Relationship Between Environmental Factors and Anorexia Nervosa in Adolescent Girls

Relationship Between Environmental Factors and Anorexia Nervosa in Adolescent Girls Anorexia nervosa (AN) is a visible, psychological illness that is detrimental to both the physical and mental well-being of an individual (Bulik et al.

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, 2005). It is an eating disorder that is characterized by not only an unwillingness to gain weight, but a fear of gaining weight. Individuals suffering from anorexia are often perfectionists, who are neurotic, obsessive, and retain a low sense of self-esteem (Kaye et al. , 2008; Bulik et al. , 2005).

These individuals tend to prioritize their physical image over their health, and as a result, AN has retained the highest mortality rate over any other psychiatric illness, occurring at a prevalence of 5% per decade of the entire human population (Bulik et al. , 2005). It has also been observed that the occurrence of anorexia nervosa is significantly greater in the female population when compared to the occurrence in the male population, with the average age of onset starting between 15 and 19 years old (Bulik et al. , 2005).

The direct cause of AN is unknown, but through excessive amounts of scientific exploring, many researchers have concluded that anorexia is influenced by both genetic and environmental factors, categorizing it as a familial disease (Kaye et al. , 2008). This positive correlation between gene-environment is often seen in offspring of parents who previously suffered from AN. They are seen as having a “double disadvantage,” as not only do they inherit the unidentified genes that increase the risk of AN, but they are exposed to an environment which increases the chances of the expression of those genes linked with anorexia (Bulik et al. 2005). This does not necessarily mean that all individuals who suffer from this eating disorder are predisposed to having AN, as the influence of environmental factors are much greater than that of genetic influence. In the study done by Peterson, Paulson & Williams (2007), they examined the three most influential factors that are associated with the development of anorexia in adolescents: maternal influence, peer influence, and media influence. More importantly, they wanted to find out to what extent is each sociocultural influence associated with the development of eating disorders and the patterns of relation between each factor.

In this quantitative study, 333 adolescent girls and boys, grades 10-12, from a public high school in suburban Detroit made up the sample. Eating disorder symptoms were assessed using two tests: the Eating Attitudes Test (EAT) and the Eating Disorder Inventory-Second Edition (EDI-2). In this study, the bulimia category of the EDI-2 was disregarded as it overlaps with the bulimia subscale in the EAT. The influence of a sociocultural factor was evaluated using The Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3), which was developed by Thompson and van den Berg (2004).

The SATAQ-3 was originally developed to assess the pressures of media, but researchers in this study modified it to also assess the pressures from mothers and peers, using a 5-point Likert-type scale for the adolescents to answer the questions. Results showed that on average, female adolescents had a greater desire to diet and strive for thinness than male adolescents, and their level of body dissatisfaction was larger on average as well (Peterson et al. , 2007).

The maternal and media influence was not as great in boys as it was in girls, and the perceived pressures by peers was equal in both sexes, having little to no influence (Peterson et al. , 2007). Peterson, Paulson & Williams (2007), concluded that maternal and media pressures in adolescent females is strong and due to these strong influences, females often lack body satisfaction, a result of low self-esteem, and strive to be more physically attractive. In order to satisfy the image expected by the environment around them, these females are then more likely to diet, and engage in anorexic behaviors.

Another important factor, which plays a relevant role in the development of anorexia, is self-esteem, as lack of self-esteem seems to be one of the main reasons women strive to be thin. Using a quantitative method, Karpowicz, Skarsater and Nevonen (2009) examined the changes in self-esteem of patients treated with anorexia nervosa, before and after treatment. 38 young female patients, ages 16 to 25, being treated for anorexia at Queen Silvia Children’s Hospital, were included in this study. All participants of this study had previously been diagnosed with AN according to the DSM-IV.

Assessment of self-esteem was conducted before treatment and after treatment using the Rosenberg Self-Esteem Scale (RSE-S), which is comprised of ten questions about the patient’s self-image: five negative and five positive. The EDI-2 was also used to evaluate self-esteem of the female patients, with the bulimia subscale disregarded. The outcomes of the two questionnaires showed significant improvement in a patient’s self-esteem between the pre-treatment assessment and the post-treatment assessment (Karpowicz et al. , 2009).

