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1. Paper 2: Critical issue: Eating disordersModel AnswersClinical characteristics1. Explain what is meant by eating disorders (3)An eating disorder is a maladaptive or…
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  • 1. Paper 2: Critical issue: Eating disordersModel AnswersClinical characteristics1. Explain what is meant by eating disorders (3)An eating disorder is a maladaptive or dysfunctional relationship with food. Anorexia involves gross undereating while obesity can result from gross over-eating. Some sufferers go through a cycle of bingeing onlarge quantities of food and then purging through using laxatives or making themselves vomit and this isknown as bulimia.522. Explain what is meant by anorexia nervosa and bulimia nervosa (3+3)Anorexia has physical, emotional, cognitive and behavioural symptoms. The person’s body mass will be lessthan 85% of the expected weight for their height and may be suffering from malnutrition. They may have adistorted perception of their own body image and extreme fear of weight gain. They may become secretiveand dispose of food so that it appears to others that they have eaten.65Bulimia involves weight loss but this is not so drastic as in anorexia. Sufferers will binge eat and then purgethemselves with laxatives or by making themselves sick. This relieves the anxiety or guilt associated withbingeing. Also, as in anorexia, people with bulimia may also fast for periods of time and experience undueconcern about their body image. However they are aware that their behaviour is out of control.703. Outline two clinical characteristics of anorexia nervosa (3+3)1. Sufferers lose weight rapidly through gross under-eating. Their weight loss takes their body mass to below85% of their expected weight for height. Anorexics do not consider their weight loss to be serious ordamaging.2. Sufferers have a distorted perception of their body image. They believe that they are overweight whenthey are extremely underweight. This belief about being fat is associated with anxiety and fear.68Alternative3. Sufferers may experience amenorrhoea, where menstruation ceases. Missing three consecutive periods mayindicate this condition. Eventually, anorexia can also affect a woman’s fertility.244. Outline two clinical characteristics of bulimia nervosa (3+3)1. Bingeing involves eating excessive quantities of food in a short space of time. To be classed as bulimia thisbingeing must be regular and there will have been numerous episodes of the behaviour. The person withbulimia may realise that his or her behaviour is out of control but is unable to do anything about it.2. Following bingeing behaviour, the person starts to feel guilty about potential weight gain and thereforepurges themselves through self-induced vomiting or use of laxatives. This relieves their anxiety. In someforms of bulimia the guilt is countered by excessive exercise or fasting.100Alternative
  • 2. 3. Body image is distorted as in anorexia and the bulimic person is overly concerned with their physicalappearance. They may use this as an indicator of their overall self-worth. They may make inaccuratecomparisons with their peers, believing themselves to be overweight and ugly.457. Describe three differences in the clinical characteristics of anorexia nervosa and bulimia nervosa(2+2+2)Difference 1: In anorexia weight loss falls below 85% of the expected body mass for the person’s heighthowever, in bulimia weight loss is not so severe.Difference 2: In anorexia the person may not be concerned about their weight loss believing themselves to benormal and not to have a problem, however in bulimia the person may be fully aware that their behaviour isout of control but they feel unable to do anything about it.Difference 3: In anorexia weight is controlled through eating very small quantities or fasting, however, inbulimia weight gain is controlled through purging, which can be extremely damaging to teeth and oesophagus. • You could be asked for only 2 differences but for three marks. • Could you make an additional point?Biological and Psychological ExplanationsNB. You don’t necessarily have to know all 3 psychological explanations of eating disorders - youcould revise 2 in detail (e.g. psychodynamic and behavioural) and have outline knowledge of the 3rd(cognitive)1. Describe one biological explanation of eating disorders (6)Biochemical explanation: Biological psychologists suggest that eating disorders may be caused by animbalance or deficiency in levels of certain neurotransmitters. This affects the transmission of nerveimpulses in the brain. Low levels of serotonin have been implicated in the development of eatingdisorders and Jimeson (1997) found impaired serotonin levels specifically in bulimic Pps compared withhealthy controls. Serotonin levels may be low due to a decreased number of serotonin receptor sitesor a problem in the way in which serotonin is recycled by the pre-synaptic