Thursday, November 1, 2012

Dissertation on shame. Chapter 19.1 Eating disorders

19.1 Eating disorders

Eating disorders are usually characterized by severe disturbances in eating behavior; principally the refusal to maintain a minimally normal body weight and an intense fear of gaining weight (anorexic symptoms), and recurrent episodes of binge eating accompanied by purging, excessive exercise, or other inappropriate methods of preventing weight gain (American Psychiatric Association/APA 1994; Williamson, Baker and Norris 1993). Brach (1973) argues that these are symptoms that reflect the individual’s doubt about their own worth and value. Talking about ones eating disorder in a focus group, as in this study, can in my opinion, be seen as an ethically proper way of exploring this subject, because the participants’ self-worth and self-value are strengthened rather than weakened because of the solidarity felt in such a group.

Burney and Irwin (2000) have investigated the eating-disorder reality described above by Dagny, Camilla, Bodil and Anne, in a sample of 97 women, and their results show that shame associated with eating behavior was the strongest predictor of the severity of an eating-disorder. Other effective predictors were guilt associated with eating behavior and body shame. Eating disturbances were unrelated to proneness to shame and guilt in a general sense. Feelings of unworthiness and inadequacy were consistent with the phenomenon of shame in their investigation. The results of the regression and correlation analysis they have carried out show that the severity of an eating disorder is not related to a general proneness to shame or guilt but rather to shame and guilt in eating contexts and to shame about the body. Women with eating disorders tend both to condemn their disturbed eating behavior (guilt) and to condemn their own inadequacy in this regard (shame).

Burney and Irwin (2000) argue that it seems plausible to believe that eating disorders are a consequence of shame and not the cause of shame. In my opinion, eating disorders are like self-harming also a consequence of shame and not from sexual abuse in it self. Being sexually abused, may lead to shame, and it seems to me through this study, that it is shame which is the basis of both self-harm and eating disorders. Participants in this study, who have been sexually abused without feeling shame afterwards or give reports of others in this situation, do not seem to have developed either self-harming activities or eating disorders. The opposite seems to be the case for those feeling shame after being sexually abused. This finding might suggest that helping victims of sexual abuse to overcome their feelings of shame, instead of focusing directly on the sexual abuse in itself, might be a proper manner of treating both conditions of self-harm and eating-disorders.

Being sexually abused has of the consequence of feeling a loss of body control, and victims tend to try in various ways to take this control back again. Margaret explains that denying oneself food or eating too much has to do with control; both having control and losing control.

Margaret_1:    Those who stop eating, they deny themselves food. They see themselves as ugly and horrible; they have absolutely no self confidence, why in the world should they eat? And it has to do with control. Those who eat too much and throw up afterwards, they have so much to control, they make an image of themselves, and if they go too far, they lose control and panic ((Twists her hands together in front of her)).

Those with eating disorders might according to Margaret have a distorted self-image. The relation between shame and self-image has already been discussed in this study, showing that those feeling most shame also have the lowest evaluation of self-image.  Goodsitt (1985) argues that anorexics may feel guilty about the act of eating and this serves to exacerbate feelings of self negation. Fairburn (1997) argues that bulimics’ episodes of overeating are marked by a profound sense of loss of control that evokes guilt and self disgust. There seems to be a diversity of opinions as to the place of shame and guilt in the aetiology of eating disturbances. Some see shame-proneness and guilt-proneness as causal factors in the psychodynamics of eating disorders, while others view these affects more as consequences of having an eating disorder. Whether they are a cause or consequence of eating disorders seems to have been subjected to limited empirical study (Sanftner, Barlow, Marschall and Tangney 1995). The finding in this study seems to support in my opinion that sexual abuse may lead to shame and that it is shame which is the foundation for developing eating disorders, not sexual abuse as such. But validating this finding will demand further investigation. 

The way one relates to food, can be seen as a form for self-harm and according to Gunhild and Helga, but Helga also argues that eating helped her and was the factor that kept her going. Even though eating was a helping factor in her life, she was ashamed of it.

Gunhild:         There are many different ways one can harm oneself, intoxication, not eating.
Helga:             Or eating
Gunhild:         Or eating too much
Helga:             Compulsive eating… I can eat and eat, I eat a lot. Sometimes I eat until I throw up. I don’t have a normal relation to food. I can eat a whole loaf of bread… I eat everything. I don’t enjoy eating food. I eat till I have to lie down, I become feeble and fall asleep…it’s a kind of intoxication. Yeah I think it gets me high… I’m ashamed of it… But it was eating that kept me going.

All these interviews show the vast amount of different ways which victims of sexual abuse may use food, but in my opinion, it is the shame which is induced by the sexual abuse and not the sexual abuse in itself which is the basis for their relation to food. Moyer, DiPietro, Berkowitz and Stunkard (1997) have carried out a study of the relation between child sexual abuse and eating disorders in a sample of 68 sexually abused girls between 14 and 18 years old. Their results showed significantly higher degrees of depression, control, and binge eating in the sexually abused girls than in the control group used in the study. Eating disorder and sexual abuse has also been studied by Nordbø, Espeset, Gulliksen, Skårdrud and Holte (2005) who have carried out a qualitative study of patients’ perception of anorexia nervosa in a sample of 18 women between the ages of 20 and 24. Their results suggest the psychological meanings given to anorectic behavior may have to do with eight constructs: security, avoidance, mental strength, identity, care, communication and death. Anorexia can be seen as a psychologically purposeful form of behavior for many patients. They argue that it is important to encourage patients to express their personal values and to explain how their eating disorders both fulfil and compromise these values. Neither of these studies has focused on the importance of shame for the development of eating disorders, but instead tried to find a relation directly to the experience of sexual abuse. The finding from this study seems in my opinion to be that shame should be viewed as a necessary link between sexual abuse and eating disorder, although I am aware that this assertion will demand further examination.

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