The results concluded that an individual suffering from anorexia had very high body dissatisfaction and weight phobia before treatment- a result of low self-esteem- but after three months of intense treatment, both body dissatisfaction and weight phobia diminished, and self-esteem increased, resulting in a positive correlation between overcoming anorexia and self-esteem (Karpowicz et al. , 2009). This allowed Karpowicz et al. (2009) to summarize that low self-esteem is a very important factor in developing AN. Rothschild-Yakar et al. 2010), chose to do additional research on how relationships with parents act as a precursor of disordered eating. They also believed that lower mentalization ability was a factor that made individuals more vulnerable to anorexia nervosa (Rothschild-Yakar et al. , 2010). In this study, 34 female patients who had previously been diagnosed with AN using the DSM-IV made up the experimental group. The control comprised of 35 female high school students that had no history of an eating disorder, and individuals who scored below 20 in the EAT.

The QRI, created by Pierce (1994), measured quality of relationships and was administered twice, once regarding maternal relationship and once regarding paternal relationship. Two subscales- drive for thinness and bulimia- from the EDI-2 was used to measure anorexia symptoms. Results demonstrated that AN patients showed a lower capacity for mentalization when compared to the control group, and they also reported to have less support and greater conflict in parental relationships (Rothschild-Yakar et al. , 2010). The data that Rothschild-Yakar et al. 2010) obtained are similar to previously researched outcomes by Peterson et al. (2007), showing that maternal and paternal relationships are important in preventing anorexia behaviors in female adolescents, especially maternal relationships, as the associations between father-child relationships have been seen as protecting females from developing eating disorder symptoms. This led them to the conclude that strong maternal pressures had a great impact on an adolescent female’s chances of developing AN (Rothschild-Yakar et al. , 2010). As summarized by Peterson et al. 2007), media influence has a strong impact on an adolescent’s perception of body image. Harrison and Hefner (2006), further investigated how early media exposure can have a significant role in young females later on in life, with relation to their body ideals. A sample of 257 second, third, and fourth grade girls took part in this study. Each girl’s perception of body ideals was measure by two pictorial scales: one of prepubescent female children, and one of sexually mature female adults. Each scale featured seven body types ranging from very thin to very fat.

The children were asked to pick the body types that represented how they currently look, how they would like to look currently, and how they want to look when they are fully mature adults. Instead of using the EAT to measure disordered eating symptoms, the Children’s Eating Attitudes Test (ChEAT), a modified version of the EAT (Maloney et al. , 1988), is used instead. To measure the amount of media exposure, participants were asked to report how many hours of television they watched, and a weekly television-viewing index was computed.

Magazine exposure was measured the same way. The data was collected in two waves, each wave a year apart from the other. Harrison and Hefner (2006), found that, in both waves, television viewing was a stronger predictor of a girl’s future body ideal, than their current body ideal, and greater television viewing led to a thinner future body ideal. The average body ideal was very thin, ranging between the second and third body figures out of seven, indicating that girls wish to be thinner, even before they hit puberty (Harrison & Hefner, 2006).

There is little evidence that preadolescent girls engage in disordered eating behaviors in order to achieve a thinner body, but research evidence proves that increased media exposure does lead to a desire for a thinner body in preadolescent girls (Harrison & Hefner, 2006). These results allow Harrison and Hefner (2006), to conclude that media exposure does not have an effect on the current body ideals of young girls, but instead, on their future body ideals. This pressure from the media on future body ideals may act as predictors of disordered eating in the future, when the girls are adolescents (Harrison & Hefner, 2006).

Contrary to the other four quantitative research strategies discussed in this paper, the study done by Nilsson et al. (2007) uses a qualitative method that focuses on why former anorexia nervosa patients believe they developed an eating disorder. The study includes women who had previously been diagnosed with AN- using the DSM-IV- during adolescence and who had gone through treatment and recovered from AN. The interviews with these women took place 8 years and 16 years after treatment.

They were asked a very open ended question: “what do you think today about the reasons why you got anorexia nervosa? ” in both the first and second follow-up. The results were sorted into subcategories: four concerning self-image, three regarding familial influence, and four considering sociocultural influence. The self-image subcategories included things that had to do with the individual’s perception of their image: self demands of being perfect, low-self esteem, dieting/body dissatisfaction, and development of physical or mental symptoms.

Familial influences were divided into: difficulties with family interaction and communications, high demands from family members and stressful family events. Peer and bullying problems, moving and separation from friends, bad situations at school, and sports, were categories sorted in the sociocultural influences. Overall, the interviews showed that the women believed self-image had the greatest impact as to why they developed anorexia; as each woman’s own demands for perfection and lack of self-esteem is what caused them to engage in anorexic behaviors (Nilsson et al. , 2007).