cell. In practical term, thisexplanation suggests that bulimia could be treated with SSRIs (antidepressants) and studies suggeststhat this is an effective drug treatment.110Alternative:Neuroanatomical: Damage to the hypothalamus in rats has been shown to induce excessive under orover eating. This implies that this brain structure is involved in eating disorders. Some psychologistsbelieve that the hypothalamus works a little like a weight thermostat whereby the lateralhypothalamus, which induces hunger kicks in if weight falls below a given level and the ventromedialhypothalamus suppresses appetite if weight rises above a given level. A malfunction of lateralhypothalamus could therefore bring about anorexia while problems with the ventromedial couldinduce compulsive eating, leading to obesity.91You could also write an answer based on genetic inheritance.2. Give two criticisms of the biological explanation described above (3+3)CRITICISM 1: The limited nutrient intake caused by the eating disorder may lead to malnutrition and thismay cause the serotonin deficiency rather than the deficiency leading to the disorder. This is supported bythe fact that the substance tryptophan found in starchy foods can raise serotonin levels and these foodsmay not be included in the diet to a great enough degree.61
  • 3. CRITICISM 2: One strength of this explanation is that it has led to the development of drug treatments forpeople with eating disorders. It should be possible to increase serotonin levels artificially using drugs suchas SSRIs. These drugs have been shown to be effective and can provide relief of symptoms for long enoughfor sufferers to begin to change their behaviour and participate in psychological treatments (e.g. familytherapy). However, clinical practitioners such as Dee Dawson of Rhodes Farm Clinic, say that increasingnutrient intake alone will be enough to increase serotonin levels without the need for drugs.683. Describe one psychological explanation of eating disorders (6)Psychodynamic: Freud explains anorexia as an expression of repressed conflict or trauma, possibly from apoorly resolved Electra complex. This occurs during the phallic stage (3-5/6years) where little girls develop apassion for their fathers and a wish for a baby. They become resentful of their mothers, who rival them fortheir fathers’ attention. The suggestion is that for one reason of another, the little girls never resolve thiscomplex thoroughly and therefore do not identify fully with their mothers. This means that they do not seekto become more like them and in fact at adolescence they reject womanhood altogether. Under eatingallows them to maintain their child-like figure and amenorrhoea means they are unable to become pregnantas ovulation also stops. This may be an example of ‘reaction formation’ (an ego-defence mechanism) againsttheir unconscious desire for a baby with their father.143Alternative: Minuchin et al explained that anorexia may result from ‘enmeshment’ within the family system,whereby individual family members have no clear identity as they do everything together as a family and arenot allowed to explore their individuality. Psychoanalysts suggest that individuation occurs between the agesof 1 and 2 (anal stage) when toddlers start to assert themselves and develop their ego. Most eating disordersbegin in adolescence and psychoanalysts explain that this is an important time for ‘reindividuation’, whererelationships outside the family become important. The suggestion is that adolescents are denied theopportunity to take control of their lives, grow up and become independent. Instead they take control oftheir eating habits and become obsessed by the routine, order, structure that this provides.1254. Give two criticisms of the psychological explanation described above (3+3)Criticism 1: Concepts such as the Electra complex lack validity. They are hard to assess scientifically and aretherefore unfalsifiable. Freud used case studies as evidence for his concepts but this method is notcontrolled, thus cause and effect cannot be established and the findings should not be generalised as theyare based on single cases. Neo-Freudian, Paul Kline says we shouldn’t reject Freudian concepts simplybecause we haven’t yet found ways to test for them yet.75Criticism 2: Freud has been accused of determinism, i.e. adult personality and behaviour is determined byour childhood experiences. This provides a negative outlook suggesting that a poor start in life will lead topsychological disturbance later. Some anorexics may have been raised in families with more conflict orhostility than average (Kalucy et al 1977) and some may have experienced sexual abuse, but theseexperiences do not always lead to eating disorders.715. Describe one psychological explanation of eating disorders (6)Behavioural: Behavioural psychologists would say that eating may have become associated with anxietythrough the processes of classical conditioning. For example, if family rows