Women and weight: A normative discontent.

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Abstract
Suggests that cultural norms and female sex-role stereotypes and attitudes provide a context for understanding women's preoccupation with thinness and their pursuit of beauty. In this society, obesity is a strongly stigmatized condition and is met with punishment (psychological, social, and economic). In examining biological aspects of weight reduction, it is suggested that the contemporary beauty ideal of "thinness equals attractiveness" prescribes a body weight that is unrealistically low due to developmental milestones that tend to increase fat (e.g., puberty, pregnancy, menopause) and women's metabolic systems. It is argued that women's preoccupation with their appearance comes out of shame and social pressure and leads to psychological consequences such as decreased self-esteem, distorted body image, and feelings of helplessness and frustration in response to unsuccessful dieting efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    Within dominant U.S. culture, the feminine body has been positioned as an object to be looked at and sexually gazed upon; thus, females often learn to view themselves from an observer’s perspective and to treat themselves as objects to be looked at (i.e., self-objectification). Self-objectification often results in negative outcomes, such as body dissatisfaction, among Caucasian samples, but the correlates and consequences of self-objectification among African Americans are less clear. Given that this construct may vary considerably across racial/ethnic groups, the current study considers how self-objectification affects both African American and Caucasian college women’s body dissatisfaction. This was assessed via two prospective mediation models that utilized bootstrapping techniques. In the first model, trait anxiety was tested as a mediator of the relation between body surveillance, the behavioral indicator of self-objectification, and body dissatisfaction; in the second model, body surveillance was examined as a mediator of the relation between trait anxiety and body dissatisfaction. Participants at Time 1 were 276 undergraduate women attending a Midwestern university in the U.S.; 97 (35%) described themselves as African American/Black, and 179 as Caucasian non-Hispanic/White; at Time 2, 70 African American females and 156 Caucasian females provided data. At these two time points, separated by about 5 months, participants completed the same set of questionnaires. Results indicated that the first mediation model was not significant for either group, but the second model was significant for the Caucasian women. Results provide some support for the differential effects of self-objectification on women’s body dissatisfaction depending on race/ethnicity.
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    The aim of this study was to explore the moderating effect of a number of psychological variables on the relationship between media pressure and body dissatisfaction. A total of 200 young women completed questionnaires assessing body dissatisfaction, perceived media pressure, self-esteem, depression, anxiety, and social phobia. Media pressure, anxiety and self-esteem revealed direct effects in the prediction of body dissatisfaction. However, when the interaction terms were examined, only the interaction between social phobia and media pressure was a significant predictor of body dissatisfaction. The findings of the study reveal the importance of psychological functioning regarding vulnerability to the effects of media pressure.
  • Article
    Full-text available
    This article is a comment on Fikkan and Rothblum’s (2011) article “Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias.” They argued that fat women in North America experience significantly more prejudice and discrimination than fat men do, marshaled evidence to support their argument in several domains (e.g., employment, education, romantic relationships, health care, the media), and wondered why feminist scholars have not paid much attention to the oppression of fat women. Here I suggest several reasons why fat women experience more prejudice and discrimination than fat men do: the objectification of women, gender-related aspects of health behavior and knowledge about health and illness, and the importance of self-control to the performance of femininity. I also suggest that there is some overlap in negative stereotypes of both feminists and fat women, which might lead to a desire to distance oneself from both. However, feminists should recognize the intersectionality of fat oppression and the way it colludes with the sexualization and objectification of women in popular culture. Thus, fat should be a feminist issue.
  • Article
    Mainstream North American media promotes the message that attaining a thin, youthful appearance is central to a woman’s value and social role while appearing older is highly undesirable. However, appearance ideals and attitudes toward aging differ substantially across cultural and ethnic groups, which may influence the degree to which one internalizes media ideals and holds anti-aging attitudes. Consequently, this study examined the relationships between internalization of the youthful, thin-ideal appearance perpetuated by mainstream North American media and attitudes toward the elderly in a sample of 281 undergraduate females under the age of 30 attending a university in the Western United States. Specifically, European American (n = 115), Asian American/Pacific Islander (n = 74), Hispanic/Latina (n = 52), and African American (n = 42) women voluntarily completed self-report measures of internalization of media ideals and attitudes towards older adults. Attitudes towards the elderly were significantly more negative at higher levels of internalization of North American appearance ideals, independent of ethnicity. These data suggest that internalization of North American appearance ideals perpetuated by media are related to negative attitudes towards older adults. Future research should investigate the influence of negative attitudes about aging on behaviors toward older adults or one’s own aging process.
