Eating disorders such as anorexia nervosa and bulimia often provide individuals with a sense of purpose; as if they are on a mission to remake themselves and finally become happy. People suffering from an eating disorder may have that inner voice telling them they will be happy if they can just lose the weight. This same voice tells a person with anorexia or bulimia that their worth is primarily measured by how they physically look. (more…)
Social media is a popular tool for communication and entertainment. Few people would question the fact that people are spending an increasing amount of time on these new media platforms. In recent years, social media has become much more visual in presentation and layout. However, it is the evolution of the technology used to manipulate and alter images that have researchers concerned. (more…)
When the term eating disorder is mentioned, there is usually a specific mental image that comes to mind. Traditionally, the stereotypical person with this type of mental health issue is a young, wealthier Caucasian female. Mass media and pop culture images usually reinforce the portrayal of hyper-thin, white women who are suffering from the effects of conditions like anorexia nervosa. However, this stereotype that eating disorders only inflect younger, white women is not correct.
Eating disorders are usually placed into four overall categories: anorexia nervosa, bulimia nervosa, binge eating disorder and Other Specified Feeding or Eating Disorder (OSFED). Other mental health issues are also commonly assisted with these eating disorders such as general anxiety, Post-Traumatic Stress Disorder (PTSD), depression, bipolar disorder and Obsessive-Compulsive Disorder (OCD).
The American Psychiatric Association defines an eating disorder as an illness where people experience severe disturbances in their eating behaviors. They also have problems related to the regulation of thoughts and emotions, usually becoming obsessed with food consumption and their body weight. The prevalence of reported eating disorders, with the exception of anorexia nervosa, is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asian Americans in the United States.
Decades ago, American societal portrayals of eating disorders were almost always shown as a white-woman problem. Shockingly, this misconception was also maintained by physicians and other healthcare professionals.
For example, behavioral health research from 2006 challenged the notion that African-American women were less likely to develop eating disorders. In this study, healthcare providers read 1 of 3 passages describing disturbed eating patterns of a fictional patient named Mary. The only differences between the passages were that the patient’s race, which was randomly changed for each provider. This meant that every fictional patient’s symptoms were identical, with only the person’s race randomly rotating between African-American, Caucasian, or Hispanic.
Healthcare professionals were then asked to diagnosis the patient’s level of depression, anxiety as well as whether an eating disorder might exist. In cases of a white racial profile, the eating behavior was considered problematic 44% of the time. For Hispanic profiles, the behavior was considered problematic in 41% of the cases. Surprisingly, when the patient was identified as African American, the eating behavior was identified as problematic in only 17% of the cases. The study’s final results suggested that healthcare clinicians appear to hold race-based stereotypes about eating disorders that could limit their detection of symptoms in African-American girls.
The results of the 2006 study reinforced earlier research from 2002 which found that the race of adolescent girls had a significant impact on the detection of disturbed eating patterns. In this study, undergraduate college students recognized the existence of an eating disorder more often when they read about a Caucasian female, rather than when they read about a minority female (Hispanic or African American) with the same behavior.
National statistics indicate that eating disorders predominantly occur in white females, but many eating disorder professionals increasingly believe that the data is skewed. Women of color have likely been alienated from personal support networks. In addition, healthcare professionals use to believe that African-American and Hispanic women were somehow more immune to eating disorders.
Until recently, people with an African American racial identify were underrepresented in treatment centers and research studies about eating disorders. Gathering quality data was more of a challenge due to societal misperceptions and prejudice. Now it is clear that perceptions of body image and disordered eating patterns are not just problems for young, white women.
Here is some additional information on eating disorders and minorities:
- Individuals of Hispanic descent were more likely to suffer from bulimia nervosa versus their non-Hispanic peers.
- Studies and news reports have found elevated rates of anorexia and other eating disorders among teenage girls in Orthodox Jewish communities.
- People of color with self-acknowledged eating and weight concerns were less likely than white participants to have been asked by healthcare providers about eating disorder symptoms, despite similar rates of eating disorder symptoms across ethnic groups.
- For American Indian/Native American, a significantly higher percentage of women reported disordered eating behaviors.
