Recovering from an eating disorder in a western culture

Women continue to be more likely to suffer from eating disorders than men (Hudson, Hiripi, Pope Jr., & Kessler, 2007) and the incidence amongst young women is increasing (Smink, van Hoeken, & Hoek, 2012). The core psychopathology of eating disorders is an over-evaluation of shape, weight and their control (Fairburn, 2008). This effectively means that women with eating disorders evaluate their self-worth largely (if not exclusively) in terms of shape and weight, and their ability to control them. Aspects of western culture fuel the notion that the self-worth of a woman is tied up in appearance, discipline, purification and fragility.

Popular western culture objectifies women and encourages scrutiny, manipulation and transformation of bodies. It is more likely, therefore, that women will internalise the ‘thin ideal’ (Thompson & Stice, 2001), a reference point used for evaluation via self-objectification. Self-objectification is where a woman takes an observer perspective of her body, seeing herself as an object, focusing on the imperfections (Fredrickson & Roberts, 1997). Self-objectification is a direct result of a culture of objectification and is thought to be a key mechanism that influences body-hatred and through which the messages from popular culture become harmful. Research affirms that social media, television and sexist advertising encourage objectification and body comparison and therefore impact negatively on body satisfaction, self-esteem (Bardone-Cone & Cass, 2007; Tiggemann & Slater, 2013), the perception of heaviness in the body and lowered self-worth (Bardone-Cone & Cass, 2007), and influence eating behaviour (Smith, Hames, & Joiner Jr., 2013).

Gendered context plays a role in the development and maintenance of eating disorders. The recovery from eating disorders unavoidably occurs in this same context; a context which is incongruent with recovery-oriented values. It is important that psychologists, where possible, address gendered contexts and stereotypical misperceptions in the following ways:

• Be informed about cultural objectification and self-objectification contributing to the development and maintenance of body image and eating issues.
• Ask about the values that stem from a client’s own ethnic background, culture, faith and community, and their understanding of what it is to live well, what it means to be a woman, and how self-worth may be understood and accessed in different ways.
• Consider the stereotypes of eating disorders that nurture an objectification of a woman’s body and how they impact on the client. An example is making an assumption about a stage of recovery because they ‘don’t look anorexic anymore’.
• Enquire about the impact of pressures about weight and shape on a client’s day-to-day life. Concerns about shape and weight can underlie presentations of depression, social anxiety and other mental health disorders in women.
• Encourage clients to stop following blogs or posts that reinforce harmful cultural messages such as the need to discipline and alter the body. Encourage clients to focus instead on values-directed activities.
• Encourage others to avoid commenting on weight or appearance. For example, replacing ‘you look so healthy’ with ‘it's good to see you’. Those with anorexia interpret even ‘you look healthy’ as ‘you look really fat’ and saying, ‘I think you are losing weight’ can be received as a threat and trigger anxiety.
• Request publishers not use graphics that only serve to sensationalise eating disorders in some way and objectify a woman’s body further.
• Consider the ‘ever-changing’ body image in body-image research, rather than focusing on a single point in time. This may include considering factors that influence how a woman feels within her body, rather than reinforcing self-objectification by assessing how a woman sees her body. Research more about recovery stories and how people manage to recover; focusing on interpersonal and social influences, rather than reductionist explanations.

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