Remind me, again, what nervosa means: A Fresh Old Look at the Spectrum of Disordered Eating on Colle

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Remind me, again, what nervosa meansA
Fresh Old Look at the Spectrum of Disordered
Eating on College Campuses

• Michael Levine, Ph.D., FAED
• Department of Psychology, Kenyon College
• Gambier, OH 43022-9623
• levine_at_kenyon.edu

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Goals Overview

• Ground zero (or at least .05) Starting Points
• Semantics
• Sociocultural factors, genetics, and a continuum
  of outcomes
• More semantics Statistics
• Implications for colleges and universities
• Conclusions and implications
• Questions and discussion

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Some Basic I think Facts and Assumptions

• Eating disorders are very serious
• The most common eating disorder being treated
  throughout the world is EDNOS
• Anyone who says Eating disorders are just
  __________ does not have much experience or
  useful knowledge
• Developmental principles of
• equi finality
• equi- potentiality

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Some Basic I think Facts and Assumptions
Continued/Belabored

• Eating disorders are very complex
• Co-morbidity
• Anxiety and/or mood disorders
• Abuse of substances
• Welcome to Axes II and III
• Eating disorders require a bio-psycho-social
  perspective

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Some Basic I think Facts and Assumptions
Continued/Belabored

• Eating disorders require a gender-cultural-politic
  al perspective
• Hows that war on obesity working out?
• Gender differences in disorders such as
• Schizophrenia
• ADHD
• Alcohol abuse and dependence
• Panic disorder with agoraphobia
• Major depression

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Levines Wrestle-mania

• Pronounced gender difference in body image
• issues and disordered eating (8-101)
• Developmental and historical risk points
• The extraordinary prevalence of negative
• body image and unhealthy eating patterns
• among girls and women
• The explosion of body image concerns
• problems and disordered eating (including
• obesity) over the past 30-35 years
• Emergence of body image problems and
• steroid abuse among males

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Perception Semantics Reification Distance
Learning

• Perceptions and judgments
• Names and problem-solving
• Convenient fictions or hypotheses become
  diagnostic categories
• Categories, as schema, have names
• People suffering from bulimia nervosa quickly
  become bulimics
• Even that becomes BN

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Remind Me (Again, Maybe)What Does Nervosa
Mean?

• An-orexia
• Bulimia
• Nervosa
• OED revisited no entry
• OED perused archaic nervose
• OED abandoned

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Remind Me (Again, Maybe)What Does Nervosa
Mean?

• In the 1870s, why wasnt AN called Anorexica
  Hysterica?
• Why isnt Panic Disorder called Asthmatica
  Nervosa?
• Why do Anorexia Nervosa and Bulimia Nervosa share
  a Nervosa?
• What is the shared Nervosa?

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OK I Dont Really Know Exactly Nervosa Means?

• Underlying psychogical characteristics Underlying
  psycho path ology
• Shared Features Psychological
• Undue influence of weight and shape, and control
  of same, on self-concept and identity
• Irrational attitudes (beliefs, feelings,
  behaviors, resistance) in regard to fat and
  fat people
• Glorification of and internalization of
  impossible ideals
• Low and unstable self-esteem (sometimes
  accompanied by musts and shoulds)

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OK So Maybe I Kinda, Like, Know What Nervosa
Means?

• Shared Features Psychological
• Negative body image
• Disconnections from emotions and
• feelings such as anger and fatigue
• Objectification of self and others
• disconnection from same

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Body Image/Schema

• Visual
• Emotional
• Cognitive
• Kinesthetic
• Performance
• Social - Interpersonal

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Levines Wrestle-Mania (continued)Multiple
Determinants of Body Image

• Genetic Heritage
• Physical experiences
• Models and models
• Direct social experiences
• Cultural messages

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OK So Maybe I Kinda, Like, Know What Nervosa
Means?
Overlapping Behavioral Features

• Chaotic eating
• Poor nutrition
• Calorie-restrictive dieting
• Binge eating
• Use of tobacco and other drugs
• Oral substitutions
• Extremes of exercise