It is clear that eating disorders do not only occur in certain racial or socioeconomic groups. Race, ethnicity and/or socioeconomic status does not make individuals immune to these health conditions. In the past, eating disorders were primarily associated with heterosexual, young, white females. In fact, these mental health issues affect people from all demographics and ethnicities at similar rates. However, minority groups (particularly African Americans) are significantly less likely to receive help for eating disorder problems.
Regardless of one’s racial or ethnic identity, treating and recovering from an eating disorder takes time as well as professional help. An experienced mental health professional can help a person understand the origins of this behavior, whether it is an eating disorder as well as acquire coping skills.
For additional information or questions about this topic, please contact the staff at River Centre Clinic (RCC). Their Eating Disorders Programs provide a full range of treatment options for both adolescents and adults. The River Centre Clinic’s main phone number is 1.877.212.5457.
The EAT-26 is the most widely cited standardized self-report screening measure that may be able to help you determine if you have an eating disorder that needs professional attention. Take the EAT-26 now and get immediate and anonymous feedback.
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Eating Disorders, Minorities
Contributor: ABCS RCM
The topic of girls and women’s perception of their bodies, as well as how this topic is portrayed by the society, has long been a subject of discussion. An individual’s perception of her (or his) body has long played a critical role in understanding how to treat eating disorders. Much of this understanding is increasingly looking at the role of media and societal pressures on people’s perceptions. Popular media and the fashion industry appear to actually encourage a culture of fat-shaming and weight stigma. This history of shame and stigma has created devastating consequences.
Low Body Esteem:
According to studies performed by the Dove (Unilever Corporation), feelings of low body esteem impact the majority of both women and girls. The report states that 85% of women and 79% of girls say that they purposely skip major life activities and events due to the fact that they do not feel good about the way they look. Shockingly, 69% of Women and 65% of girls state that pressure from advertising and mass media pushes them to reach an unrealistic standard of beauty. On a worldwide scale, the report states that out of the 13 countries in the study, Japan ranked lowest, with only 8% body confidence among respondents, followed by the UK and Canada at 20%, the US at 24%, and South Africa topping the list at a modest 64% of women who feel confident in their bodies.
The Body Positivity Movement:
Reports like these have inspired a growing empowerment trend known as body positivity movement. This movement is quickly gaining popularity on the internet and in mass media. The concept of body positivity evolved as a way to counteract feelings of poor body image in society at large. Generally, body positivity asserts that all bodies are good bodies. How people’s bodies physically appear should not determine their worth as a person. “In Western society, this idea fights against long-held valuations of physical appearance, primarily as portrayed (or conspicuously not portrayed) in the media. Body positivity proponents across social media, therefore, seek to make diverse body types more visible, partly as a reminder to rethink our cultural conceptions of what it means to be beautiful, and that such concepts are not fixed.”
Fat Shaming as Entertainment:
Whether the body positivity movement able to create permeant societal change is still unclear. The entertainment industry still produces shows that seem to send the opposite message. For example, for the last few months controversy has been swirling around the new Netflix show Insatiable. Described as a dark comedy set in the Southern world of beauty pageants, the show is labeled as a “coming of rage” story. The series follows the actions of a vengeful teenager who was called “Fatty Patty” by school bullies. However, this character loses a substantial amount of weight, after having her jaw wired shut; and then teams up with a disgraced pageant coach in order to seek revenge against the people who once tormented her. The show’s creator argues that the Netflix series draws from her own experiences dealing with bullies and an eating disorder while growing up in the suburbs. Critics have called the show “an offensive mess,” “almost unwatchable” and “obscenely cruel” for perceived fat shaming.
One of the actors from the series, Alyssa Milano, defended the series arguing that the show is not engaging in fat-shaming behavior. “We are addressing (through comedy) the damage that occurs from fat shaming.” Milano explains that she hopes the show is a conversation starter, since the series explores body images issues, rather than sweeping it “under the carpet.” Insatiable’s main star Debby Ryan agreed with Milano and argues that the subject matter is difficult, but she hopes that the show serves a purpose by “stirring conversation” about fat shaming and low body esteem.