became common at the dinnertable and were a source of anxiety to the child, this tension may become associated with food. This anxietyand fear is then maintained through operant conditioning; the anxiety is relieved through avoidance of food(negative reinforcement). Also, the child may have gained attention for not eating. Even if this attentionwas negative the child may have found the emotional arousal reinforcing, making the avoidance of foodmore likely.976. Give two criticisms of the psychological explanation described above (3+3)CRITICISM 1: One strength of this explanation is that it has led to the development of treatments such astoken economy, whereby sufferers are rewarded with tokens (which can be saved towards trips andprivileges) for making progress towards a target weekly weight gain. This therapy can be highly effective and
  • 4. the suggestion is that if rewards help clients to ‘unlearn’ maladaptive eating behaviour, then they may havebeen involved in the original acquisition of the behaviour.75CRITICISM 2: Behavioural psychologists exaggerate learning and environment to the exclusion of geneticinheritance. There is substantial evidence to suggest that genes play a part in predisposing some peopletowards eating disorders. Holland showed that concordance was 56% for MZ twins and only 7% for DZ,suggesting that genes have an important role to play in anorexia although environmental triggers arerequired for the disorder to be expressed.66Alternative behavioural explanation: Social learning theorySocial learning theory explains eating disorders by saying that those with eating disorders may have beenexposed to ultra-thin role models, such as celebrities in magazines, TV and films and are attempting toimitate them, through weight loss. They have selected these celebrity women as role models on the basisthat they are seen to be rewarded through media attention, interest and approval. They then identify withthese women and wish to become more like them; finally they attempt to imitate their thinness througheither fasting as in anorexia or binging and purging as in bulimia. The process of vicarious reinforcementexplains how people are rewarded indirectly observing someone else being rewarded for a certain behaviourwith the effect that this behaviour becomes more likely in the observer.128CRITICISM 1: One strength of SLT is that it explains why eating disorders are far more common in the Westwhere there is a multi-million pound fashion industry and we are bombarded with images of extremely thinwomen. This has shaped our cultural expectation of how women should look. SLT is further supported by therarity of eating disorders in collective cultures such as China which value contribution to family andcommunity over personal success and physical appearance.76CRITICISM 2: SLT as an explanation of eating disorder, has been criticised for not explaining why all women,exposed to images of extremely thin women, do not seek to emulate them in the same way and only aminority end of with an eating disorder. It would appear that while cultural pressure plays its part, theremust be other factors which make some young people more vulnerable than others such as a geneticpredisposition or family conflict.75Alternative: CognitiveCognitive psychologists explain eating disorders in terms of cognitive biases, distorted or unrealistic thoughtsand beliefs. People with anorexia and bulimia have been shown to over-estimate their body weight and bemost dissatisfied with their body image; i.e. a greater discrepancy between their perceived body image andideal body image when compared to controls without eating disorders. They also may have mistaken beliefsabout the impact on their body image of eating small snacks. It has also been found that anorexics have atendency towards perfectionism and this may lead to frustration, decreased self esteem and reducing abilityto cope when things go wrong. This may trigger an eating disorder, as weight loss becomes another area inwhich they can set goals by which to measure their success or failure.130CRITICISM 1: Anorexia and bulimia are almost certainly associated with cognitive biases about body imagefor example, but it is difficult to disentangle whether these cognitive biases have led to the development ofan eating disorder or whether the disorder has increased the unrealistic thought patterns. A very limitedintake of nutrients, could certainly lead to depression which may in turn lead to unrealistic beliefs.63CRITICISM 2: On strength of this theory is its practical implications. The suggestion is that as countriesbecome more Westernised, cognitive biases may creep more and more into the thinking styles of youngpeople within that society as they compare themselves with unrealistic role models. This means that healthand education services in these countries need to be proactive in developing strategies to combat thepotential rise in the number of young people presenting with eating disorders.
