Discussing the cultural parts of eating disorders may make treatment more effective

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Eating disorders are often viewed through a singular lens. Either people think of them as “social issues” brought on by the pressures people face to maintain or achieve a specific body type, or they are seen as a mental health issue. Of course, the truth is that eating disorders are both of these and more. The roots of eating disorders are deeply involved in genetics, cultural issues, and mental wellness, making them very difficult to treat.

However, treatment programs for eating disorders may be more effective if they better address the multi-faceted nature of eating disorders, according to new research published in the journal Eating Disorders. Specifically, the team of researchers from the University of East Anglia says treatment programs need to better consider the cultural aspects of eating disorders.

Dr. Su Holmes, a reader in UEA’s School of Art, Media, and American Studies says that most treatment programs, especially in the UK, fail to address the cultural contexts that contribute to eating disorders, especially those involving gender.

While people of any gender, ethnicity, and age can develop or live with an eating disorder, younger women are disproportionately likely to be affected. Many have suggested this is largely due to unique cultural standards that women face. Despite this, the most commonly used types of treatment – such as cognitive behavioral therapy (CBT) – largely avoid addressing these issues.

According to Holmes’ past research, patients who specifically ask to talk about issues relating to gender are often ignored, either because professionals lack training in these areas or because these issues are thought of as less important.

To test whether treatment programs that were designed to address cultural issues and gender were effective, the team designed a 10-week long treatment group at an inpatient clinic specializing in eating disorders. The group included female patients who were being treated for anorexia at the clinic, between the ages of 19-51.

Each week, the group focused on a specific way culture might affect eating disorders or body image, such as:

  • Gendered constructions of appetite
  • Cultural expectations surrounding female emotion and anger
  • ‘Reading’ the starved body in relation to cultural prescriptions of femininity
  • The dynamics of ‘healthy’ eating/living and fitness cultures’ aimed at women

The group also explored media, like advertisements, Disney films, and stock photography, to help develop discussion on these topics. At the same time, this media was not treated as the “cause” of anorexia or eating disorders. Rather, many participants said they found that perspective to be patronizing or simplistic.

One said the belief that seeing something like “a skinny model in a magazine” could cause the development of an eating disorder “completely trivializes” their complex nature.

Many of the participants said they felt that this approach was helpful for contextualizing eating disorders without self-blame, but it may have also brought disillusionment with treatment for some.

As one told a researcher, “as the groups went on it’s like OK, maybe this society’s norms are quite disordered. But then it’s like … if society’s norms are disordered … then … I don’t know, how am I meant to change kind of things?”

In response to this, Dr. Holmes says, “The medical framework may offer the patient a greater sense of personal agency when it comes to feelings of control in recovery. Given that anorexia in particular is seen to be tightly intertwined with issues of control, this is clearly worth some thought.”

While the method used by the researchers may have its own flaws, the findings show that including more cultural perspectives on eating disorders into current treatments may allow for more comprehensive recoveries.

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