Critics of the show have not agreed with Ryan and Milano’s analysis. As of August 31st, 2018, a Change.org petition has garnered more than 200,000 signatures to have the show canceled. The originators of the petition state that the shows central plot is not an isolated case, but part of a much larger problem every single woman has faced in her life. The Netflix series “perpetuates not only the toxicity of diet culture but the objectification of women’s bodies.”
Other critics have agreed with this analysis and have called the show dangerous. Behavioral health professionals have noted that the U.S. society has made significant improvements in advancing the body positivity movement. However, fat-shaming and body weight stigmas are still a problem. Netflix’s show Insatiable only proves there’s still a lot about the way body image is portrayed in the media that needs to improve. The show’s core premise displays a plotline that is based on some ugly body image ideas. Body Positivity activists have pointed out that series shows that “a fat girl could never stand up for herself while fat and of course she has to be assaulted and have her mouth wired shut before she becomes her best self, her skinny self.” Other news sources have raised the question that perhaps the series is just misunderstood.
Whether the show is deemed offensive or is actually secretly progressive, the judgment that people feel about their physical appearance will continue. As a social trend and topic of conversation, River Centre Clinic will monitor this story as it unfolds. Our trained staff understands the complexity and sensitivity surrounding these issues. For additional questions or comments about this or other related topics – please contact us.
The River Centre Clinic’s primary purpose is to provide high quality, cost-effective, specialized care for patients with eating disorders in a state-of-the-art treatment environment. The clinic follows a treatment philosophy designed to provide an affordable treatment alternative to inpatient care. Our innovative approach to treatment is designed to reduce costs without compromising our high quality of care. The River Centre Clinic provides state-of-the-art treatment located in a modern, spacious and tranquil setting in Sylvania, Ohio — an historic suburb of Toledo, Ohio. The facility was designed to provide an attractive, and safe alternative to hospital or hospital-based programs. Living facilities are located in the main building to comfortably accommodate adults and adolescents in separate units.
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Body positivity, Body Image, Weight Stigma, Low Body Esteem
What is Body Image Disturbance?
Body image disturbance is one of the most common clinical features attributed to eating disorders. Most contemporary theories consider body dissatisfaction to be the most immediate or proximal antecedent to the development of an eating disorder and empirical studies indeed confirm this association.
It is generally agreed that the body image construct is multidimensional, involving attitudinal as well as perceptual components. The perceptual deficit was best described by Hilde Bruch in her seminal publications based on years of clinical experience (1) and almost 40 years ago, one of us (DG) published one of the first empirical studies documenting size estimation in anorexia nervosa(2).
While size overestimation generated tremendous interest over the years, it has had limited impact on the understanding and the treatment of the disorder.
Nevertheless, recent research has linked body image disturbance to both psychopathology measured by the Eating Disorder Inventory(3) and temperamental characteristics confirming Bruch’s early observations regarding the relationship of body image disturbance to other core features such as poor interceptive awareness and feelings of ineffectiveness(4).
Eating Disorders Without Body Dissatisfaction
Although body dissatisfaction may be one of the most common modes of entry into an eating disorder, early case descriptions of anorexia nervosa and evidence from non-Western cultures indicate that some patients voluntarily reach an emaciated weight for a variety of psychological reasons body but do not show the characteristic body dissatisfaction.
Some of earliest 19th century clinical descriptions of anorexia nervosa do not even mention body dissatisfaction as a clinical feature of the disorder. Cases of apparent anorexia nervosa from China and India lack the “fear of becoming fat” or the body dissatisfaction so prominent in Western cases.
Some Patients Began Restricting Food Intake Because of “Spiritual” Concerns
Even in Western culture, research studies, as well as clinical experience, indicate that there is a small minority of patients who present with a very low weight but who deny body dissatisfaction at any point during the development of their disorder.
Some of these patients began restricting their food intake because of “spiritual” concerns, fears of choking, aversion to the texture of certain foods, food allergies, or a brief phase of physical illness. These cases have been traditionally classified as “atypical”; however, the diagnostic designations may be too restrictive as evidenced by the changes to the DSM-5.
