Etiology: Sociocultural Level Of Analysis

De’Ja commons
Pgs. 176-179
Etiology: Sociocultural level of analysis
Lee et al. suggest that a social fat phobia may underlie anorexia, and this phobia is starting to thrive in other parts of the world
Places where anorexia has increased a lot it is due to media influence and large amounts of info about dieting and eating disorders
Girls who become anorexic are more likely to accept the messages about beauty and thinness in the media. It isn’t clear whether this acceptance lead to the anorexia or if anorexia caused the acceptance of the media
Lee et al also hypothesized that the increase in anorexia in other countries could be a result of increased use of Western diagnostic systems that increase behaviors.
Body weight is NOT indicative
of psychiatric problems --- 16% of healthy but slim Chinese women would meet Western diagnostic criteria for anorectic weight
Strahan et al. believe that media is not so much a cause of women believing that they are the wrong shape, but encourages them to think that everyone else accepts thin models and actresses as normal and attractive
They then conform to the perceived expectations of others which lead to excessive dieting
This influence could affect both males and females in their development from a very young age
The interaction between biology, cognition, and the sociocultural context of a person’s life is needed in order to completely understand how anorexia develops.
Treatments for anorexia nervosa
Biomedical therapy: SSRIs are commonly used to treat anorexia, but there isn’t much evidence to indicate that it is very effective.
Kaye et al did a double blind study which showed that patients who were given a placebo over a one-year period were more likely to drop out, indicating that there is some benefit from the drugs.
However, it seems that the medications targets symptoms of anorexia that are not causing the disorder and contrasts with the idea that negative mood or depression play a causal role in development of anorexia
Instead of focusing on medication, the biomedical approach ensures that weight gains happen in the first instance, which can mean attaching the patient to a drip (IV). Which after, the patients will be encouraged to eat normally again within their individual
therapies.
Anorexia is sometimes seen as a form of anxiety disorder or depression, and for some people ongoing use of medication can prevent the emotional state that precedes relapses.
Individual Therapies
Bowers details a form of CBT that is recommended for use in a multidisciplinary team because an anorexia patient can’t be dealt with alone.
Aim of CBT: help the individual understand that their thought processes and belief systems are causing problems, and help them change them. CBT aims to change negative self-schemas (I’ll never be thin enough) and basic assumptions that are fixed and resistant to change; usually high personal expectations
It may require practice for patients to identify their own moods and thoughts about weight, food, and control. They can be challenged to produce evidence for these ideas and encouraged to come up with logical thoughts as alternatives to what are generally negative or self-defeating but persistent thoughts.
Behaviorist treatments are also available for anorexia which is usually operant conditioning. Certain target behaviors are to be reinforced with a reward personalized to the patient.
Token economies aren’t uncommon in hospital wards dealing with anorexic inpatients; these offer staff a way to observe and reward small improvements in behavior (watching television, spending time socializing with others, IF they finish a meal)
Sometimes patients are asked to eat a meal that is on a scale. This is for the patient to see the weight of the meal decreasing as they eat it. This forms immediate feedback about success in learning new eating habits. However, relapse is more common in this method than the CBT becauseeeee: -the reasons behind the disorder have not been addressed whether biological, cognitive, or sociocultural -the reward process should be internalized, or have strong support from family or friends because the reward system is likely to be neglected ..
which is also a reason why family therapy is sometimes offered
Family therapy bridges the gap between individual and group therapy. The family is trained to give support to the sufferer. Sometimes, the whole family benefits from therapy to change their communication styles.
Models of causation assume that interactions are contributing factors to the development of the disorder, and learning more effective ways to communicate is beneficial for many family members not just for the person with anorexia.
Harris and Kuba noted that there are more individuals with eating problems than are being diagnosed, and that treatment for minority groups require special attention. They recommend that therapy involve not just the individual patient and therapist, but family, community, and other practitioners of more cultural relevance.
Group Therapy
Group therapies are very common for anorexia patients – both as inpatients (receiving treatment) and outpatients to help prevent
relapse.
Woodside and Kaplan put males and females together in group therapy that targeted negative and destructive attitudes towards food and eating, they used a CBT approach similar that in the individual therapy section. Both males and females showed improvement on the eating attitudes test.
Group therapy is more cost-effective than individual therapy and offers the opportunity for group members to interact with others who are at different stages in dealing with the disorder.
This provides hope for those in early stages and confirmation of progress for those who are successful, along with increased self-esteem because they can help others
Polivy identifies two significant problems with group therapy
Being in a group of other anorectic patients lends legitimacy to the development of a new identity based on group membership; the patient then requires individual therapy to help find their own identity
Members of the group often teach each other, sometimes unintentionally, strategies to avoid weight gain or hide weight loss which means group therapy can sometimes undermine individual progress.