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Shifting the Focus to Culture,As in . . . . Us
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Shifting the Focus to Culture,As in . . . . Us
Eating Disorders
YOU
I
Disordered Eating
Culture
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A Focus on Nervosa Calls Our Attention to
Continuum Model

• Prevalence of eating disorders (0-4)
• Prevalence of EDNOS (3-8)
• Prevalence of significant negative body image and
  unhealthy dieting/nutrition/activity (10-20,
  chronic) - ??
• Use and abuse of steroids and supplements (2-5)
• Rates of obesity for older children and
  adolescents nearing 20

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A Focus on Nervosa Calls Our Attention to Us
and Our Cultures

• Fascination with Eating Disorders
• Connection with issues that challenge our
  cultures Gender, Control, Food, Image vs.
  Substance, Sexuality
• Our ambivalence about Eating Disorders
• How do we think about and understand Eating
  Disorders?

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Summer 2004 Still the Objectof My Gaze (and
Your Own?)
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The Adonis Ideal

• Mesomorphic ideal
• Men are defined by size, power, and strength
• Lean muscular attractive
• muscularity manly success
• muscularity health

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Youll Always Be the Object of My Attention
Always quilted sanitary napkins
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Pervasive Messages--Multiple Sources

• Health professionals
• Parents
• Educators
• Mass media
• Books
• Peers
• Citizens

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What A Sociocultural Perspective Is (Smolak,
Levine, Murnen, 2006)

• Focuses on socially constructed or culturally
  endorsed variables
• A transactional approach
• Culture will determine what is ideal for whom and
  how to attain it
• Culture will determine what is normative (even if
  unhealthy) and pathological (templates of
  deviance)
• There will be within- and across-group
  differences based on exposure to various
  sociocultural factors

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Thus, According to a Sociocultural Perspective

• There is a Culture of the Ideal Body A body
  that is desirable, attractive, attainable, and
  associated with success
• If the body ideal is unrealistic or is rigidly
  enforced, self-perceived investment in and/or
  failure to achieve this body will result in a
  continuum of problems ranging from body
  dissatisfaction to full clinical syndromes.

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Behavior Genetics and the New Biopsychiatry

• What explains the illnesses?
• Why are the disorders so rare and serious?
• What explains vulnerability to numerous risk
  factors?
• What is the biochemical basis and could it help
  us to develop better pharmacotherapies?
• Could we identify those at high risk and
  intervene early?
• Could we avoid making the same kinds of hurtful
• mistakes we made with autism and schizophrenia?
• Can we bring to bear the power and status of
  scientific research to bear on eating disorders,
  as we have done with mood disorders,
  schizophrenia, and substance abuse?

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Polygenic, Pleiotropic, QTL-basedThreshold-Liabil
ity and the Spectrum Concept (Jang, 2005)
B Spectrum prediction
EDNOS?
C Full-Blown AN, BN, BED
Strength of genetic influence
Strength of environmental effects
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Thus, According to a Sociocultural
Perspective Sociocultural variables are causal
factors in the development of risk factors (for
eating problems and eating disorders

• Negative body image
• Weight concerns
• Thinness and/or
• muscularity/leanness
• schema

Sociocultural Factors or Pressures
Continuum of Clinically Significant Disordered
Eating
Parents
Parents
Peers

• Negative affect
• Negative self- concept

Media

• Ego deficits
• Emotional instability
• History of overweight
• Impulsive or SS

Other (School, Athletics)
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A Simple Continuum Model
From Neumark-Sztainer (2004)
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Implications of a Sociocultural Perspective --An
Ecological ApproachA Simplified Look at the
Rose Paradox (Austin, 2001 Rose, 1995)

• Number Risk - Disorder N___
  
• 10,000 High
  12 1200
• 90,000 Lower
  2 1800
• 100,000 total Low-mod? 3
  3000

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A Sociocultural Perspective Does Not

• Deny any role for genetics or neurobiology as
  important but not the only important sources
  of individual differences in vulnerability
• Minimize the seriousness of full-blown eating
  disorders, nor fail to make any distinctions
  between different types or levels of disordered
  eating
• Expect that one model will fit all cultures or
  both genders or all ages

