Mental health articles

Socio-cultural factors

‘Thin is attractive.’ People with both anorexia and bulimia place a prime importance on shape and weight, probably because of a more general cultural emphasis placed on physical appearance within Western society. Images of femininity and female attractiveness have shifted since the 1960s to a slimmer, less ‘hour-glass’ shape. The classic ‘figure’ portrayed in Playboy magazine, for example, slimmed during the 1990s, with smaller hips, waist and bust measurements. Not surprisingly, the prevalence of low body weight and eating disorders is particularly high among those groups where physical attractiveness or performance is placed at a premium, such as models, dancers and athletes. As social groups develop positive attitudes towards thinness, levels of eating disorders rise within them.

In the USA, for example, as a high value on thinness has shifted from white upperclass women to those in the lower socio-economic groups and other ethnic groups, so has the prevalence of dieting and eating disorders. Judgements based on weight are not only aesthetic; attributions of a variety of personal attributes can be based on the appearance of the individual. Food, eating and weight are seen by many as moral issues, and body shape can be a major criterion of self- and other-evaluation; many people hold prejudicial views against overweight individuals. Over half the families in which an individual develops an eating disorder are likely to place a strong emphasis on weight and shape. They are also likely to come from families with high levels of negative affect and discord and have mothers who are perfectionist. Successful dieting may be one way of gaining acceptance from parents with high aspirations, particularly where the child has not ‘succeeded’ in other life domains. Not eating may make an individual important within the family, and give them some degree of control over other family members (‘I’ll eat if you  .  .  .’). It may also provide a means of punishing them (‘I’m not eating because you  .  .  .’). A second consequence of anorexia is that it can lead the individual to be treated as a child, and allow them to avoid the responsibilities they would otherwise have to face; again, this may be most infl uential in families where there is a high emphasis on achievement. A completely different model of anorexia is afforded by some family therapists, in which the person with anorexia is viewed as a symptom of a dysfunctional family. Minuchin et al. defined the characteristic of ‘anorexic families’ as being enmeshed, overprotective, rigid and confl ict-avoidant. That is, there is confl ict between parents which is controlled and hidden. According to Minuchin et al., adolescence is a stressful time for such families, as the adolescent’s push for their independence within the family increases the risk of the parental confl ict being exposed. The development of anorexia prevents total dissension within the family, and may even hold it together as the family unites around the ‘identifi ed patient’. The presentation of the young person as weak and in need of family support ensures that they become the focus of family attention and defl ects it away from parental confl ict. Evidence for this theory is mainly based on the clinical experience of the Minuchin group of family therapists.

A final socio-cultural model suggests that both anorexia and bulimia may occur as a result of sexual abuse. According to this model, abuse results in the adolescent girl having strong negative attitudes towards her femininity, resulting in a rejection of the typical feminine shape and attempts to avoid it. This is most likely to occur around puberty. The evidence for this is not strong. Even though rates of sexual abuse are relatively high among people with eating disorders, it is not a defi ning characteristic, as they are no higher than those among people with mood, anxiety and other psychological disorders.

Tags: anorexia, bulimia, cultural, social