Nature, Cultural and Religious Aspects.
According to DSM-V, the extreme disturbance of nutrition behavior is an eating or feeding disorder. Among the diseases which group consists of are not only anorexia nervosa and bulimia nervosa but also “pica, rumination disorder, avoidant/restrictive food intake disorder, and binge-eating disorder” (DSM-5, 2013, p.329). Each of these diseases has it typical features and often presupposes co-morbidity. For instance, the main diagnostic criteria for eating dysfunction are the complexity of weight gain or weight loss caused by eating restrictions, intentional or involuntary regurgitation of food, overeating, etc. Moreover, there is a spectrum of eating abnormalities which are the attributes of this group, if they are not culturally induced. Every disorder has its diagnostic criteria. For example, pica is eating of nonnutritive or nonfood substances on the regular basis during at least one month. The minimal age for this diagnosis is 2 years old. Furthermore, most of eating disorders are typical for other mental dysfunctions. Typically, these disorders may be associative features of intellectual disability (or other neurodevelopmental disorders), autism, schizophrenia and other mental disorders with impaired social functioning (DSM-5, 2013, p.p.329-354). Anorexia nervosa is extreme thinness perused by dieting. Bulimia nervosa is recurrent binge eating which causes measures for weight control (over-exercising, vomiting) (Wilson and Vitousek, 2007, p.p.199-203). Nevertheless, it is problematic, that the majority of real-life cases do not suit this classification. That is why scientists are aiming to create more clearly defined groups in this classification (Striegel-Moore & Bulik, 2007, p.181).
Historical context of eating disorders
Nevertheless, the understanding of eating disorders has been different through the history of humanity. The first recordings of abnormal eating behavior were during the times of Cesar when reach people were purposely vomiting during the banquets so that they could return to eating. Moreover, some of the eating behavior disorders took place due to social and economic factors like famine. People were eating thing which are not normally eaten and starved to save food for children (Engel, 2011, n.p.). There are very little accidents of anorexia registered before the 20th century. Mostly, these cases had the religious context and had a connection with the ascetic ritual of self-denial. Saint Catherine of Siena was the most famous representative of anorexia nervosa in the 13th century. But the 16th century changed the attitude to ascetics who got a status of witches and were burnt at the stake (Deans, 2011, n.p.). 1690 is the date of the first formal description of anorexia case. It was a woman whose “sadness literally ate away at her” (Engel, 2011, n.p.). This case has forced scientists to define anorexia nervosa as the loss of appetite. Moreover, researchers of those days have concluded that anorexia could develop in rich families with plenty of food. In addition, refusal to eat was a form of protest among children and women in distress. Scientist believed that the nature of disease was medical – the cause of the eating disorder was in hormone imbalance and endocrine deficiencies. Only in 1930’s scientific community adopted the idea of the emotional nature of eating disorders. By the end of the 20th century, eating disorders became diversified, so that cultural, social, psychological, biological and other causes defined its classification (Engel, 2011, n.p.). Thus, the models of understanding this disease have preceded from purely biological to bio-psychological and purely socio-cultural (Striegel-Moore & Bulik, 2007, p.182). Nowadays, the approach to understanding and treatment of eating disorders is more personalized as it considers the multitude of factors.
Causes of Eating Disorders
Striegel-Moore and Bulik (2007) define socio-cultural and biological causes of anorexia - and bulimia nervosa. Nowadays, scientists consider eating disorders to be a dysfunctional attitude to body image which causes a will to change it. One of the reasons for this intention is the role-model of beauty which exists in our culture. The “western” femininity presupposes extreme leanness which brings social success. This idealized image undergoes internalisation and reinforces representatives of the female gender to match it. Nevertheless, the core roles in disease development play personal traits like social anxiety, perfectionism, impulsivity, etc. Moreover, sex plays a significant role in the development of eating disturbance. While males are more likely to compensate the excess weight by exercising (sometimes, over exercising), females are decreasing the amount of food they consume. Hence, women are more vulnerable to eating disorders, caused by weight and shape concerns (Striegel-Moore & Bulik, 2007, p.184).
