Feminist Psychology and Possibilities for Eating Disorder Treatment: An Exploration of the Existing Research.
According to the American Psychiatric Association eating disorders are most prevalent in women between the ages of 12 and 35 years old and are defined as illnesses in which sufferers experience severe disturbances in eating behaviors and are pre-occupied with food and their body weight. Given the higher rates of eating disorders among females, we can turn to feminist psychology to examine how gender is a risk factor for eating and body disturbances (Piran, 2010). Many studies have focused on investigating the causes and risk factors of eating disorders within specific individuals, but feminist psychology expands the investigation to exploring the risk factors that put the female population at risk of developing eating disorders and calls on gender to be a focus for eating disorder prevention and treatment (Piran, 2010). A feminist perspective examines the impact of social variables, including power and privilege related to gender, on women’s experiences of their bodies and how these unique gender experiences put women at risk for eating and body disturbances.
Nivan Piran (2016) conducted a research program to explore a range of narratives of both positive and disrupted embodiment to provide a basis for developing a quantitative measure of experiences of embodiment. The resulting Experience of Embodiment construct focuses on lived-in experiences of the body including feelings and physiological states which are missing in the body image construct of disturbances in eating and body behaviours (Piran, 2016). The construct addresses experiences of girls and women as they engage with their bodies in the world and these experiences can be clustered into five dimensions to impact the quality of: connection and comfort with one’s body, embodied agency, connection and expression of desires, attunement to self-care, and engagement in meaningful pursuits not focused on an objectified gaze upon one’s appearance (Piran, 2016). Piran’s study showed that the increase in body and eating disturbances that occurs in adolescence involves a multi-dimensional disruption in body connection and comfort, agency, desire, self-attunement and objectification, which extends beyond the idea of simply a drop in self-esteem (Piran, 2016). Positive embodiment is defined by positive body connection and comfort, embodied agency and passion, as well as attuned self-care and this way of inhabiting the body can provide a guide and goal for health promotion interventions and therapy for girls and women. This research led to the emergence of the Developmental Theory of Embodiment that addresses challenges to experiences of embodiment across the lifespan and describes the interactions of different aspects of social experiences and location on experiences of embodiment. This theory looks beyond what causes disruptions to embodiment in individuals, to explore disruptions in embodiment for girls and women providing a means to explore gendered risk factors for eating and body disturbances.
The Developmental Theory of Embodiment suggests that objectification is one cause of a disruption in healthy embodiment (Piran, 2016). Many Western cultures sexually objectify the female body, which leaves all women to varying degrees vulnerable to the experiences of self-objectification and disordered eating (Calorgero, Davis & Thompson, 2005). Through a feminist lens, eating disorders can be explained as women’s response to feeling powerless over the systematic objectification of their bodies and an exploration of this has expanded our understanding of eating disorders as a consequence of fat-phobia to include broader sociocultural forces. In Calogero, Davis and Thompson’s (2005) study of women with eating disorders, self-objectification predicted a drive for thinness and showed that self-objectification negatively impacted emotional experiences and it motivated the women to strive toward the attainment of unrealistic cultural beauty ideas (Calorgero, Davis & Thompson, 2005). Their findings showed that treatment programs may further benefit patients by including opportunities to address the experiences of sexual and self-objectification in women’s lives. Because women with eating disorders rarely recognize that self-objectification is a problem, it is important to educate women struggling with eating disorders that it is a harmful, socially constructed from of self-perception or a significant contributing factor to eating disorder pathology will not be addressed (Calorgero, Davis & Thompson, 2005).
In order to counteract the emphasis on how a woman’s body is perceived in western cultures, it may be helpful to emphasize appreciating the functions of the body. Body appreciation theory suggests that body appreciation exists on a separate spectrum than negative body image and encourages an exploration of positive and adaptive components of body image. Body appreciation has been shown to relate to adaptive psycho-social measures of well-being including self-esteem, optimism and self-compassion (Andrew, Tiggeman & Clark, 2016). When it comes to eating disorder treatment and prevention it’s important to note that intuitive eating is predicted by body appreciation because people with higher body appreciation are more attuned to, and respectful of, their bodily needs (Andrew, Tiggeman & Clark, 2016).
