Running head: EATING DISORDERS
Eating Disorders:
Determining Prominent Cause
Jennifer Dowdy
Psychology 3120
Introduction
Eating disorders are difficult to treat. Given their multifaceted nature, determining the approach to treatment can feel overwhelming. My diagnostics systems were designed to determine the prominent cause of the eating disorder based on either social pressure or emotional turmoil. Pinpointing the more specific struggle that contributed to the onset of the eating disorder allows the therapist to find the most effective place to start treatment.
The first diagnostic system was based upon social pressure. It was divided into three categories: family pressure, athletic/professional pressure, and media saturation. Family pressure described growing up in a critical atmosphere where perfectionism was verbally pressured or nonverbally implied through reinforcement and where there was a strong push for overachievement. Athletic/professional pressure described a lifestyle where one participated in a career where importance was placed upon having a lean body mass and where participants were pushed to be the best. Further, there was a presence of peers in one’s social group who struggled with body image. Finally, media saturation indicated a strong identification with celebrities through media sources such as women’s magazines. These categories are not mutually exclusive, as it would be possible to experience both family pressure and media saturation concurrently. The diagnostician was directed to indicate the most prevalent cause.
The second diagnostic system was based upon emotional turmoil. This system was divided into two categories: life disruption and sexual abuse. Life disruption described a structural change (break up, divorce, relocation, etc.) that resulted in loss of control and feelings of powerlessness. Sexual abuse indicated a history of sexual abuse: molestation as a child, sexualization from an early age or recent involvement in a sexually abusive relationship. As in system one, these categories are not mutually exclusive, as it would be possible to experience both life disruption and sexual abuse. The diagnostician was directed to indicate the most prevalent cause.
Method
Ten student diagnosticians were given three case studies
each, and were instructed to make two diagnoses: one for each system. Diagnosticians were randomly selected from an
undergraduate Abnormal Psychology class.
These student diagnoses determined interjudge reliability. To determine
the validity of the diagnostic systems, the case studies were presented to and
diagnosed by Jacquie Sellers-Womack.
Sellers-Womack works as a counselor for
Results
Results of diagnostic test one: Social pressure
|
|
Case Study #1 Sarah |
Case Study #2 Rachael |
Case Study #3 Amanda |
|
|
Family Pressure |
9 |
1 |
7 |
Reliability: 25/30 |
|
Athletic/Professional Pressure |
0 |
9 |
2 |
Validity: 25/30 |
|
Media Saturation |
1 |
0 |
1 |
|
Results of diagnostic test two: Emotion turmoil
|
|
Case Study #1 Sarah |
Case Study #2 Rachael |
Case Study #3 Amanda |
|
|
Life Disruption |
10 |
0 |
10 |
Reliability: 30/30 |
|
Sexual Abuse |
0 |
10 |
0 |
Validity: 30/30 |
*Gray shading indicates expert’s diagnosis
Case study reliability and validity results
|
|
Case Study #1 Sarah |
Case Study #2 Rachael |
Case Study #3 Amanda |
|
Reliability |
19/20 |
19/20 |
17/20 |
|
Validity |
19/20 |
19/20 |
17/20 |
Discussion
In any diagnostic system, information is both gained and lost depending on design. In the first diagnostic system, information about the client’s environment is gained while information regarding biological factors (mood disorders, low serotonin, etc.), personality factors (one's own perfectionistic tendencies, etc.), and the presence of life events (stressors) are lost. This system was 83% reliable and 83% valid.
In the second diagnostic system, information is gained about the life events (stressors) that led to the onset of the eating disorder. However, information is lost regarding ongoing life pressure and challenges. As with the above system, information regarding biological factors and personality factors is lost. This system was 100% reliable and 100% valid.
I believe the high
rate of reliability in these systems can be attributed to clear categories as
well as a general familiarity with the topic of eating disorders. Student diagnosticians at
Both systems had strong validity. I attribute this to the clean-cut case studies, where the prominent cause was clear and obvious. Had these cases been more complex with more factors contributing to the onset of the eating disorder, validity may have been much lower.
Regardless of the diagnostic systems’ reliability and validity, it is important to remember that every client’s case is unique and complex. A diagnosis of prominent cause may help to begin treatment; however, it may be necessary to depart from the diagnosis to address other factors that contribute. This is the limitation of diagnostic systems based on prominent causes: their value lasts only as long as preliminary treatment.
An unavoidable weakness of both diagnostic systems is the issue of mutual exclusiveness. Due to the complex nature of eating disorders, the majority of cases will suggest a multitude of causes. This was illustrated well by Amanda’s case study. The study highlights struggles with family pressure, athletic/profession pressure, and media saturation. Diagnosis into any of these three categories could be argued, as they are not mutually exclusive. Also, these experiences do not automatically lead to the onset of an eating disorder. Often it is a combination of social pressures and emotional turmoil that produces vulnerability to eating disorders. Both systems fail to capture this reality.