Body Dissatisfaction is Still a Major Risk Factor
Nevertheless, to point out the exceptions is not to deny the overwhelming evidence that body dissatisfaction is one of the most important risk factors for restrictive dieting which, in turn, predicts the onset and the maintenance of serious eating disorders.
It is a major predictor of relapse in both anorexia and bulimia nervosa; patients who do recover report that body image is one of the major impediments to lasting change. The most challenging problem is how to affect lasting change in body dissatisfaction among those with eating disorders.
Methods to Correct Distorted Body Size
Various methods have been used to attempt to correct distorted body size estimation. One method has been to provide corrective feedback to anorexia nervosa patients with the aim of improving accuracy over time. This can be accomplished in several ways.
One strategy involves providing feedback on standardized measures of size estimation. Another involves directing patients to study their body in a mirror and try to develop a more objective or realistic view of their weight or shape.
Confronting patients With Their Own Distorted Self-perception has Little Therapeutic Effect
Some studies have shown that this exercise may have value in helping patients overcome denial of the severity of their disorder. However, most clinicians agree that directly changing body size perceptions has very limited role in the treatment of anorexia nervosa.
It is not surprising that confronting patients with their own distorted self-perception has little therapeutic effect since most patients have a long history of feedback by friends, family and therapists that they are too thin and must gain weight. This alone seems to have little impact.
A Cognitive Approach to Re-Interpreting Body Image
In our treatment setting, we prefer a cognitive approach aimed at re-interpreting the meaning of body size overestimation rather than trying to change it directly. Body size overestimation can be thought of as a perceptual anomaly that is often observed in eating disorders.
This is similar to other situations where people are encouraged to not rely on a particular perceptual state but rather defer to a higher-order judgment regarding the perception – for instance, a person trying to decide whether or not to drive a car after drinking alcohol.
Accordingly, patients are encouraged to view their body-size misperception as an unfortunate perceptual disability (like being a color-blind person trying to coordinate his or her wardrobe). In this case, it is preferable to rely on objective data or a trustworthy person, rather than self-perception to determine actual body size.
Body image usually does not improve early in the process of recovery from anorexia nervosa, and in fact, it often becomes worse during weight gain. If it does improve, it is often in the later stages of recovery.
Treatment For Anorexia Nervosa
There has been remarkable advancement in recent years in the technology for treating body dissatisfaction in those at risk for eating disorders, and for obese individuals. The application of these approaches to anorexia nervosa has been less fully developed.
Treatment for anorexia nervosa requires increasing weight and weight gain is not uncommon in those with bulimia nervosa which predictably increases body dissatisfaction in the short-term.
Cognitive restructuring can be focused on identifying the idiosyncratic meaning that “being thin” and “weight control” has for the patient, and then finding more elegant personal and interpersonal solutions that do not require the life-long physical, psychological and interpersonal disadvantages of maintaining anorexia nervosa.
Within the context of a broader cognitive approach to anorexia nervosa (5), we have found group therapy focused on the “appearance assumptions” from Cash’s workbook particularly useful (6).
Avoiding Self-Defeating Practices
Developing a more positive body image often involves avoiding certain self-defeating practices (e.g. weighing, looking in the mirror, wearing revealing clothing and compulsive exercise) that provide short-term relief, but become rituals that only accentuate anxiety, discontentment and dysphoria.
These can be replaced by body image enhancement activities (yoga, movement, pleasure walks, listening to music,) that emphasize the body as a source of pleasure rather than a vehicle for control, mastery or self-definition. We emphasize the importance of viewing the functional aspects of the body rather than the ascetic features.
Finally, one of the most potent set of interventions derives from education about discrimination related to obesity (7) and the important advancements in advocating Health at Every Size as it’s health and civil rights implications (8).
Addressing Peer Relationships to Promote Change
It is also vital to understand the role of the interpersonal context in body dissatisfaction and to address peer relationships in promoting change. Recent evidence indicates that girls tend to select friends who are similar to themselves in terms of body dissatisfaction and bulimic symptoms but dissimilar in terms of dieting (9) and that body dissatisfaction is predicted by peer conversations about dieting, body consciousness and thin idealization (10).
