The Stigma is Real: Self-Blame and Explanations for Eating Disorders

Stigma is a real thing. There you go, the most profound statement I’ve ever written. In all seriousness though, there’s a big stigma problem around eating disorders, and not all of it is imposed from the outside. Many people with eating disorders also self-stigmatize, feeling responsible for their disorder (Holliday, Wall, Treasure & Weinman, 2005 wrote more about this). Other stigma is externally imposed; for instance, the widely held (and erroneous) belief that eating disorders are only something vain young girls get or that they are a choice.

Stigma around eating disorders sometimes differs betweens diagnoses, and especially between eating disorders and other mental illnesses – for instance, Roehrig and McLean (2010) found that eating disorders (both anorexia nervosa and bulimia nervosa) were more stigmatized than depression, and that eating disorder stigma uniquely (and horribly) included a certain degree of envy. The stigma associated with AN is … Continue reading →

Eating Disorders & Socioeconomic Status in the Community

The assumption that eating disorders only impact young, white, affluent women seems so out dated as to be laughable – and yet somehow this image persists, one of the most prominent stereotypes about eating disorders. It’s a damaging stereotype on so many levels; as we know, stereotypes about who might suffer from an eating disorder can lead people to feel that they don’t actually have an eating disorder and de-legitimizing their distress. The stigma that stems from having a body not expected to have an eating disorder can lead people to avoid seeking treatment out of fear of being dismissed by doctors, not thinking the type of treatment on offer will be appropriate or helpful, and more. Somehow, in the face of this, the image of the privileged and vain young woman who chooses to not eat marches on. And it is a shame.

Researchers are exploring stereotypes such as … Continue reading →

Exploring Family Based Treatment for Eating Disorders in China

Not much is known about eating disorders in China, especially compared to its East Asian counterparts of Hong Kong and Japan. It would appear that researcher-practitioners in China are not publishing much data about eating disorders in the country; in fact, the author of the study I’ll be looking at in this post, Joyce Ma, practices primarily in Hong Kong. In this study, Ma explores China-specific patterns of ED presentation and how they relate to the social context. As she notes, treatment models have been slow to develop from the mother-blaming paradigm proposed by Chen (1990), which recommended that eating disorder patients be isolated from their parents. No other study appears to have been done (at least that she cites) using evidence-based modalities.

In her study, she reports on the results of treatment with 10 families in a Shenzhen clinic, with patients of a relatively wide age range – … Continue reading →

Eating Disorders: What’s Feminism Got to Do With It?

There has been a lot of talk in the Twittersphere lately about feminism and eating disorders. Because I live and breathe my feminism and my eating disorder research and activism, I’ve been struggling to reconcile my commitment to making sure people feel heard and my commitment to clarifying what I feel are misconceptions about the links between feminism and eating disorders.

Certainly, it can’t be denied that some have adopted the name “feminism” and supported some decidedly shady claims or research. Then again, people of all stripes have done shady research with questionable motives and outcomes. Science and research are never neutral. Everything from what is seen as being “important enough” to study to how results are interpreted and used takes place in a socio-political context. Try as we might, we can’t fully remove ourselves from our research, whether we research micro-RNA or eating disorders (or both? It’s probably possible … Continue reading →

We’re In This Together: Collaborative Care for Eating Disorders

This week I had the pleasure of attending a workshop with Janet Treasure on collaborative care in eating disorders. Treasure focused her workshop on supporting caregivers of people with eating disorders, offering practical skills for carers and clinicians alike to improve interactions with those with eating disorders. Though I am neither a carer nor a clinicians, I got a lot out of the workshop, and it reminded me of a few of Treasure’s articles I’ve read over the years, and how much I appreciate her strong focus on working collaboratively with patients and families to facilitate recovery.