  • Article
    Full-text available
    The present study examines the suggestion that associations between dance participation and body image are influenced by dance type and level. A total of 82 female dancers varying in dance type (ballet vs. contemporary dancers) and level (beginner vs. advanced) completed measures of body appreciation, actual-ideal body weight discrepancy, body awareness, body responsiveness, dancer identity, length of time as a regular dancer, and provided their demographic details including age and body mass index. Analyses of variance showed that beginner ballet dancers had significantly higher body appreciation compared with advanced ballet dancers, whereas advanced contemporary dancers had significantly higher body appreciation compared with their beginner counterparts. Additionally, advanced ballet and contemporary dancers both had significantly higher body weight discrepancy compared with their beginner counterparts. Multiple regressions showed that body awareness, body responsiveness, dancer identity, and time as a dancer did not significantly predict body image once dance type and level had been accounted for. These results are discussed in relation to the promotion of positive body image using dance/movement therapy.
  • Article
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    Although disordered eating behaviors are relatively common among college women, many questions about their etiology remain. In the present study, structural equation modeling was used to investigate potential mediating associations among variables previously found to be associated with the continuum of disordered eating behaviors in a large sample of college women. Results indicated that family conflict, family cohesion, and childhood physical and emotional abuse and neglect were not directly associated with disordered eating. Rather, their association with disordered eating was mediated by alexithymia and depression. These results were cross-validated in a second sample of college women. These data highlight the complexity of disordered eating and provide future directions for the prevention and treatment of the continuum of disordered eating behaviors.
  • Article
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    Fat talk is a social phenomenon during which women speak negatively with each other about the size/shape of their bodies (Nichter and Vuckovich 1994). In this study, exposure to fat talk from peers was experimentally manipulated to determine the effect of hearing fat talk on a woman’s own likelihood of engaging in fat talk and on state body dissatisfaction, guilt, and sadness. Undergraduate women (n = 87; all of a healthy weight) from a Midwestern university in the United States participated in a study ostensibly about discussing magazine advertisements. Two female confederates were present for the discussion. While discussing an advertisement featuring an attractive and thin female model, participants either heard both confederates engage in fat talk, neither confederate engage in fat talk, or the first engage in fat talk and the second challenge the fat talk. Hearing a confederate fat talk made the participants more likely to fat talk themselves (especially if the fat talk went unchallenged) and increased participants’ self-reported state body dissatisfaction and guilt. Participants who engaged in fat talk reported higher levels of self-reported state body dissatisfaction and guilt, compared to participants who did not engage in fat talk (even when controlling for pre-existing trait body dissatisfaction). Participant fat talk mediated the effect of condition on both state body dissatisfaction and guilt. Additionally, correlational analyses revealed that participants with higher levels of trait body dissatisfaction (assessed at a pre-test) were more likely to engage in fat talk (regardless of condition).
  • Article
    Three hundred twenty-seven undergraduatemostlyEuropean American women and men were surveyed totest whether feminist theoryabout how women come to viewtheir bodies as objects to be watched (Objectified Body Consciousness or OBC) can be useful inexplaining gender differences in body esteem. The OBCscales (McKinley & Hyde, 1996) were demonstrated tobe distinct dimensions with acceptable reliabilities for men. Relationships between bodysurveillance, body shame, and body esteem were strongerfor women than for men. Women had higher surveillance,body shame, and actual/ideal weight discrepancy, andlower body esteem than did men. Multiple regressionanalysis found that gender differences in body esteemwere no longer significant when OBC was entered into theequation, supporting feminist theory about women's body experience.
