The role of family relationships in eating disorders in adolescents: a narrative review

Abstract: Background: Adolescents’eatingdisordershavebeenexploredthroughvariousconceptual andempiricalmodels. Onlyrecently,scientificliteratureinthisareahasmorespecificallyinvestigated theroleofrelationships,withparticularattentiontofamilyfunctioning. Objective: Thispaperreviews family relationships aspects of eating disorders in adolescence. Methods: A narrative literature review of relational issues in adolescents’ eating disorders was performed. Results: Empirical evidence of family relationships in adolescents’ eating disorders confirms the relevance of relational aspects in the development and maintenance of the pathology. In particular, the contribution of the relational-systemic approach is wide, suggesting the need to refer to the family context for a better understanding of adolescents’ sufferance. Additionally, the empirical contributions from the conceptual model of Developmental Psychopathology, highlighting the importance of risk and protection factors in family relationships, provides knowledge about the phenomenon of adolescents’ eating disorders in terms of complexity. Conclusions: An integrated relational model aimed to explore adolescents’ eating disorders is worthy of investigation to accomplish specific program of intervention

Anorexia nervosa and reproduction: connecting brain to gonads

Anorexia nervosa (AN) is a psychiatric disorder that predominantly affects young women and is characterized by low caloric intake and a major dissatisfaction with one’s body image. It is often overlooked and, while patients and family seek medical help, emaciation and nutritional misbalances may become extreme and potentially life threatening. Among the many somatic complications, an accumulation of early endocrine adaptations occurs, leading to functional amenorrhea and impaired reproduction as a result of dysfunction of the hypothalamic-pituitary-ovarian axis. Even though these conditions are reversible, long-term consequences may affect the fertility of women with AN and can lead to maternal and fetal complications during pregnancy and birth. This review presents the clinical particularities of reproduction in the context of AN, along with the possible pathophysiological mechanisms involved

The quantification of gender: Anorexia nervosa and femininity

The ways in which Anorexia Nervosa (AN) has been described and explained has differed drastically over time although since it was first named in 1874 it has been primarily associated with women and girls it is argued in this paper that it came to be more fundamentally associated with femininity due to certain disciplinary changes in the psy sciences. The influential psychiatrist Hilde Bruch lamented the loss in clarity of the clinical picture that was the result of psychoanalytic interpretations, to remedy this she reformulated AN into a pathology that was the result of the individual being too determined by external influences. Bruch’s changes increased the emphasis that psychiatrists placed on the relationship between women and their social context and the lack of individual autonomy that many felt. Feminist writers adapted Bruch’s theory to suggest that patriarchal culture was colonizing the lives of women and that social rather than individual change needed to occur. Psychiatrists subsequently developed scales for assessing gender identity which switched the emphasis back onto individuals and rendered gender as an individualised, quantifiable, manipulable object. When reified and individualised in this fashion it became more legitimate to discuss femininity as causative of, and masculinity as a protection against, AN

Beyond the clinic? Eluding a medical diagnosis of anorexia through narrative

The persistence and recurrence of anorexia nervosa poses a clinical challenge, and provides support for critiques of oppressive and injurious facets of society inscribed on women’s bodies. This essay illustrates how a phenomenological, linguistic anthropological approach fruitfully traverses clinical and cultural perspectives by directing attention beyond the embodied experience of patients diagnosed with anorexia nervosa to those who are not clinically diagnosed. Extending a model of illness and recovery as entailing sufferers’ emplotting of past, present, and imagined future selves, I argue that women’s accounts of their experiences do not simply reflect lived reality, but actually propel health-relevant states of being by enlivening and creating these realities in the process of their telling. In indexical interaction with public and clinical discourses, narratives’ grammar, lexicon, and plot structures modify subjects’ experiences and interpretations of the events and feelings recounted. This article builds on the insight that linear narratives of “full recovery” that adopt a clinical and feminist voice can help tellers stay recovered, whereas for those “struggling to recover,” a genre of contingent, uncertain, sideshadowing narratives alternatively renders recovery an elusive and ambivalently desired object. This essay then identifies a third narrative genre, eluding a diagnosis, which combines elements of the first two genres to paradoxically keep its teller simultaneously sheltered from, and invisible to the well-meaning clutches of medical care, leaving her suffering, yet free, to starve. This focus on narrative genres illustrates the utility of linguistic analyses for discerning and interpreting distress in subclinical populations.First author draf

'The Young Hunger Artists: The Portrayal of Eating Disorders by Contemporary Austrian Women Writers'

This paper explores how the abuse of food by young women is an expression of the need for attention as well as a form of self-punishment in psychological and physiological terms. In Anna Mitgutsch’s novel “Die Züchtigung” (“Punishment”, 1985) the daughter attempts to hinder the development of her femininity in order to abate her mother’s increasing hatred of her. At the same time she binges to prove to the rest of society that her mother has been feeding her well and is therefore a ‘good’ mother. In this ambivalent mother-daughter relationship Mitgutsch illustrates how the daughter agonises over her mother’s self-sacrifice, whilst eating/not eating in an almost sacrificial manner. Later she diets to please her lover and in the process becomes anorexic. This obsessive behaviour is the focus of Helene Flöss’ “Dürre Jahre” (“The Lean Years”, 1998). Here the desire to have the figure of a model begins at the age of 15 and ends after 7 years of calorie counting in a psychiatric ward for psychosomatics, where the protagonist weighs just 34 kilos. Both Mitgutsch’s and Flöss’ novels feature young women who suffer at the hands of family and social pressures, so much so that they are prepared to starve and are starved of love

Body Image and Food Disorders: Evidence from a Sample of European Women

Excessive preoccupation for self-image has been pointed out as an essential factor explaining food disorders. This paper draws upon Akerlof and Kranton (2000) to model how ’self-image’ and others’ appearances influence health related behaviours. We estimate the influence of ’peers’ image’ on the likelihood of anorexia and self-image using data from a cross sectional European representative survey for 2004. We follow a two-step empirical strategy. First, we estimate the probability that a woman is extremely thin and, at the same time, she sees herself as too fat. Our findings reveal that peers’ average Body Mass Index decreases the likelihood of being anorexic. Second, we take apart the two processes and estimate a recursive probit model of being very thin and perceiving one self as being too fat. Although peers’ Body Mass Index decreases the likelihood of being very thin but increases that of seeing one self as too fat, the unobservables explaining both processes are significantly correlated.self-image, identity, body image, eating disorders, anorexia