Eating Disorders in Women
While it is beyond the scope of this paper to cover eating disorders in their
entirety, a brief review of the literature shows that the most prevalent (and
deadly) form of eating disorders is purging anorexia. In fact, some experts have
argued that the present form of classification, which focuses on anorexia and
bulimia as separate entities would be more descriptive for mental health professionals
and include more women if the focus was changed to restrictive type anorexia and
purging type anorexia, with bulimia as an antecedent to purging anorexia. A longitudinal
study of 136 women seeking treatment for anorexia and bulimia found that at the
8 year follow-up, all women with bulimia had experienced dangerous episodes of
food restriction, and only 12% of women with anorexia had never reported binge/purge
behaviors (Eddy, Keel, Dorer, & Delinsky, 2002). Several other studies have
found similar results. The remainder of this discussion, therefore, will focus
on the symptomatology of anorexia nervosa, with the understanding that bulimia
nervosa is most often an antecedent to purging anorexia.
Historically, mental health issues that primarily affect women have received
little attention, although there have been some recent advances. Consistent and
competent research on anorexia nervosa has only begun to accumulate within the
past ten years. There are still significant gaps in knowledge and evidence of
prevalence rates, but a body of research is beginning to report significant evidence
of similarities in affective symptoms and factors that may contribute to anorexia
in women.
A construct known as "self-silencing", or internalizing feelings
and emotions has consistently been reported by women who suffer from anorexia
as a primary method of coping both before and during the development of their
anorectic symptoms (Role- Warren, 2001). Low self-esteem and a lack of belief
in their own self-worth, especially in regards to their ability to maintain primary
relationships, is also frequently reported. In order to deal with these internalized
emotions and lack of self-worth, women begin to restrict their food intake both
as a means of control and self-denial: self-denial because they feel unworthy,
and control to balance feeling out of control of their emotions and relationships.
Episodes of binging and purging often follow attempts at food restriction,
which results in immense feelings of guilt, shame, and self-blame. These negative
feelings lead to further attempts at food restriction, and the cycle is established:
feeling helpless and out of control, attempts to control through food restriction
and purging, guilt, shame and self-blame (Tiggemann & Raven, 1998).
As the cycle progresses, it becomes an ingrained, addictive strategy for dealing
with deep feelings of personal ineffectiveness and a nearly morbid fear of loss
of self-control. At this point, seeking help or treatment is not an option that
suffering women consider, as it would mean an admission that they are out of control.
Further barriers to treatment are societal and cultural attitudes, which promote
the "superwoman" stereotype, who denies her own needs, is in complete
control, and achieves an emaciated, artificial beauty through extreme control
of her appetites (Maine, 2001).
In summary, researchers find that anorexic women tend to internalize their
feelings, suffer from extreme fear of loss of self-control, have high levels of
guilt, shame and self-blame, low self-worth, and "self-treat" these
feelings with a cycle of food restriction and purging. There is a lack of social
support for these suffering women as well, which leads to less treatment.
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© Susan M. Sherman, 2002
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