  • Article
    A content analysis of 28 different prime-timetelevision situation comedies examined the body weightsof 52 central female characters (88% White, 10% Black,2% Asian), the verbal comments they received from other characters as a function of bodyweight, and their self-comments with respect to theirown body weight, shape and dieting behaviors. Comparedwith the general population, below average central female characters were over-represented insituation comedies; above average weight characters wereunder-represented. Below average weight femalecharacters received significantly more positive verbal comments from male characters with regards tobody weight and shape than their heavier counterparts.Dieting female characters gave themselves significantlymore verbal punishment for their body weight and shape than those less involved in dieting.This combination of modeling the thin ideal and theverbal reinforcement associated with this modelinglikely contributes to the internalization of the thin ideal and may put some young female viewers atrisk for developing eating disorders.
  • Article
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    This study asks if self-derogation in early adolescence increases the odds of adopting disordered eating practices (DEPs) in young adulthood. Using a racially/ethnically diverse random sample of 1,209 youth, our (longitudinal) data show that both boys and girls who disliked themselves at age 13 were more likely to adopt disordered eating practices at age 22. Following Kaplan's theory of deviance, we view disordered eating as a form of internally directed deviance that youth may adopt in an effort to “correct” for negative self-feelings. We find that girls/women adopt DEPs more than boys/men do, although this is not true for African Americans. Family socioeconomic status fails to predict DEPs. Exploratory analyses aimed at understanding connections between self-derogation and DEPs show that perceptions about weight matter. In particular, women who are more anxious about their weight are more apt to engage in DEPs (compared to less anxious women). Our study contributes to debates about theories of deviance and theories of gender, relative to explaining disordered eating practices.
  • Article
    This investigation was a representative survey, conducted in 1993, of the body images of 803 adult women in the United States. Included in the survey instrument were selected subscales from the standardized Multidimensional Body-Self Relations Questionnaire, which had been used in a U.S. survey in 1985. The results indicated substantial levels of body dissatisfaction, possibly surpassing levels observed in the 1985 survey. Nearly one-half of the women reported globally negative evaluations of their appearance and a preoccupation with being or becoming overweight. Whereas age effects were minimal, significant race/ethnicity effects were found, with clearly more positive body images among African American than Anglo or Hispanic women. The social and clinical implications of the findings were discussed.
  • Article
    This study investigated the effect of reported eating behavior on person perception. Subjects (87% white, 4% African-American, 9% Asian; 60% female) were presented with brief descriptions of a fictitious male or female target subject that included a food diary describing either a small, medium, or large breakfast and lunch. One-half the food diaries of male targets were calorically adjusted to compensate for the male target's larger physical size. Subjects recorded their impressions of the target on a number of physical and attitudinal characteristics. Targets were perceived as being less feminine and more masculine as meal size increased. Attractiveness ratings showed an interaction between meal size and gender. Female targets were judged to be more concerned with appearance and more attractive as meal size decreased. However, ratings of male targets on attractiveness variables were less affected by reported meal size in the standard diet condition, suggesting the existence of a double-standard for eating behaviors between men and women. However, male targets whose diets had been size-adjusted were rated in a pattern similar to ratings of female targets. These results expand on prior work demonstrating that meal size affects social judgements of both men and women. Further, these results suggest the presence of a cognitive schema in which the relative size of males and females is taken into account when making social judgements based on eating behavior. Work that does not take this schema into account is more likely to produce results suggesting a double-standard for eating behavior based on gender.
  • Article
    Objective Recent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada. Method: Among a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype could be distinguished from the nonpurging group on a variety of parameters of comorbidity, family history, and childhood environment. Results: The purging subtype was distinguishable on the basis of early age of onset, and high rates of affective disorders and anxiety and alcoholism, sexual abuse, and parental discord. Discussion: The data support the taxonomy and point to the need for better understanding of the meaning of purging behavior. © 1996 by John Wiley & Sons, Inc.
  • Article
    An investigation of current American society's depiction of the ideal female body was performed. Body measurements of Playboy magazine centerfolds and Miss America contestants for 1979-1988 indicated body weight 13-19% below expected weight for women in that age group. Miss America contestants showed a significant decrease in expected weight between 1979 and 1988. Comparisons were made with an earlier study which had demonstrated that body measurements of both groups had decreased during the period 1959-1978. Diet-for-weight-loss and exercise articles in six women's magazines were tabulated for 1959-1988. A significant increase in both diet articles and exercise articles occurred during this period. These findings suggest that the overvaluation of thinness continues and thinness is now sought through both dieting and exercise.