  • 5. Biological research study: Holland et al (1988)1. Describe the aims and procedures of one study into biological explanations of eating disorders (3+3)AIM: Holland et al (1988) aimed to explore whether anorexia is determined more by nature or by nurture.They planned to do this by comparing concordance rates for anorexia nervosa amongst MZ twins and DZtwins, noting that since MZ twins share 100% of their genetic material and therefore if anorexia were geneticthis group would have a significantly higher concordance rate than DZ twins who share only 50% of geneticmaterial.71PROCEDURE: In this longitudinal twin study, Pps were selected on the basis that one twin must have alreadyreceived a diagnosis of anorexia. 16 MZ twin pairs were compared with 14 DZ twin pairs and thepsychologists tracked the twins to see whether the other twin went onto develop anorexia, thus it waspossible to calculate the concordance rate for each group.612. Describe findings and conclusions of one study into biological explanations of eating disorders (3+3)FINDINGS: A significant difference was found between the MZ twins and the DZ twins. Concordance was 56%for MZ twins and only 7% for DZ twins. Also, in 3 cases in the MZ group, even thought the twin did not goonto develop anorexia, they developed another psychiatric illness and in 2 cases, minor eating disorderswere diagnosed.57CONCLUSIONS: Holland et al concluded that there is a genetic component in the development of anorexia asalthough the concordance rate for MZs was well below 100% (which would be expected if anorexia wascompletely genetic) at 56%, it was much higher than 7% which was found for DZ twins. It is likely thatanorexic is caused by a genetic predisposition which is only expressed under certain environmentalpressures.683. Give two criticisms of one study into biological explanations of eating disorders (3+3)CRITICISM 1: As this is a natural experiment, whereby Pps were assigned to groups on the basis of theirgenetic relatedness, it is difficult to establish cause and effect with certainty. Other confounding variablesmay have contributed to whether or not the undiagnosed twin went onto develop anorexia, e.g. MZ twinsmay be treated differently to DZ twins because they are so similar and this treatment could influence thedevelopment of psychiatric disorder.71CRITICISM 2: Twin studies such as Holland et al’s underestimate and ignore the role of environmentalfactors. In 44% of cases the MZ sibling did not go onto to develop anorexia despite sharing the exact samegenes. Holland et al does not tell us anything about environmental factors which must have protected them.514. Describe findings of research into biological explanations of eating disorders (6)Holland et al (1988) found concordance rates of 56% for MZ twin pairs and only 7% for DZs twin pairs whereone twin had previously been diagnosed with anorexia. In 3 cases in the MZ group, even though the twin didnot develop anorexia, they developed another psychiatric illness and in 2 cases, minor eating disorders werediagnosed. Kendler et al (1991) found that when one twin as diagnosed with bulimia, concordance was 23%for MZ twins and 9% for DZ, suggesting that both anorexia and bulimia have a genetic component but thatthis is more pronounced for anorexia. Research looking at biochemical differences has also shown thatpeople with eating disorders have lower than average levels of serotonin. (Fava, 1989, Jimeson 1987)1235. Describe conclusions of research into biological explanations of eating disorders (6)Holland et al (1988) concluded that anorexia has a genetic component as the concordance rate wassignificantly higher for MZ than DZ twins. However, environmental factors are also important as concordancewas only 56% meaning that in 44% of cases despite sharing the exact same genetic material the twins did notgo onto to develop anorexia. This implies that despite having a genetic predisposition it takes certain
  • 6. experiences for this to be expressed. Kendler (1991) concluded that bulimia also had a genetic component asconcordance was higher in MZs than DZs however, at only 23%, this suggests that environmental factors mayme more influential in the development of bulimia.109Psychological research study: Behar et al (2001)1. Describe the aims and procedures of one study into psychological explanations of eating disorders(3+3)Aims: Behar et al (2001) aimed to investigate whether acceptance of the female gender role was greater inwomen with eating disorders than a control group without eating disorders. They wanted to see whetherwomen with a strong female gender identity are more likely to identify with the ‘perfect’ female bodyimage portrayed in the media, thus supporting a social learning explanation of eating disorder.64Procedure: The study compared a group of 63 patients with anorexia and bulimia with a control group of 63women without eating disorders. Eating disorders were diagnosed through a structured clinical interviewusing the DSM–IV. The women were also tested using the Bem Sex Role Inventory to give a valid measure oftheir gender identity.692. Describe findings and conclusions of one study into psychological explanations of eati
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