When I first became familiar with the DSM-IV, I was struck by its shortcomings. Surely with all its revisions, a more valid and reliable system could have been developed than what is available. Now that I have completed this project, I have a greater appreciation for the DSM-IV, shortcomings and all. Truly, it is difficult to design a diagnostic system that is clear and concise that still manages to capture the unique qualities of a client’s case. If this assignment taught me anything, it was to be understanding of the weaknesses of a diagnostic system while appreciating it for what it is: a tool.
Given the opportunity to complete this assignment in the future, I would make several changes. First, I would choose a topic that lends well to mutually exclusive categories. Second, I would use shorter case studies. I found that it was difficult and time-consuming to read long case studies within the timeframe allotted. Lastly, I would staple my three case studies together. I was unaware that each diagnostician would diagnose all three studies. Therefore, in the future I would be sure to have prepared packets for each diagnostician to facilitate efficient diagnosis.
Appendix
Case
Study #1: Amanda
Amanda’s struggle with anorexia began the fall of her
freshman year at college. She had gone
away for school in
When Amanda returned home at Christmas, she was reinforced
for her thinness, despite looking ill.
Nobody acknowledged that a problem might exist. Growing up, her mother was very critical,
demanding perfection from her daughter in school and beauty. Being a curvy girl, Amanda recognized that
she didn’t have the underdeveloped body of her young adolescent peers. Her mother made her more acutely aware of her
figure by suggesting “more flattering/slimming garments.”
In the eighth grade, Amanda began cheering. She remembers constant comparison between
herself and her peers on a physical level.
The women she surrounded herself with had unhealthy body image and often
took unhealthy measures to control their weight. Amanda turned this message inward with an
attitude of self-hate, vowing to control her weight as her friends had and as
her mother suggested that she should.
Case
Study #2: Rachael
Rachael grew up in a home where her parents were rather
distant. To her, they served as a mere
financial support. In order to gain
their attention and affection, she rebelled during her early teens only to
discover it did not bring about the result she hoped for. Instead, Rachael turned to perfectionism in
hopes of satisfying her emotional needs.
This, too, was of no avail.
Still, she pushed herself over and above in her education,
relationships, and eating. She felt that
by controlling these things she could gain a better grasp on her life.
As a child, she remembers feeling as though she was the
biggest girl in her gymnastics class.
Admittedly, she noted that this was probably a distortion, but still
sent her a significant message regarding body image. In high school, Rachael was a swimmer. Her struggle with body image became more
obvious in this sport, as she was very uncomfortable wearing a swimsuit in
public. The competitive nature of this
sport caused her to compare herself with the other members of the team and try
to control her body weight as best as she could.
Sexual abuse was a constant
aspect of Rachael’s development. At 3
years old, and again as a preadolescent, she was sexually advanced upon by two
older male cousins. For the duration of
junior high and high school, she was sexually assaulted by her youth
minister. It was during this time that
her eating disorder reached its peak. Given her distant relationship with her
parents, she felt unable to seek out help from an outside source. Instead she silently suffered the abuse until
the abuse was publicly brought to life by the offender’s wife.
Case Study #3: Sarah
Sarah is the younger of two
daughters. Her parents are still
married. Her eldest sister was a
prodigy, who met her mother’s unrealistic expectations of perfection. Sarah was naturally bright, but never put in
the same amount of effort as her older sister.
This caused a great deal of friction between Sarah and her mother. As she grew older her mother continued to
pressure her more and more in a highly controlling manner.
Admittedly, Sarah
recognized the influence the media had on her body image despite her repulsion
with the objectification of women. She
felt this internal struggle was a silent struggle for much of her late
adolescence.
Just after going away to
college (4 hours) Sarah started dating someone quite seriously. For the duration of their year and a half
relationship, Sarah was very controlling in order to maintain the security of
having someone in her life forever.
Following the dissolution of this relationship, Sarah felt very out of
control and often lost her appetite from emotional distress. In order to cope, Sarah began restricting her
diet so much that she dropped to a BMI of 11.
When her eating disorder
came to light, her mother did not validate her emotional struggles. She forced Sarah to see doctors and have
tests taken to show it was a thyroid issue.
The friction existing between Sarah and her mother is a daily struggle
for Sarah.
Diagnostic
System Test Table
|
Diagnostic System A |
Diagnostic System B |
|
Social Pressure |
Emotional Turmoil |
|
1. Family Pressure
|
1. Life Disruption
|
|
2. Athletic/Professional
Pressure
|
2. Sexual Abuse
|
|
3. Media Saturation
|
These categories are not mutually
exclusive. Choose the most prevalent
cause.