  • Article
    Objective: This study examined the importance of potential risk factors for eating disorder onset in a large multiethnic sample followed for up to 3 years, with assessment instruments validated for the target population and a structured clinical interview used to make diagnoses. Method: Participants were 1,103 girls initially assessed in grades 6-9 in school districts in Arizona and California. Each year, students completed the McKnight Risk Factor Survey, had body height and weight measured, and underwent a structured clinical interview. The McKnight Risk Factor Survey, a self-report instrument developed for this age group, includes questions related to risk factors for eating disorders. Results: During follow-up, 32 girls (2.9%) developed a partial- or full-syndrome eating disorder. At the Arizona site, there was a significant interaction between Hispanics and higher scores on a factor measuring thin body preoccupation and social pressure in predicting onset of eating disorders. An increase in negative life events also predicted onset of eating disorders in this sample. At the California site, only thin body preoccupation and social pressure predicted onset of eating disorders. A four-item screen derived from thin body preoccupation and social pressure had a sensitivity of 0.72, a specificity of 0.80, and an efficiency of 0.79. Conclusions: Thin body preoccupation and social pressure are important risk factors for the development of eating disorders in adolescents. Some Hispanic groups are at risk of developing eating disorders. Efforts to reduce peer, cultural, and other sources of thin body peeoccupation may be necessary to prevent eating disorders.
  • Article
    Eating disorders, such as anorexia nervosa (AN) and bulimia nervosa (BN), have genetic and environmental underpinnings. To explore genetic contributions to AN, we measured psychiatric, personality and temperament phenotypes of individuals diagnosed with eating disorders from 196 multiplex families, all accessed through an AN proband, as well as genotyping a battery of 387 short tandem repeat (STR) markers distributed across the genome. On these data we performed a multipoint affected sibling pair (ASP) linkage analysis using a novel method that incorporates covariates. By exploring seven attributes thought to typify individuals with eating disorders, we identified two variables, drive-for-thinness and obsessionality, which delimit populations among the ASPs. For both of these traits, or covariates, there were a cluster of ASPs who have high and concordant values for these traits, in keeping with our expectations for individuals with AN, and other clusters of ASPs who did not meet those expectations. When we incorporated these covariates into the ASP linkage analysis, both jointly and separately, we found several regions of suggestive linkage: one close to genome-wide significance on chromosome 1 (at 210 cM, D1S1660; LOD = 3.46, P = 0.00003), another on chromosome 2 (at 114 cM, D2S1790; LOD = 2.22, P= 0.00070) and a third region on chromosome 13 (at 26 cM, D13S894; LOD = 2.50, P = 0.00035). By comparing our results to those implemented using more standard linkage methods, we find the covariates convey substantial information for the linkage analysis.
  • Article
    Full-text available
    Explores why women in general are more prone to develop bulimia than men and which women in particular have a higher risk of becoming bulimic. Risk factors for bulimia are discussed in terms of sociocultural variables, such as the central role of beauty in the female sex-role stereotype; developmental processes; psychological variables; and biological factors, including genetic determinants of weight, the disregulation of body weight and eating through dieting, affective instability, and family variables. The sociocultural and psychological mediators that contribute to the increased risk of bulimia in this era are discussed, including a shift toward an increased emphasis on thinness, the effects of media attention on dieting and bulimia, fitness, and shifting sex roles. Results indicate that female socialization is a major contributing factor in bulimia. Although significantly fewer men than women currently show evidence of bulimia, it is hypothesized that the general pressure on men to become conscious of physical fitness and appearance, together with certain male subcultures that emphasize weight standards, will lead to an increased incidence of bulimia in men. (5½ p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Eating disorders have been studied extensively over the past several decades, yet research of their etiology has lagged behind treatment outcome research. This article reviews the challenges inherent in this research. It illustrates the epidemiologic designs that have been used to test risk factor hypotheses and describes the major studies designed to answer the question of what causes eating disorders. It points to significant gaps in knowledge, chief among them the absence of representative data on prevalence and correlates of eating disorders, and the lack of data regarding eating disorders in ethnic minority populations.