The study conducted by Dohnt and Tiggemann (2006, p. 934) has examined the role of psychological aspects of cultural influence, for instance, the effect of media on body satisfaction and self-esteem of teenagers. According to results, the majority of female respondents are satisfied with their bodies, although they want to become thinner. This means that the cultural message of thinness is a kind of construct which exists in minds of adolescents. Furthermore, they have found a correlation between dissatisfaction with the body and low self-esteem. A core factor which influences the formation of role models is television. Recent research have shown that browsing of soap operas contributes in internalisation of beauty standards by young girls as well as music videos induce the willingness to muscularity among boys (Tiggemann, 2005, p. 375). Thus the desire to match the role model among young susceptible girls is a temporal antecedent of low self-esteem (Dohnt & Tiggemann, 2006, p. 935).
Secondly, there is a genetic factor which causes the development of eating disorders. According to biological attitude, there are inner determinants of vulnerability to these dysfunctions. Among these causes are the genetic propensity to higher appetite and weight deregulation. Nevertheless, attitudes of personality underpin the biological susceptibility. Hence, the socio-cultural and biological factors create a background for systematic understanding of eating disorders causes (Striegel-Moore & Bulik, 2007, 194).
The final step to eating disorder is unhealthful weight control which includes both dieting and weight gaining. According to Neumark-Stainer et al. adolescents who are highly likely to be dissatisfied with their appearance use ineffective methods of weight loss, that harm their health and psychological estate. Thus, it is highly important to study, treat and prevent this unnatural behavior which the popular culture induces.
Each type of eating disorder requires special methods of treatment. It is highly complex to study treatment methods for anorexia nervosa as long as there are very little completed and published treatment trials. Nonetheless, the family therapy is widely spread method of anorexia treatment. According to the studies, that systematic treatment of the person with the disease and his or her surrounding is successful. However, the recent studies have criticized this attitude by showing that separate treatment of a child and his or her parents is much more effective than group family therapy. Another therapeutic approach which psychologists frequently apply in cases of anorexia is cognitive-behavioral therapy. Although it is challenging to analyze the data of researching the effectiveness of this kind of treatment as long as there are very little proves of its application. However, the existing results indicate its effectiveness as a supporting method for medication treatment. The main factor which makes anorexia treatment more difficult is the high level of resistance among patients who deny medical intrusion (Wilson and Vitousek, 2007 p.201-203).
Bulimia nervosa presupposes rigid and dysfunctional dieting. The most evidence-based way of treatment for this disease is manual-based cognitive-behavioral therapy. This treatment enhances the impetus for the change of rigid diet and for replacing it with flexible eating rules. Moreover, it helps to create new self-image which avoids stereotypes. Another way of treatment is the interpersonal therapy which underlines the crucial effect of the interpersonal relationship on the development of the disease. Thus, the eating disorder is not in the direct focus of therapeutic influence.
In addition, there are numbers of mixed disease of this spectrum like binge-eating disorder. Cognitive therapy is also applicable in this case. Nevertheless, the insurance doesn’t cover the whole process of recovery. That is why the therapist has to provide self-help lessons for his client and his surrounding for them to proceed to the complete recovery. Thus, the sphere of eating disorders treatment requires further studies. Nonetheless, it is important to attitude every case in specific way and to apply appropriate therapeutic methods in addition to medical treatment (Wilson and Vitousek, 2007 p.203-213).
Prevention of eating disorders
The deep consideration of all the factors which cause this disease can help to develop the prevention strategy. Taking into account socio-cultural factors and the definition of most vulnerable groups of the population, it becomes obvious that the target group of preventing measures would be children. Neumark-Steiner et al. suggest creating school level interventions for overeating and abnormal dieting. Children should get information about skills and ways of behavior which would help them to avoid unhealthy weight control behavior which leads to eating disorders (2006, p.566).
Another point is to avoid the mediated transition of thin-ideal messages. The obesity of thin women on television influenced negatively the self-image of young girls who trust the stereotypes of beauty. This fake picture of femininity causes not only psychological changes, but also physical suffering of those who try to reach the perfection. At the same time, the lack of normal dieting causes obesity, which is also a type of eating disorder. Propaganda of healthy way of life among American schoolchildren will contribute into decrease of early mortality level (Striegel-Moore & Bulik, 2007, 194).
Another important aspect of eating disorder prevention is targeting children of women which already have this disorder. Mothers can provide abnormal feeding to their children and become a role model for them. What is more she can induce the irrational self-image and harming nutrition. That is why providing psychotherapeutic support of families with eating dysfunctions is crucial (Striegel-Moore & Bulik, 2007, 193). Moreover, the eating behavior of people with obesity can also presuppose not only physical features, but also the ration of their children. That is why interventions in local communities may help to prevent the spreading of potential eating disorders.
