Clinical characteristics of Anorexia Nervosa – DSM-IV-
Weight loss that this considered
abnormal and drops below 85% of
what was previously considered
normal. Control of weight through
unusual eating habits.
Anxiety about being overweight – this
is an excessive fear. Not only
obsessed with weight but fearful of
Body image distortion – they do not see
their own thinness and deny the
seriousness of their low body weight.
Continue to see themselves as fat despite
the fact that bones can be seen. Thinness
is vital to their self esteem.
Cessation of menstrual
periods – Amenorrhoea.
Absence of periods for
more than 3 months.
Lack of menstrual cycle
caused by inadequate
nutrition – become very
Anorexia causes a general physical decline
Cessation of menstruation (amenorrhoea)
Low blood pressure
Dry and cracking skin
Depression and low self-esteem
Up to 20% cases of Clinical AN are fatal
A BMI of below 18.5 is an indicator & 15
Explanations for this disorder:
• Sociocultural – SLT – media influences,
Ethnicity and peer influences
• Psychological – psychodynamic,
• Biological explanations – Neural and
• Diathesis stress model – genetic
predisposition + environmental triggers
What is the explanation for this?
Portrayal of thin models on
TV and in magazines.
Drive for thinness by
SLT - Media influences:
• Body image concern amongst adolescent girls because of the portrayal of
• People imitate and copy people they admire.
• Young women see female role models rewarded for being slim and
• Association of being slim with being successful – vicarious reinforcement
• Reward is being received indirectly by observing another person being
rewarded. When they slim the reinforcement will be direct.
• AN a learned behaviour through observation which is maintained by positive
reinforcement. An individual who diets and loses weight is encouraged by
peers and society.
• Those that remain overweight get criticised and are disapproved of and
sometimes face ridicule because of their bodily appearance (Susan Boyle)
• Positive reinforcement for weight loss becomes so powerful that the
individual maintains the anorexic behaviour despite threats to health which
could result in death.
SLT – media - research
• Practical learning activity – go the website:
• Summarise the findings in fewer than 500
SLT – media - support
• Goresz et al (2001) support the view that the mass media portray a slender beauty ideal. Review
of 25 studies showed that this ideal causes body dissatisfaction and contributes to the
development of eating disorders. Effect most marked in girls under 19 years.
• Hofschire 2002 – media have a preoccupation with a thin body shape particularly in the case of
girls and younger women, this pressure encourages women to become more and more
dissatisfied with their own body shape and physical appearance (Thompson 1999).
• Done in an explicit way with slim models and articles on achieving the ideal (thin) body shape
however implicitly peers voice admiration of certain role models they see as being successful.
Slim ideal is equated with success and health whereas average weight or overweight becomes
synonymous with failure. This view slowly becomes the dominant belief in society (Harrison
• Forehand (2001) found that women feel undue pressure on their appearance and reported that
27% of girls felt that the media pressure them to strive to have the perfect body.
• High incidence of AN in ballet dancing and modelling - great pressure to be thin (Alberge 1999).
• Further support for it being a western ideal in that eating disorders are not so prevalent in non
western societies (eg China) – fewer role models exist.
• Increase in eating disorders in Fiji (Fearn 1999) with the introduction of American television
programmes which emphasise a westernised idealised body shape.
Sociocultural – ethnicity and peer
• Value of thinness in women not the same in non western society and in
black population in western society.
• Meta analysis of 98 studies (Grabe and Hyde 2006) found a difference
between African-American and Caucasian and Hispanic females. African-
Americans reported significantly less body dissatisfaction than other 2
• Positive attitudes toward large body sizes in non-Western cultures such as
Fiji and Caribbean – associated with attractiveness, fertility and nurturance
• AO2 – Cachelin and Regan (2006) found no signficant differences in
prevalence of disordered eating between African Americans and white
caucasian participants. Roberts et al (2006) report that it is only in older
adolescents that white populations have a higher incidence of Anorexia than
Sociocultural – peer influences
• Peer acceptance during adolescence
• Peers susceptible to peers influence in disordered patterns of eating
• US study – dieting among friends was significantly related to
unhealthy weight control behaviours such as diet pills or purging
(Eisenberg et al 2005)
• Jones and Crawford (2006) – teasing – mechanism on overweight
girls and underweight boys (most likely) – enforces gender based
• AO2 – Shroff and Thompson (2006) found no correlation among
friends on measures of disordered eating in an adolescent sample.
However the gender differences in teasing do not emerge until
• Study of 10 year olds found positive correlation between body mass
index (BMI) and teasing for both boys and girls (Lunde et al 2006).
Evaluation – AO2
• Face validity in that in the Western society women are exposed to
images of thin women and have a complex relationship with food.
• Helps to explain why so many women diet and why so many women
are dissatisfied with their body shape.
• Problem in that this analysis cannot explain why only a minority of
women develop eating disorders.
• Does not help explain why that so many anorexics continue to
starve themselves when they no longer receive praise and
compliments about their size – it could be about the attention that
they receive that’s reinforcing being anorexic.
• Underplays the cognitive aspects of anorexia – eg it does not really
explain the faulty perceptions of body image that play such a large
part in eating disorders.
• Other synoptic points:
Diathesis stress model
• Perfectionism as a personality trait appears to run in families – suggests a
genetic vulnerability for the development of AN
• Patients in a study by Halmi et al 2000 included patients with relatives who
suffered from AN.
• Investigated the relationship between perfectionism and anorexia.
• 322 women with a history of AN across Europe and USA.
• Individuals who had a history of AN scored significantly higher on the
Multidimensional Perfectionism Scale when compared to a comparison
group of healthy women.
• Extent of perfectionism directly related to the severity of AN experienced by
The diathesis model
Genetic Predisposition + Environmental Trigger = Disorder
Psychological factors –
psychodynamic and personality
Hilde Bruch (1973) – Psychodynamic
• Origins in early childhood
• Effective parents (responding to child’s needs when hungry) vs
ineffective parents (who fail to respond to child’s needs)
• Inadequate parenting by ineffective parent – might feed child when
the child is crying and anxious as well as not feeding the child when
they are actually hungry.
• Children will grow up confused about their internal needs becoming
overly reliant on their parents.
• During adolescence they try to exert control and autonomy (more
prevalent at this time) but they may be unable to do so as they do
not own their own bodies.
• To overcome this they can take excessive control over the body
shape and size by developing abnormal eating habits.
• Supported by observations in that parents of
adolescents with AN define their children’s
physical needs rather than letting the child
define their own (Steiner et al 1991).
• They never let the child feel hungry instead they
anticipate their child’s needs (Bruch 1973)
• Supports the claim that people with AN rely
excessively on the opinions of others, worry
about how others view them and feel lack of
control over their lives (Button and Warren