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Pace University DigitalCommons@Pace Honors College Theses Pforzheimer Honors College 2020 The Social and Cultural Factors of Anorexia Nervosa in Adolescent Women Hannah Daddario Follow this and additional works at: https://digitalcommons.pace.edu/honorscollege_theses Part of the Psychology Commons The Social and Cultural Factors of Anorexia Nervosa in Adolescent Women HONORS THESIS Presented to the Pforzheimer Honors College at Pace University In Partial Fulfillment of the Requirements for University Honors By Hannah Daddario Applied Psychology and Human Relations Business Thesis undertaken in the Department of Psychology May 2020 Approved by: Hannah Daddario, Student Johna Pointek, PsyD, Faculty Advisor Len Mitchell, Pforzheimer Honors College Director 1 Table of Contents: Abstract…………………………………………………………………………………….…..…2 Background………………………………………………………………………………………3 Literature Review………………………………………………………………………………...4 Social Factors…………………………………………………………………………………….12 Advertisements In the Media…………………………………………………...………………..23 Cultural Factors……………………………………………………………………………….….27 Discussion………………………………………………………………………………………..31 Appendix ………………………………………………………………………………………...34 References………………………………………………………………………………………..37 2 Abstract: Anorexia Nervosa (AN) is an eating disorder that typically begins in adolescence and it is characterized by three diagnostic criteria defined within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This criterion consists of the restriction of energy intake, leading to a significantly low body weight, the intense fear of weight gain, and the disturbed sense in which someone perceives their body weight or shape. Adolescence is characterized as the time in a person’s life which is the period of growth between the ages of 10 and 19 years old. This period of development spans through many milestones, including puberty and the end of high school into college. Adolescence has also been characterized by the need for social acceptance and when an individual may develop their attitudes and behaviors towards eating. Females who are within this period of adolescence, are under extremely impressionable through the society we live in and their own cultural influences that may occur at home. Growing up in an ever- changing technological world, children are constantly exposed to the world of social media, and different advertisements that are on TV or phone applications they use on a daily basis. With these new aspects growing in society, suggestible minds are seeing these posts and advertisements of people with seemingly perfect lives, and bodies and believing that they need to be ‘better’ than the person that they already are. As focus on body image in this society has continued to grow, there has also been a movement of “body positivity” in which advertisers are marketing women to be comfortable in the body that they own in comparison to the advertisements towards the “ideal” feminine body. Each person is also influenced by their own cultural background. This may include how food is seen in your household, and if it is considered to be a focal point in a daily routine, or during larger gatherings. Culture also plays a large role in the diagnosis of AN in general. Anorexia had generally been considered to be a “white-middle-class-female disorder”, which has been proven incorrect. In countries that are not considered to be westernized, the diagnosis of Anorexia Nervosa seems to be lower, which is due to how our culture idealizes thinness. In other cultures, AN presents itself without this idea of “fat-phobia”. Because people in other societies are not presenting this idea of the fear of weight gain, they are not diagnosed with AN even though they may be presenting other symptoms such as excessive weight loss and amenorrhea. The discussion of Anorexia Nervosa needs to continue evolving as our society and cultures do in order to provide current research on topics such as social media influencers, and AN presenting in other cultures. 3 Background: All through my childhood if I had been asked what I wanted to do with my life, I knew I wanted to be a teacher and I wanted to be able to guide young minds. I worked as a babysitter and in a preschool for many years, but it didn’t dawn on me that I was interested in the field of psychology until it started to deeply affect my life due to mental health. My sophomore year of high school my best friend was diagnosed with anxiety, depression and binge-eating disorder. I never had any real experience with mental illness up until that point, or at least never truly understood what was going on when someone claimed to be anxious. Being such a young age, it was hard to understand at first and was something that I never would have been able to just point out signs of without her telling me what was going on. From that point on, my friends and I were her biggest support system and the people that were looking out for her with every little thing that may happen. It started to get extremely real by the end of our junior year of high school, when she admitted to having suicidal ideations and that her binge-eating disorder had grown worse, and senior year she contemplated an in-patient program to help her recovery. I never understood exactly how it felt to be uncomfortable with your own body until my sophomore year of college when I had surgery to correct a chest deformity I have. It changed my body completely, and made me stop so much of my daily routine for months. During this time, I noticed myself comparing my body to things I saw on TV and carefully hearing how people in my life would make comments about their own bodies, or make me feel bad for not feeling confident. It has always been important for me to spread the word of mental illness and advocate for eating disorders and body image awareness, but it took until then to start asking myself why. This is why I will be researching the topic of: “The Social and Cultural Factors of Anorexia 4 Nervosa in Adolescent Women” and how these factors contribute to the body image and potential creation of eating disorders in women. Literature Review In the everyday life of a psychologist, the use of the Diagnostic and Statistical Manual of Mental Disorders, most recently in its fifth edition (DSM-5) (American Psychiatric Association, 2013), helps counselors to diagnose disorders and even differentiate symptoms between co- occurring disorders. One of the categories within the DSM-5 is Feeding and Eating Disorders, which includes, but is not limited to, Anorexia Nervosa (AN). Feeding and Eating Disorders “are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food… impairs physical health or psychosocial functioning” (American Psychiatric Association, 2013, p. 329). This can help to diagnose with disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/restrictive food intake disorder, pica and rumination disorder. There are many common symptoms between these disorders, but the DSM is designed to help diagnose during a single episode, or time period described by the patient, so that they are able to receive the correct treatment for their specific needs. One of the main goals of the DSM-5 is for the client to be accurately diagnosed with an eating or feeding disorder that reflects their symptoms, so a treatment plan can be created (DSM- 5 Fact Sheets, 2013). Anorexia Nervosa typically begins occurring within adolescence and young-adulthood, which is typically a transition phase in a persons’ life. According to the American Psychiatric Association (APA), and the DSM-5, AN has 3 different criteria that must be met to diagnose a patient with the disorder. Criterion A consists of “restriction of energy intake… leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical 5 health” (American Psychiatric Association, 2013, p.338); the measurements of a “significantly low weight” is a value considered to be less than ‘normal’ or what is the typically expected range in an adolescent. If a person is restricting their caloric intake on a daily basis to something significantly less, then their weight will begin to fall below the “normal range”. Criterion B is the intense fear of gaining weight, or the persistent behavior that interferes with weight gain, even if they are already at a significantly low weight (American Psychiatric Association, 2013, p. 338). A person with AN is extremely terrified of gaining weight, even when they are at a lower than normal body weight. This leads to criterion C, which is the disturbed way in which someone perceives their body weight or shape, and the lack of recognition that they have a seriously low body weight (American Psychiatric Association, 2013, p. 338). All three of these diagnostic criterion tends to lead into each other, meaning if someone is restricting their energy and losing weight, it will lead to the fear of gaining weight and/or they will see their body shape in a disturbed way. This is especially true in a Western society that is so concerned with body image. AN is also separated into two different subtypes and measured in severity and remission status. The two different categories of Anorexia Nervosa include: Binge-eating/purging type and Restricting type. The DSM-5 is helpful for clinicians because to the untrained eye, binge- eating/restricting in AN would just be seen as bulimia nervosa (BN) but it does have its differences, mainly with weight-loss. BN is considered to be the recurrent episodes of binge eating, or having a lack of control during a 2-hour period, with repeated compensatory behaviors such as the use of laxatives or vomiting, but does not result in severe weight loss (American Psychiatric Association, 2013). The binge-eating/purging subtype is different from bulimia nervosa because patients with BN tend to maintain a normal body weight, while a patient with AN has a significantly low body weight (American Psychiatric Association, 2013).

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