Cross-cultural Issues Concerning Eating Disorders
According to Striegel-Moore and Bulik eating disorders appear in limited number of cultures. The fact of the overrepresentation of white women with this disease in general sample underpins this idea (2007, p.185). The main reason of this determination is the presence of preferences of female thinness. The cultures which do not build the connection between success and thin waist are less vulnerable to eating disorders. The studies have shown that some people may value big women and avoid “western” ideals. Nonetheless, the globalization spread the role model of thin girl across the globe. Recently, this ideal invaded the areas with completely different image of a woman (2007, p.186).
Other cross-cultural peculiarities, which are important for understanding the differences in eating behavior, are the traditions. For instance, eating ground is a part of ritual behavior in some cultures. Nevertheless, it is a diagnostic criterion of pica disorder in other cultures which do not have related traditions. That is why scientists who conduct the cross-cultural research of eating behavior should make a fundamental adaptation of methods which they applied to representatives of different areas.
Christian Prospective on the Issue
“Don't you know that your body is the temple of the Holy Spirit, who lives in you and was given to you by God? You do not belong to yourself, for God bought you with a high price. So you must honor God with your body” (1 Cor. 6:19-20, New International Version).
The Bible doesn’t encourage torturing the body which exists for making love to the world. Nevertheless, there are some vital confuses which every girl faces in her life. The main point is that external world invades the spirituality of a person and introduces its rules and standards. Grenfell provides different examples reasons for female starvation. The author bases her theory on the fact that the invasion into a sensitive female spiritual world causes a protest or abnormal reaction in eating behavior. For instance, the woman who is ashamed of her body uses this disease to articulate her inner pain. Thus, women often express the spiritual anxiety by irrational dieting. The eating disorder is a result of frustration about community, church and parental pressure (2006, p.370-372).
The main idea of Christian treatment of eating disorders is highlighting the love to the body and deep self-understanding of those are overeating of starving. The older members of Christian community support girls and share their wisdom with them. Moreover, due to the fact that eating disorders are often the results of social dysfunction, the Christian community provides a curing atmosphere of understanding and acceptance. Thus, understanding of female roles may be challenging for girls who face the reality, nevertheless the Christian community support, based on physically grounded spirituality and honesty provides an opportunity to recover and to defeat the anxiety. Moreover, the research of spiritual support during eating disorders has shown that therapist may manage the beliefs of the client in the way he or she can reduce irrational behavior. Thus the spirituality may have positive therapeutic effect (Buser et al., 2014, p.110).
Eating disorders is a group of behavioral dysfunctions of nurturing. The diseases of this spectrum may be divided into two groups: dysfunctions which cause the decrease of the weight and obesity. The first cases of eating diseases take place in ancient Rome where people were intentionally vomiting to continue the banquet; nevertheless, the times have changed. Nowadays anorexia and bulimia are the results of widespread role model of thinness. Thus, young girls underestimate themselves because of the cultural stereotype which spreads over the world. Nonetheless, there are cultures which have different vision on female beauty; as a result they have a low level of eating dysfunction. However, the globalization causes the intrusion of pop-culture into most innocent populations. Hence, to treat people with eating disorders therapist should use the complex attitude and combine the medical prescription with appropriate psychotherapy (cognitive-behavioral, family or another). However, the best way to fight a disease is to prevent it. Therefore, the scientists should study this issue precisely and create a set of interventions for young people, which would provide information on healthy dieting and preventing oneself from the disease. Furthermore, there is a spiritual perspective of this issue which emphasizes the importance of Christian community support in order to decrease anxiety which causes eating disorders among girls. Thus, further research should take into account different attitudes to this issue to find a multicultural solution.
Buser, J., Parkins, R., & Buser, T. (2014). Thematic Analysis of the Intersection of Spirituality and Eating Disorder Symptoms. Journal of Addictions & Offender Counseling, 35(2), 97-113.
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Dohnt, H., & Tiggemann, M. (2006). The contribution of peer and media influences to the development of body satisfaction and self-esteem in young girls: A prospective study. Developmental Psychology, 42(5), 929-936.
Engel, B., Staats Reiss, N., & Dombeck, M. (2007). Historical Understandings. Retrieved July 2, 2015, from https://www.mentalhelp.net/articles/historical-understandings/
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