The second greatest factor that was believed to have the most impact on anorexia was familial influences, specifically stressful events in the family, and the lack of family interaction and communication (Nilsson et al. , 2007). The study led by Nilsson et al. , provided insight into the causes of AN, through the view of someone who suffered from the illness. In the research studies discussed, eating disorder symptoms were assessed using multiple tests. The first one is the Eating Attitudes Test (EAT), a test developed by Garner and Garfinkel (1979), assessing dieting, bulimia and oral control of the individual.

The second test is the Eating Disorder Inventory-Second Edition (EDI-2), a test developed by Garner and Olmsted (1984), assessing bulimia, body dissatisfaction, and drive for thinness. Both tests consist of questions that are answered using a 6-point Likert-type scale, ranging from never to always (Garner & Garfinkel, 1979; Garner & Olmsted, 1984). The third test used in the majority of the studies is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), developed by the American Psychiatric Association (2000), which is used to diagnose anorexia nervosa.

The use of standardized tests in these five articles increases the validity of the results, as there is a consistency between the articles. Although Harrison and Hefner (2006) modified the EAT to accommodate the age of their participants, the results of the ChEAT is still just as valid as the EAT, as the ChEAT was only modified to help the younger girls better comprehend the questions (Harrison & Hefner, 2006). The results of the study done by Nilsson et al. (2007), is supported by the conclusion of Peterson et al. 2007), as they both found that parental pressures and self-esteem played the greatest role the development of anorexic behaviors. The findings of Rothschild-Yakar et al. (2010) and Karpowicz et al. (2009), also support the claims found by Peterson et al. (2007), regarding a connection between parental influence and self-esteem as predictors of disordered eating, leading to anorexia. Harrison & Hefner’s study (2006) is also in accordance with the analysis done by Peterson et al. (2007), as both studies concluded that pressures from the media play a large role in the development of anorexia.

None of the studies mentioned previously in this paper were able to consider factors such as race, and how racial profile influences an individual’s likeliness to exhibit anorexic behaviors, as racial background has been found to be an important indicator of differences between self-esteem of young females (Thompson et al. , 1997). The next logical step in anorexia nervosa research would be doing a mixed method longitudinal study of how early media exposure, familial influences, and racial background affects a large group of preadolescent girls’ self-esteem.

By investigating how those three environmental factors increase the likelihood of the girls displaying anorexic symptoms, as they become adolescents and young women, it could help with future prevention and treatment programs. Based on the future directions of anorexia nervosa research, a reasonable research question would be: How does early media exposure and different racial backgrounds affect an adolescent female’s self-esteem and their risk of developing anorexia nervosa, also taking into account whether the girl is in a traditional family setting (i. e. ne male parent married to a female parent), or a non traditional family setting (i. e. divorced parents)? The population of adolescent females is chosen not only to maintain consistency with the discussed articles in this paper, but because it has been found that females are more susceptible to the disorder when compared to males and the average age of onset for anorexia is during adolescence (Bulik et al. , 2005). Media exposure and family influences were chosen because it has been found that both media and family are the most significant when evaluating environmental factors (Peterson et al. 2007; Rothschild-Yakar et al. , 2010). Family setting was added to observe how important family communication, interaction and events are as roles in AN development. The last factor, racial background, is added to the model because none of the above studies were able to incorporate how race influences body image into their research. Since different races each have their own unique perspectives of an ideal body type, by adding racial background, it would help researchers recognize which groups of individuals are most susceptible to the disease (Thompson et al. 1997). Measurement using self-esteem was chosen, as it was found in previous studies that females with lower self-esteems are more at risk for AN (Karpowicz et al. , 2009). Today, women are convinced that the thinner body ideal is more attractive, all the while living in a society in which obesity is not only abundant and increasing (Karpowicz et al. , 2009). By further researching the factors that influence the development of AN, it can help prevent, as well as develop better treatment for the disorder.

Anorexia is something that can be prevented, and perhaps by distinguishing the population that is most susceptible to the illness, the mortality and occurrence of this disorder can be decreased significantly. References: American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. , text revision). Washington, DC: American Psychiatric Association. Bulik, C. M. , Reba, L. , Siega-Riz, A. , & Reichborn-Kjennerud, T. (2005). Anorexia nervosa: definition, epidemiology and cycle of risk.

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Relationship Between Environmental Factors and Anorexia Nervosa in Adolescent Girls. (2017, Dec 07). Retrieved from

Relationship Between Environmental Factors and Anorexia Nervosa in Adolescent Girls
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