Eating Disorders and Self Concept Disturbances

Self Concept Disturbances and Eating Disorders

 Eating Disorders,Types of Eating Disorders,Disturbance in Self Identity,Eating Disorders and Self Concept Disturbance,Nursing Research and Cognitive Model,Self Schemas and Self Guidelines,Characteristics of Self Concept.

Eating Disorders

    Dating from early psychodynamic theories to the more contemporary cognitive approaches, the eating disorders have been characterized as disorders of the self. 

    Research that has focused on the self-concept as a determinant of eating disorder symptomatology has addressed three aspects of the self-concept: body image, self-esteem, and structure of the self-concept. 

    Although the majority of empirical work on the self-concept in the eating disorders has focused on body image and self-esteem disturbances, studies related to structure of the self-concept are distinguished in that they build on early clinical theories that focus on disturbances in the development of the total collection of beliefs about the self as the core vulnerability contributing to formation of the disorders. 

    An overview of studies that suggest that disturbances in the structure of the self-concept serve as a cognitive vulnerability that contributes to internalization of unrealistic cultural norms regarding body weight and the formation of eating disorder symptoms is presented.

Types of Eating Disorders

    Two eating disorders are recognized by the American Psychiatric Association, anorexia nervosa (AN) and bulimia nervosa (BN). 

Diagnostic criteria for AN include: 

(a) body weight less than 85% of ideal

(b) amenorrhea for 3 consecutive months

(c) disordered attitudes toward body weight. 

Diagnostic criteria for BN include: 

(a) going on binges (ingesting large quantities of food within 2 hours while feeling out of control)

(b) compensatory weight control behaviors (vomiting, laxative or diuretic use, fasting, or excessive exercise) in response to the binge with the cycle occurring at least twice weekly for 3 months

(c) disordered attitudes toward body weight. While important differences between the disorders have been identified, theories of etiology of the two disorders often converge.

Disturbance in Self Identity

    Although clinical theories converge to suggest that disturbances in identity and self-concept are the core vulnerability that contributes to the development of eating disorders, the lack of clarity in theoretical and operational definitions of these constructs has limited empirical testing of the proposition. 

    The first study to address identity and self-concept disturbances in women with BN used no theoretical framework for the self-constructs. In this study of 26 women with BN, identity confusion was defined as the subjective experience of inconsistency in beliefs about the self, and meshment was defined as high reliance on others to define the self (Schupak-Neuberg & Nemeroff, 1993). 

    Both concepts were measured using scales developed for the study. Identity stability was measured by determining the degree of consistency in self-description over 2 weeks. Despite the limitations, results support the identity disturbance hypothesis showing that women with BN had higher levels of confusion, instability, and enmeshment compared to controls.

Eating Disorders and Self Concept Disturbance 

    More recently, studies that have focused on self-concept disturbances in eating disorders have used the cognitive model as the theoretical framework. 

    In this model, the self-concept is conceptualized as a well-developed set of memory structures that are formed through interaction with the social environment and have been shown to play a primary role in information processing and behavioral regulation (Kendzierski & Whitaker, 1997).

    The total set of memory structures about the self is referred to as the self-concept, which in turn is composed of units of self-knowledge, referred to as self-schemas. Each self-schema is itself an organized collection of memory structures that reflect knowledge of oneself within one specific domain. 

    Self-schemas have been shown to be functional memory structures that influence attention and encode and recall of stimuli, and motivate and regulate goal-directed behavior. Hence, individual differences in the number, valence, content, and organization of the self-schemas have important implications for emotional and behavioral self-regulation.

Nursing Research and Cognitive Model

    Two studies using the cognitive model have focused on the valence and organization of self-schemas. Using a card sort instrument with 31 women with subclinical BN, Showers and Larson (1999) found that women with BN differed from controls in the following configuration of self-schemas: 

(a) more negative and fewer positive self-schemas

(b) a negative physical appearance self-schema

(c) more linkages between the negative physical appearance self-schema and other schemas. 

    Similarly, in a study that examined valence and organization of self-schemas in a sample of women with clinically diagnosed BN, Stein, KF, Corte, and Nyquist (2004) found that women with BN had fewer positive and more negative self-schemas com wall to controls. 

    Furthermore, the number of positive self-schemas positively predicted the availability of a fat self-schema which in turn was highly predictive of eating disordered attitudes and behaviors.

 Self Schemas and Self Guidelines

    Finally, another study focused on discrepancies between the content of the current self-schemas and self-guides, which are defined as knowledge structures that reflect the self-one would ideally like to be (ideal self-guide), and the self-one believes that she is obliged to be (ought self-guide) (Strauman, Vookle, Berenstein, Chaiken, & Higgins, 1991). 

    Previous studies have shown that discrepancies between the way the self is currently defined and 'ideal' and 'ought' self-guides have important affective and motivational consequences (Higgins, 1987). 

    In two studies using nonclinical samples of college students, Strauman found that women with extreme discrepancies between their current and ideal self-schemas had high levels of body dissatisfaction and bulimic symptoms, whereas women with extreme discrepancies between their current and ought self-schemas had high dieting and anorexic symptoms.

Characteristics of Self Concept

    These studies provided evidence to support the hypothesis that characteristics of the self-concept, including the relative absence of positive self schemas, the presence of many negative self schemas, high interconnectedness among the self schemas, and discrepancies between the content of the Current self-schemas and self guides contribute to formation of a negative body weight/appearance self schema, which in turn is predictive of disordered eating attitudes and behaviors. 

    These findings are consistent with clinical eating disorder theories that suggest that disturbances in the structure of the self-concept are a core vulnerability that contribute to eating disorder symptoms. 

    Furthermore, these findings challenge current eating disorder treatment approaches that focus on modifying weight related cognition, and point to the importance of interventions designed to modify the overall structure of the self-concept by building new and separate positive self schemas and modifying the content of negative self schemas and self-guides to promote long term recovery from the eating disorders.