Qualitative studies have shown that people with positive body image accept their bodies, take a functional view of their bodies, think critically about appearance information and advocate from a broad conceptualization of beauty (Andrew, Tiggeman & Clark, 2016). Looking at body appreciation as a mechanism to improve body image could be an avenue to reduce gendered risk of eating and body disturbances. In a study of body image in adolescent girls, Andrew, Tiggeman and Clark (2016) found that higher perceived body acceptance by others, lower self-objectification and social comparison, and greater body appreciation predicted higher intuitive eating over time. Their results provide empirical evidence that individuals with body appreciation, measured by respect and attention toward bodily needs, will engage in self-care behaviours that benefit physical health and actively avoid behaviours that could physically harm their body, such as dieting (Andrew, Tiggeman & Clark, 2016). Given the high rates of dieting among adolescent girls the results indicating decreased dieting suggests that supporting body appreciation might be one way to resolve maladaptive eating behaviors.
Further research is needed to explore more precisely the nature of the relationship between body appreciation and engagement in physical activity as a means to foster body appreciation in samples of difference ages (Andrew, Tiggeman & Clark, 2016). Studying other ways to foster body appreciation including embodiment practices, such as sensorimotor psychotherapy, yoga, and somatic experiencing would be beneficial to innovating treatment approaches for eating disorders in females.
Another means to counteract the emphasis on how a woman’s body is perceived in western cultures, is to support the development of a feminist identity. An examination of the protective role that feminist identification can play in body image and eating behaviours has the potential to offer information to improve treatment and prevention programs for eating disorders in girls and women. Moving beyond objectification theory, feminism points to the everyday sexism and historically lower social status of women as well as sexual abuse and violence against women as ways by which women are at greater risk for body disturbances (Borowsky, Eisenberg, Bucchianeri, Piran & Neumark-Sztainer, 2016). To identify as a feminist, one recognizes that women are discriminated against and experiences a connection to the fate of women as a group, and wants to work to improve women’s status ((Borowsky, Eisenberg, Bucchianeri, Piran & Neumark-Sztainer, 2016). Identification as a feminist suggests that one rejects the traditional gender relationship of power and this rejection may serve to reduce the chances of internalizing the thin ideal and poor body image. Research has shown that feminist women experience higher body satisfaction, but feminist-identification is not a consistent protective factor against disordered eating behaviours (Borowsky, Eisenberg, Bucchianeri, Piran & Neumark-Sztainer, 2016). The less clear relationship of feminist identification with disordered eating behaviours points to the need for treatment and prevention interventions to make a clear link between ideals drawn from feminist identification and and eating behaviours (Borowsky, Eisenberg, Bucchianeri, Piran & Neumark-Sztainer, 2016).
Objectification of women’s bodies is a major contributor to disrupting a sense of attunement with bodily needs. The Attuned Representation Model is a comprehensive model that extends beyond objectification to look at cultural, individual and interface issues to assess risk factors related to eating-disordered behaviours (Cook-Cottone, 2006). The model identifies cognitive, emotive and physiological components as contributing to eating-disordered symptomology as well as family, community and cultural components (Cook-Cottone, 2006). The Attuned Representation Model explains eating disorder pathology as being a consequence of misattunement between the child and their greater social context including family community and culture. According to this model, the misattunement leads a child to believe they are unacceptable and that to be accepted they must be the way others want, expect or need them to be (Cook-Cottone, 2006). This leads the child to develop a self that is artificially attuned to their outer world and an eating disorder may develop to manage and regulate their internal experiences they’ve hid to become acceptable (Cook-Cottone, 2006). This model speaks to the need for treatment efforts to address the eating disorder sufferers over focus on how they are perceived and received in their social context, and support enhancing a self-concept, emotional regulation, tolerance of negative affect and imperfection as well as risk reduction (Cook-Cottone, 2006). Though this model does not focus on gender, the greater cultural influences are considered which would include gender specific pressures to be accepted. As cultural trends continue to affect mental and physical health, further empirical exploration of a comprehensive model of understanding and treating eating disorders is a pressing matter (Cook-Cottone, 2006).
Andrew, R., Tiggermann, M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology, 52(3), 463-474.
Borowsky, H., Eisenberg, M., Bucchianeri, M., Piran, N., & Neumark-Sztainer, D. (2016). Feminist identity, body image, and disordered eating. Eating Disorders: The Journal of Treatment & Prevention, 24(4), 297-311.
Calogero, R., Davis, N., & Thompson, J. (2005). The role of self-objectification in the experience of women with eating disorders. Sex Roles: A Journal of Research, 52(1-2), 43-50.
Cook-Cottone, C. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychology in the Schools, 43(2), 223-230.
Piran, N. (2016). Embodied possibilities and disruptions: The emergence of the experience of embodiment construct from qualitative studies with girls and women. Body Image 18, 43-60.