  • Article
    Objectives of review. This chapter reviews articles published in 2005 and 2006 on the influence of culture, ethnicity and gender on eating disorders. Specific social environmental factors, including media portrayals of body ideals and peer and family environment, are also reviewed. Summary of recent findings. Certain non-Western values may increase the risk of eating disorders. Ethnicity and gender may moderate associ- ations between risk factors and disordered eating. The media promote different body image ideals for women and men that may contribute to gender differences in the rates and expression of eating disorders. Peers and family translate broad cultural values into personally relevant ideals that influence behavior. Future directions. Much of the research on sociocultural factors remains focused on the role of the thin ideal. Future work could examine the influence of collectivism, anonymity, and shifts from multigenerational to predominantly peer social environments as possible sociocultural factors that increase the risk of eating disorders.
  • Article
    Although laboratory experiments indicate that brief exposure to thin models leads to acute body dissatisfaction and negative affect in women, research has not tested whether longer term exposure results in lasting effects. Accordingly, we randomly assigned 219 adolescent girls to a 15-month fashion magazine subscription or a no-subscription condition and followed them over time. Despite evidence that the experimental manipulation successfully increased exposure to the fashion magazine and the ample statistical power, there were no main effects of long-term exposure to thin images on thin-ideal internalization, body dissatisfaction, dieting, negative affect, or bulimic symptoms. However, there was evidence that vulnerable adolescents, characterized by initial elevations in perceived pressure to be thin and body dissatisfaction and deficits in social support, were adversely affected by exposure to these images. Results suggest that exposure to thin-ideal images has lasting negative effects for vulnerable youth.
  • Chapter
    Debate Question The economic transformation in Eastern Europe following the decline of communism and the adoption of a market philosophy is bound to affect women's perception of themselves and of their societal roles. This theoretically should increase their confusion over gender roles and subsequently their propensity to develop eating disorders.
  • Article
    Background: Women who have anorexia nervosa may experience difficulties with fertility and reproduction. Method: We examined fertility and reproductive history in 66 women who had a history of anorexia nervosa (DSM-III-R) and 98 randomly selected community controls as part of a follow-up investigation examining the course of anorexia nervosa. Results: Although women with a history of anorexia nervosa and controls did not differ on rate of pregnancy, mean number of pregnancies per woman, or age at first pregnancy, women with anorexia nervosa had significantly more miscarriages and cesarean deliveries, and the offspring of women with anorexia nervosa were significantly more likely to be born prematurely and were of lower birth weight than offspring of controls. There were no differences between women with active versus remitted anorexia nervosa on any of these measures; however, offspring of anorexic women with no history of bulimia nervosa had significantly lower body weight than offspring of anorexic women with a lifetime history of bulimia nervosa. Conclusion: Our results argue for intensive prenatal care for women with both active and remitted anorexia nervosa to ensure adequate prenatal nutrition and fetal development.
  • Article
    Examined the prevalence of comorbid psychopathology, family psychiatric history, and perceptions of family environment in 20 women with binge-eating disorder (BED) and 20 non-binge-eating obese controls. Women with BED were significantly more likely to report current or lifetime affective and anxiety disorders as well as family histories of BED. Family histories of substance abuse did not differ across groups. Significantly more women with BED rated their parents' parenting style as consistent with "affectionless control" on the Parental Bonding Instrument (G. Parker et al, 1979), and reported significantly lower cohesion, expressiveness, conflict, independence, intellectual-cultural orientation, and active-recreational orientation on the Family Environment Scale. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    This study extends the literature on eating disorder symptomatology by testing, based on extant literature on objectification theory (B. L. Fredrickson & T. Roberts, 1997) and the role of sociocultural standards of beauty (e.g., L. J. Heinberg, J. K. Thompson, & S. Stormer, 1995), a model that examines (a) links of reported sexual objectification experiences to eating disorder-related variables and (b) the mediating roles of body surveillance, body shame, and internalization of sociocultural standards of beauty. Consistent with hypotheses, with a sample of 221 young women, support was found for a model in which (a) internalization of sociocultural standards of beauty mediated the links of sexual objectification experiences to body surveillance, body shame, and eating disorder symptoms, (b) body surveillance was an additional mediator of the link of reported sexual objectification experiences to body shame, and (c) body shame mediated the links of internalization and body surveillance to disordered eating. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria.Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0·456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely nonspecific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
  • Article
    Various factors have been implicated in the development of body image dissatisfaction. Especially important are three constructs: awareness of a thin ideal, internalization of a thin ideal, and perceived pressures to be thin. Using meta-analysis, we calculated the strength of the relationships between each of these constructs and body image, and we evaluated the differences in magnitude across the average effect sizes. We also tested the moderating effects of age and ethnicity, and we compared the average effect sizes with those from meta-analyses of prospective and experimental studies in order to determine whether the effect sizes differed by study design. The results indicated the following: all three sociocultural factors had statistically significant relationships with body image; internalization and perceived pressures have a significantly stronger relationship to body image than does awareness; the effect sizes from cross-sectional studies were significantly larger than those of both longitudinal and experimental studies; and neither age nor ethnicity was a statistically significant moderator of the relationship between awareness and body image or that between internalization and body image. In this article, we discuss the limitations and implications of the findings on future research, theory, and clinical application.