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What About the Rarity of EDs?A Look at Risk
Factors Probability (Hanson, 2004)

• If there were 4 (relatively) independent risk
  factors for bulimia nervosa, then to achieve a
  population frequency of .02 (the point
  prevalence), each would have to occur at a
  frequency of .38 in the population, because .38
  to the 4th power (.384) .0208.
• The factors that lead to schizophrenia, as Dr.
  Gottesman taught us, are multiple. These factors
  must be quite common in the population and thus
  are not necessarily abnormal. We need to get
  out of our mindset of searching for abnormal
  schizophrenia genes and broaden our view to look
  at normal individual genetic variation in
  conjunction with exposure to common environmental
  agents (p. 214)

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The Ecological Perspective Health Promoting
Schools

• School ethos
• School curriculum
• School-community partnerships

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Implications of a Focus on Nervosa for College
Campuses
Consciousness-raising Connections
Collaborations Competencies Choices Change
Undergraduate Education

• Student Life
• RA training
• Panhellenic groups
• Service learning in schools
• GLTG groups

Graduate and professional education

• Front Lines Clinical Services
• Therapy and counseling
• Support services
• Continuing education and professional development

• Athletics
• Athletes
• Training
• Coaching

• Other Forms of Outreach and Advocacy
• EDAW, or ANAD
• Alumni Magazine
• Arts and Lectures

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School Ethos - Action Committee

• Resource, action, and advocacy group
• Dialogue and needs assessment
• Action committees, with administrative support
  and academic connections
• Schools missions
• Literacy
• Citizenship and Leadership
• Service
• Community engagement

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School Ethos - Action Committee (continued)

• Ecological review
• posters, contests, practices
• multiple opportunities for success in ways that
  de-emphasize appearance for young women and
  predatory mooking for young men
• emphasis on various forms of helping, including
  reaching out to peers, community service
• Food Service
• Educational needs of professors, graduate
  students, libraries, coaches

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School Curricula - Topic Integration

• Nutrition and the bio-psycho-social-cultural
  dimensions of eating for health and well-being
• Prejudice, fairness, and respect
• Genetics and diversity
• Psycho-biology of weight and shape regulation
• Weight and shape changes during puberty
• Stress (including transitional stress) coping
• Nature and dangers of calorie-restrictive dieting
  and of obesity
• What do we know? How do we know it? What dont we
  know?
• Anthropology and economics of food production and
  consumption
• Media literacy, including the business of
  advertising
• History of fashion, critique, and courage for
  males and females
• Sports sociology, science, media, marketing,
  etc.
• Philosophy of mind-body relationships

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Goal Models in Historyand Narratives of
Resistance

• This cause is not altogether and exclusively
  womens cause. It is the cause of human
  brotherhood as well as human sisterhood, and both
  must rise and fall together. Woman cannot be
  elevated without elevating man, and man cannot be
  depressed without depressing woman also.
• - Frederick Douglas
• 1848

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Principle 9 Prevention and Education requires
a critical/analytic perspective, attention to
social justice, and activism--and thus it
requires dialogue, collaboration, and courage.

• Elizabeth Cady Stanton
• 1815-1902
• Reformer.

Mae Jemison, M.D.
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But What, Like, Really, Can Anybody Do?

• Kenyon
• 2001-2002 ?
• Andy Mills Becky
• Osborn Erica
• Neitz (01)
• (with support from Drs.
• Levine, Smolak, Murnen
• and
• several counselors, teachers, and
  principals in the Mt. Vernon City School System)

See www.gurze.com
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One Person in a Small Town Can Begin the Process
of Making a Difference

• A great model an ongoing narrative of
  courage, resistance, and change is the Red
  Wing, MN non-profit organization described at
  Higherself.com, which grew out of the GO GIRLSTM
  program guided by
• Sarah Stinson

• High school girls who have
• Protested
• Taught
• Advocated
• Testified in the US congress
• Formed a non-profit corporation

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Implications of a Sociocultural Perspective A
Bolder Model of Prevention (Irving, 1999)

• Personal
• Professional
• Political

• "Each of us must be the change we want to see
  in the world
• - Mohandas K. Gandhi