I especially appreciated how she aims to integrate those with lived experience (of either having an eating disorder or caring for someone with an eating disorder) in research and treatment design. Some of her journal articles, including this article on the potential for harm in existing treatment models, even include former patients as … Continue reading →

Poverty and Eating Disorders in Hong Kong

Eating disorders are typically seen as an illness of the middle class, with most patients coming from that socioeconomic group. However, the invisibility of poorer patients within eating disorder research in part reflects the barriers to treatment that they face, including both cost and lower levels of awareness. This paper, written by a Hong Kong social work professor, Joyce Ma, focuses less on the process of eating disorder recovery, highlighting instead the context of treatment. She discusses how family dynamics and socioeconomic status come into play in her encounters with 7 Hong Kong teenagers from low-income families.

While her sample size is very small, it reveals a more diverse — and less body image-focused –disease pathway than most American studies, with Ma breaking down the precipitating factors as follows (patient numbers in brackets):

  • Constipation (1)
  • Desire to be thin (3, 7)
  • Relationship issues (6)
  • Parental conflicts (5)
  • Poverty (2,
Continue reading →

Culture and Eating Disorders: The Thin Ideal in Singapore

The paper I’m writing about in this post is a master’s thesis published elsewhere in adapted form as a book chapter – not the usual subject here, admittedly. However, for lack of more detailed qualitative research, it’s quite useful in fleshing out some of the observations in more descriptive studies on Singaporean eating disorder patients. This origin is one among a few other caveats to bear in mind; among them, Isono Maho’s ethnography does not aim to be a representative study of ED patients in Singapore, but rather a reflection on the aspects of Singapore culture that related to her interviewees’ particular experiences. Some of the themes Isono Maho found in this data set, nevertheless, help to supplement other studies’ findings, including those indicating that patients with eating disorders in Singapore tend to:

  • Present with body image concerns
  • Attribute comments and judgments from others as factors in their eating disorders.
Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 2

I previously looked at two retrospective studies of anorexia patients in Singapore, which primarily concerned female patients. In this study, Tan et al (2014) looked at 72 male-identified patients diagnosed with all forms of eating disorders.

  • 1% had anorexia nervosa (15.3% binge-purge subtype, 20.8% restrictive subtype)
  • 3% had bulimia nervosa (27.8% purge subtype, 5.6% non-purge subtype)
  • 5% had EDNOS
  • 9% had BED

The mean age at intake was 19.9 years old; patients were mainly students (41.7%) and national servicemen (41.7%). Compulsory army service (National Service) usually takes place in the two years after high school graduation, though some may defer until completing further studies. The typical age range for those in National Service is 19-24.

Of the patients in the study, 88.9% identified a precipitating factor for their eating disorder, including being overweight (59.7% reported pre-morbid obesity) and having people make comments about their body. 68.1% of patients … Continue reading →

Eating Disorders are a Political Issue: Bulimia Nervosa and Advanced Capitalism

If you know me even a little bit, you can imagine my glee at coming across a paper entitled “The Political Economy of Bulimia Nervosa.” YES! I exclaimed. Let’s explore the ways in which our systems of food production are linked to eating disorders. Let’s complicate the idea of “the social” as it relates to eating disorders and do an analysis of the complex socio-political and economic forces that govern our world.

So, let’s get right into it, shall we?

The Article

Pirie (2011) argues that it is important to understand eating disorders from a political economic perspective so that we can look beyond an equation of the “cultural” and media representations of femininity. The way in, he suggests, is through a look at how food systems have shifted since the time at which bulimia nervosa was introduced as a psychiatric diagnosis, around 1970.

The article is not … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 1

Some previous posts on this blog have explored whether eating disorders might (or might not) be considered culture-bound, or in other words specific to or presenting specifically in certain cultures. If you consider eating disorders to be “culture bound,” they would present primarily in Western cultures, with non-Western cultures ‘receiving’ eating disorder pathology through Westernization. In this post, I explore eating disorders in the Singaporean context to continue to unpack the relationship between culture and eating disorders. Singapore is an interesting place in which to look at eating disorders (not just because I live there) because it complicates the idea of “culture-boundedness.”

Studies have been conducted in Asia; primarily in Hong Kong and to a lesser extent Japan. Most notably, Lee (1991) found non-fat-phobic presentations in Hong Kong supported by Ngai, Lee & Lee (2000) (see this post for more on the Ngai study). Singapore is … Continue reading →