  • Article
    Objective The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).Method Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained.ResultsThe participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic—strictly empirically based—model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder.Conclusion Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome. © 2005 by Wiley Periodicals, Inc.
  • Article
    Full-text available
    Objective Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted.Method The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders.DiscussionOn the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 1–20, 2000.
  • Article
    Recent research on anorexia nervosa (AN) has focused on examining the genetic underpinnings of its etiology. The current article reviews molecular genetic studies that have focused on this aspect of AN development. Medline and PsychInfo literature searches, in addition to close inspection of study reference sections, were used to identify studies that examined the genetic diathesis for AN. Findings from association studies indicate some role for the serotonin system in the development of AN. Genomic regions on chromosomes 1 and 10 are also likely to harbor susceptibility genes for AN as well as a range of eating pathologies. Findings corroborate those of neurobiologic studies suggesting that alterations in serotonergic functioning may contribute to the pathogenesis of AN. Nonetheless, future molecular genetic research would benefit from larger and more sustained investigations of candidate genes in homogeneous phenotypes. © 2005 by Wiley Periodicals, Inc.
  • Article
    Because of the growing prevalence of obesity among children and adolescents, increased attention is being directed toward its prevention. An important question is: Can we simultaneously work toward the prevention of obesity and eating disorders? To address this question, we need to determine (a) if there is a need for integrated approaches; (b) if we can bridge the fields of obesity and eating disorders; (c) if we can foster the development of environments that promote healthy eating and physical activity choices and the acceptance of diverse body shapes and sizes; and (d) if we can work toward the development of interventions that have relevance to a broad spectrum of weight-related conditions and behaviors. © 2005 by Wiley Periodicals, Inc.
  • Article
    Objective: This study investigates the longitudinal course of eating problems from childhood though adulthood. The following questions are answered: (1) How stable are eating disorder symptoms and diagnoses over a 17-year interval from childhood to adulthood? (2) Do early childhood eating problems predict the occurrence of eating disorders in adulthood? Method: An epidemiologically selected sample of approximately 800 children and their mothers received DSM-based structured psychiatric assessments in 1975, 1983, 1985, and 1992. The stability of full DSM diagnostic criteria for anorexia nervosa and bulimia nervosa, symptom scales derived from DSM criteria, and individual symptoms such as binge eating or dieting between early adolescence, late adolescence, and young adulthood was examined. Results: Early adolescent bulimia nervosa is associated with a 9-fold increase in risk for late adolescent bulimia nervosa and a 20-fold increase in risk for adult bulimia nervosa. Late adolescent bulimia nervosa is associated with a 35-fold increase in risk for adult bulimia nervosa. Symptom scale scores for anorexia nervosa and bulimia nervosa correlate in the 0.3 to 0.5 range from early to late adolescence and young adulthood. For both anorexia nervosa and bulimia nervosa, gender, as well as eating symptoms at early and late adolescence, all predict young-adult eating disorder symptoms. Risk factors for the later development of eating disorders comprise eating conflicts, struggles with food, and unpleasant meals in early childhood. Conclusion: The presence of eating problems in early childhood or an eating disorder in adolescence confers a strong risk for an eating disorder in young adulthood.