These findings point to the importance of controlling for friendship selection when examining the role of peers in adolescent body image and eating problems. These findings can be extrapolated to group therapy in clinical settings by underscoring the importance of healthy and unhealthy group affiliations and their impact on recovery and relapse.
Changing Parental Attitudes Toward Weight
It has been our experience that promoting healthy group norms is one of the most important targets of intervention over the course of therapy.
Additionally, a major impediment to change can be parental attitudes toward weight and shape or parents’ overvaluation of thinness that can have a detrimental effect on the treatment of their children.
This issue must be approached with sensitivity to the historical factors influencing parental attitudes; however, treatment must focus on changing the family imperatives that interfere size acceptance as well as respect for individual differences of a wide array of attributes.
Psycho-Educationally Oriented Prevention Programs
Finally, the remarkable advancement in recent years in the technology for treating body dissatisfaction in those at risk for eating disorders, and for obese individuals can be applied in the treatment of serious eating disorders. Psycho-educationally oriented prevention programs can reduce body dissatisfaction and reduce ameliorate disorder symptoms in college women that are sustained over a two-year follow-up (11).
Although the application of these approaches to those with clinical eating disorders has been less fully developed, we rely heavily upon psycho-education as well as cognitive approaches to challenging body image disturbance (12) and these have led to clinically and statistically significant changes in body dissatisfaction over the course of our Adult Partial Hospitalization and Adolescent Residential Programs.
1. Bruch, H., Perceptual and conceptual disturbances in anorexia nervosa. Psychosomatic Medicine, 1962. 24(2): p. 187-&.
2. Garner, D.M., et al., Body image disturbances in anorexia nervosa and obesity. Psychosom Med, 1976. 38(5): p. 327-36.
3. Garner, D., Eating Disorder Inventory-3 Professional Manual. Psychological Assessment Resources, Inc, 2004.
4. Zanetti, T., et al., Clinical and Temperamental Correlates of Body Image Disturbance in Eating Disorders. European Eating Disorders Review, 2013. 21(1): p. 32-37.
5. Garner, D.M., K. Vitousek, and K.M. Pike, Cognitive Behavioral Therapy for Anorexia Nervosa, in Handbook of Treatment for Eating Disorders1997.
6. Cash, T.F., The body image workbook1997, Oakland, CA: New Harbinger.
7. Garner, D.M. and S.C. Wooley, Confronting the failure of behavioral and dietary treatments for obesity. Clinical Psychology Review, 1991. 11(6): p. 729-780.
8. Bacon, L., et al., Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association, 2005. 105(6): p. 929-936.
9. Rayner, K.E., et al., Adolescent Girls’ Friendship Networks, Body Dissatisfaction, and Disordered Eating: Examining Selection and Socialization Processes. Journal of Abnormal Psychology, 2013. 122(1): p. 93-104.
10. Lee, K., Engaging in peer conversation about slimming predicts body dissatisfaction in Chinese college women: A study in Hong Kong. Social Influence, 2013. 8(1): p. 1-17.
11. Stice, E., et al., Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorders and Obesity Among Female College Students: 1- and 2-Year Follow-Up Effects. Journal of Consulting and Clinical Psychology, 2013. 81(1): p. 183-189.
12. Garner, D.M. and C.D. Keiper, Anorexia and bulimia, in Handbook of clinical psychology competencies, J.C. Thomas and M. Hersen, Editors. 2010, Springer: New York. p. 1429-1459.
Contributed by the following River Centre Clinic Staff:
David M. Garner, Ph.D. is the Owner and Administrative Director
Julie J. Desai, M.A. is the Director of the Adult Partial Hospitalization Program
Meggan Desmond, LISW is the Director of the Adolescent Residential Program
The River Centre Clinic has almost two decades of experience providing innovative treatment to adults and adolescents suffering from eating disorders. It has developed a ground-breaking approach to treatment, based on extensive experience and research, designed to reduce costs without compromising high quality of care.