvation effects- anaemia, hyperthermiaStarvation effects- anaemia, hyperthermia Kidney failureKidney failure Erosion of dental enamel (purging)Erosion of dental enamel (purging)

Social Effects

Withdrawal from peersWithdrawal from peers Increasing isolationIncreasing isolation Deterioration in familyDeterioration in family

relationshipsrelationships

Adolescent girls’ vulnerability

Gender-new meaningsGender-new meanings Bodies- the fat spurtBodies- the fat spurt

-1992 NZ survey-1992 NZ survey Sexuality- attractivenessSexuality- attractiveness

-Measuring up to Barbie-Measuring up to Barbie Self-awareness & Self-awareness &

self judgementself judgement

Factors in the adolescent girl Genetic factors- weakGenetic factors- weak Loss of control- body changes-pubertyLoss of control- body changes-puberty -changes in expectations-changes in expectations -increase in stressors-increase in stressors Self-esteem- link with physical appearanceSelf-esteem- link with physical appearance -developmental (Gilligan)-developmental (Gilligan) Personality traits- perfectionism, obssessionalityPersonality traits- perfectionism, obssessionality Chronic illness or serious acute illnessChronic illness or serious acute illness Conflict about autonomy and dependenceConflict about autonomy and dependence

Factors in the adolescent girlDietingDieting Normative practiceNormative practice Girls as young as 8 aware and Girls as young as 8 aware and

engage in (Hill & Pallin, 1998)engage in (Hill & Pallin, 1998) Patton et al. (1999)- 14-15 year Patton et al. (1999)- 14-15 year

olds severe dieting 18x>likely, olds severe dieting 18x>likely, moderate 5x>likely to develop moderate 5x>likely to develop an eating disorderan eating disorder

NZ survey 54% girls dieted, NZ survey 54% girls dieted, 33% binges, 12% vomited to 33% binges, 12% vomited to lose weight by age 15lose weight by age 15

Body dissatisfaction strongest Body dissatisfaction strongest predictor, normative in girls and womenpredictor, normative in girls and women

Factors in the family

Family history- eating disorders, mood Family history- eating disorders, mood disorders, substance abusedisorders, substance abuse

Food oriented family culture, dieting motherFood oriented family culture, dieting mother Sexual abuse/family traumaSexual abuse/family trauma Family factors clouded by Family factors clouded by

what is risk and what is what is risk and what is effect and by effect and by unsubstantiated theoriesunsubstantiated theories

Factors in school

Peers- teasing, importance placed on weight and Peers- teasing, importance placed on weight and eating, dieting friends (Taylor et al., 1998)eating, dieting friends (Taylor et al., 1998)

Participation in activity that demandsParticipation in activity that demands a thin body a thin body

Sociocultural factors

Western constructions of idealised Western constructions of idealised femininity and heterosexuality femininity and heterosexuality (Wolf, The Beauty Myth)(Wolf, The Beauty Myth)