  • Article
    Current psychological theories on anorexia nervosa share a common assumption that symptoms of the condition are related to cultural factors. The present article argues that the disorder can be fruitfully understood in the context of one definition of culture-bound syndromes. By way of introduction two contrasting models of the cross-cultural study of psycho-pathology are outlined in order to contextualize the agrument in a particular paradigm. Anorexia nervosa is shown to fit the criteria of the Cassidy/Ritenbaugh definition of culture-bound syndromes, and the definition is shown to have some use in elucidating issues.Implications for a more flexible approach to theory development and therapeutic practice are discussed, and suggestions are made for further work demonstrating the negotiated nature of the disorder.
  • Article
    It is well known that obtaining adequate statistical power to detect linkage to or association with genes for complex quantitative traits can be very difficult. In response, investigators have developed a number of power-enhancing strategies that consider restraints such as genotyping (and/or phenotyping) costs. In the context of both association and sib pair linkage studies of quantitative traits, one of the most widely discussed techniques is the selective sampling of phenotypically extreme individuals. Several papers have demonstrated that such extreme sampling can markedly increase power (under certain circumstances). However, the parenthetical phrase in the previous sentence has generally not been made explicit and it appears to be implied that the more phenotypically extreme the individuals, the more power one has. In this paper, we show by simulation that this is not true under all circumstances. In particular, we show that under oligogenic models, where some biallelic quantitative trait loci (QTLs) have markedly asymmetric allele frequencies and large mean displacement among genotypes, and others have less asymmetric allele frequencies and smaller mean displacement among genotypes, power to detect linkage to or association with the latter QTL can actually decrease by sampling more extreme sib pairs. This suggests that more extreme sampling is not always better. The 'optimal' sampling scheme may depend on both what one suspects the underlying genetic architecture to be and which of the oligogenic QTL one has greatest interest in detecting.
  • Article
    Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient's healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide. A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.
  • Article
    Full-text available
    The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes. Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria. Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability. The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.
  • Article
    Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.
  • Article
    Background. Many human fetuses and infants have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension. Coronary heart disease. We have become accustomed to the idea that coronary heart disease, the commonest cause of death in the Western world, may result from the “unhealthy” lifestyle that is associated with increasing affluence. The influences of this “unhealthy” lifestyle (e. g. obesity, cigarette smoking, dietary fat, stress), however, go only a small way towards explaining why increasing affluence in the Third world is so regularly followed by epidemics of the disease, or why in the Western world these epidemics have risen steeply to become the commonest cause of death but thereafter have declined. Neither do they explain why the highest rates of coronary heart disease in Western countries occur among the poor? Fetal origins. Answers to these questions may come from an understanding of how the structure of the heart and processes such as blood pressure regulation and the way the body handles sugar and fat are established in the womb. The “fetal origins” hypothesis states that coronary heart disease and the disorders related to it – hypertension, adult-onset diabetes and stroke – originate through adaptations that the fetus makes when it is under-nourished. Unlike adaptations made in adult life those made during early development tend to have permanent effects on the body's structure and function – a phenomenon sometimes referred to as programming. They allow the fetus to survive and continue to grow but at the price of a shortened life.
  • Article
    The concept culture-bound syndrome' (CBS) is elusive. In this paper an attempt has been made to tie the concept down more firmly by proposing a strict definition, examining the appropriateness of this definition in determining the CBS status of two new syndromes (anorexia nervosa and brain-fag) and analysing the usefulness or not of the basic CBS concept. A CBS is defined as a collection of signs and symptoms of disease (not including notions of cause as recently proposed in the anthropological literature) which is restricted to a limited number of cultures by reason of certain of their psychosocial features. Anorexia nervosa appears to fit the definition but further empirical evidence is required to assure that the illness is restricted to Western cultures or cultures strongly influenced by them. The question of the CBS status of brain-fag demonstrates the need to clearly differentiate such disease features as symptom clusters, labels for those clusters, and notions of etiology. Failure to keep such features distinct has led to considerable controversy, but if the proposed definition is strictly adhered to, brain-fag does qualify for the CBS designation. As regards the usefulness of the CBS concept, it is proposed that the question hinges upon whether CBS's signal a difference that makes a difference. It is demonstrated that the CBS concept is useful for medical anthropologists or transcultural psychiatrists who are concerned about relationships between symptom patterns and cultural processes. It is also useful to epidemiologists who, for example, may be interested in estimating the prevalence of depression; it is important to know that they must count some cases of CBS's along with cases of depression with a more typically Western symptomatology. The concept may be redundant for psychopharmacologists who find that they successfully treat many different culture bound syndromes with the same drugs.
  • Article
    A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.
  • Article
    The study examined influences on body satisfaction, disordered eating, and exercise behavior of a male subculture that places a heightened emphasis on appearance: the homosexual male subculture. Subjects were 71 homosexual and 71 heterosexual men. Relative to heterosexual men, homosexual men showed more body dissatisfaction and considered appearance more central to their sense of self. Also, their exercise was more motivated by a desire to improve attractiveness. Among the homosexual but not the heterosexual group, men who desired to be thinner showed more attitudes and behaviors associated with disordered eating than men who were thinner than their desired size. In contrast, heterosexual but not homosexual men who wished to be heavier had lower self-esteem scores than men who were heavier than or equal to their desired size. The findings support a view that a male subculture that emphasizes appearance may heighten the vulnerability of its members to body dissatisfaction and disordered eating.
  • Article
    Using the family history method, we assessed the morbid risk for psychiatric disorders in the first-degree relatives of 69 probands with bulimia, 24 probands with major depression, and 28 nonpsychiatric control probands. The morbid risk for major affective disorder among the first-degree relatives of the bulimic probands was 32%, significantly greater than that found in the nonpsychiatric control probands. The rate of familial major affective disorder was significantly greater in bulimic probands who had a history of major affective disorder themselves than in bulimic probands without such a history - but the latter group, in turn, displayed significantly higher rates than the nonpsychiatric control probands. Eating disorders were slightly, but not significantly, more prevalent in the families of bulimic probands than nonpsychiatric control probands. We present two alternative hypotheses which might explain these findings.
  • Article
    We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
  • Article
    The incidence of mother-blaming in major clinical journals was investigated for the years 1970, 1976, and 1982 to determine whether reductions have resulted from the efforts of the women's movement. Very few changes were found across the target years, and mother-blaming was only slightly affected by type of journal and by sex of author.
  • Article
    The 420 first-degree relatives of 14 patients with anorexia nervosa, 55 patients with bulimia, and 20 patients with both disorders were evaluated for the presence of psychiatric illness, using DSM-III criteria, by the family history method. The morbid risk for affective disorder in the families of the eating disorder probands was similar to that found in the families of patients with bipolar disorder; but was significantly greater than that found in the families of patients with schizophrenia or borderline personality disorder. These results add to the growing evidence that anorexia nervosa and bulimia are closely related to affective disorder.
  • Article
    The purpose of this study was to examine the incidence of anorexia nervosa and bulimia nervosa among patients in primary care and to evaluate the impact of urbanization, age and sex differences, and changes over time. During 1985-1989, 58 general practitioners, trained in diagnosing eating disorders, registered all of their patients who had diagnoses of anorexia nervosa and/or bulimia nervosa according to strict criteria. The study population (N = 151,781) was 1% of the population of the Netherlands; the distribution of sexes, ages, geographical locations, and degrees of urbanization in the study group was representative of the Dutch population. Main outcome measures were rates of newly detected cases and age-adjusted rate ratios. The crude annual incidence rate of detected cases in primary care per 100,000 person-years was 8.1 for anorexia nervosa and 11.5 for bulimia nervosa. The incidence of bulimia nervosa was lowest in rural areas, intermediate in urbanized areas, and highest in large cities (6.6, 19.9, and 37.9, respectively, per 100,000 females per year); no rural-urban differences for anorexia nervosa were found. Pronounced sex and age differences in incidence rates were observed. Over the 5-year period, there was no time trend in the incidence of anorexia nervosa, but the incidence of bulimia nervosa tended to increase. The incidence rates of eating disorders--as defined by detection rates in primary care--are higher than previously reported. Urbanization seems to be a risk factor for bulimia nervosa but not for anorexia nervosa.