Self Concept Disturbances Introduction
Eating disorders are complex mental health conditions characterized by persistent disturbances in eating behaviors, body image, and weight management. They often manifest as severe and unhealthy eating patterns and can significantly impact physical health, psychological well-being, and social functioning. Historically, the study of eating disorders has evolved from early psychodynamic theories to contemporary cognitive approaches. A common thread in this research is the notion that eating disorders are fundamentally disorders of the self, involving disruptions in self-concept, body image, and self-esteem.
This comprehensive exploration will delve into how self-concept disturbances are linked to eating disorders, examining the types of eating disorders, the impact of self-identity disturbances, and how cognitive models and self-schemas contribute to these conditions. We will also review nursing research and the implications of these findings for treatment and intervention.
Eating Disorders
Eating disorders have been described as disorders of the self from early psychodynamic perspectives through to current cognitive theories. These disorders often involve significant disturbances in how individuals perceive themselves and their bodies, leading to maladaptive eating behaviors.
Types of Eating Disorders
The American Psychiatric Association recognizes several eating disorders, but the most studied and prevalent are Anorexia Nervosa (AN) and Bulimia Nervosa (BN).
- Anorexia Nervosa (AN): Characterized by an intense fear of gaining weight and a distorted body image leading to severe food restriction and excessive weight loss. Diagnostic criteria for AN include:
- Body weight less than 85% of the ideal body weight for age and height.
- Amenorrhea, defined as the absence of menstrual periods for at least three consecutive months.
- Persistent, distorted attitudes towards body weight and shape.
- Bulimia Nervosa (BN): Involves episodes of binge eating, where individuals consume large amounts of food in a short period while feeling a loss of control. This is followed by compensatory behaviors to prevent weight gain, such as vomiting, excessive exercise, or misuse of laxatives. Diagnostic criteria for BN include:
- Binge eating episodes occurring at least twice a week for a period of three months.
- Compensatory behaviors to counteract the effects of binging.
- Distorted attitudes towards body weight and shape.
While AN and BN are distinct in their behaviors and diagnostic criteria, research often converges on theories suggesting that both disorders share underlying psychological vulnerabilities related to self-concept and identity.
Disturbance in Self Identity
The development of eating disorders is often linked to disturbances in self-identity and self-concept. Early clinical theories suggested that issues with identity and self-concept are core vulnerabilities that contribute to the development of eating disorders. However, empirical testing of these constructs has been limited due to ambiguities in theoretical and operational definitions.
One of the early studies exploring identity disturbances in women with BN defined identity confusion as the subjective experience of inconsistencies in self-beliefs. Meshment, another concept studied, refers to a high dependency on others to define one’s self-concept (Schupak-Neuberg & Nemeroff, 1993). This study, although lacking a formal theoretical framework, provided evidence that women with BN experienced higher levels of confusion, instability, and reliance on others for self-definition compared to controls.
Despite these early insights, further empirical research is needed to refine our understanding of how disturbances in self-identity contribute to eating disorders. The complexity of self-concept and its role in these disorders necessitates a more nuanced approach to studying and addressing these issues.
Eating Disorders and Self Concept Disturbance
Recent research on eating disorders has increasingly utilized cognitive models to understand the role of self-concept disturbances. According to cognitive models, the self-concept consists of organized memory structures about oneself, formed through interactions with the social environment. These self-schemas, or units of self-knowledge, play a critical role in how individuals process information and regulate behavior (Kendzierski & Whitaker, 1997).
Self-Schemas and Eating Disorders
Self-schemas are cognitive structures that organize and interpret information about oneself. They influence attention, memory, and behavior. In the context of eating disorders, research has shown that individuals with these disorders often have a high number of negative self-schemas related to body image and self-worth.
Two significant studies have explored self-schemas in the context of eating disorders using the cognitive model. Showers and Larson (1999) examined the valence and organization of self-schemas in women with subclinical BN. They found that these women had:
- More negative and fewer positive self-schemas.
- A negative self-schema related to physical appearance.
- More linkages between negative physical appearance self-schemas and other self-schemas.
Similarly, Stein, Corte, and Nyquist (2004) investigated self-schemas in women with clinically diagnosed BN. They observed that these women had fewer positive and more negative self-schemas compared to controls. Additionally, the number of positive self-schemas predicted the presence of a fat self-schema, which was highly predictive of eating disordered attitudes and behaviors.
These findings indicate that disruptions in self-schemas, particularly those related to body image and self-worth, play a significant role in the development and maintenance of eating disorders. The presence of negative self-schemas and the lack of positive self-schemas contribute to maladaptive eating behaviors and attitudes.
Nursing Research and Cognitive Model
Nursing research has also explored the cognitive model’s application in understanding eating disorders. Studies focusing on self-schemas have provided insights into how self-concept disturbances contribute to these disorders. For example, research has examined how the valence and organization of self-schemas affect eating disorder symptoms.
One study utilized a card sort instrument to analyze self-schemas in women with subclinical BN. Results revealed that these women had a predominance of negative self-schemas and a negative physical appearance self-schema. The linkages between negative self-schemas were also more pronounced compared to controls. This research underscores the importance of addressing self-schema disturbances in the treatment of eating disorders (Showers & Larson, 1999).
Another study by Stein et al. (2004) found similar patterns in women with clinically diagnosed BN. The findings indicated that the presence of negative self-schemas and the lack of positive self-schemas were associated with disordered eating attitudes and behaviors. These results highlight the need for interventions that target the restructuring of self-schemas to promote recovery from eating disorders.
Self Schemas and Self Guidelines
Self-guides are cognitive structures that represent the self one aspires to be (ideal self-guide) or believes one should be (ought self-guide). Discrepancies between the current self and these self-guides can have significant affective and motivational consequences (Higgins, 1987). Studies have shown that discrepancies between current self-schemas and ideal or ought self-guides are associated with various eating disorder symptoms.
Strauman et al. (1991) investigated how discrepancies between current self-schemas and ideal or ought self-guides relate to eating disorders. They found that:
- Women with extreme discrepancies between their current self and ideal self-guides exhibited high levels of body dissatisfaction and bulimic symptoms.
- Women with significant discrepancies between their current self and ought self-guides showed high levels of dieting and anorexic symptoms.
These findings suggest that addressing discrepancies between self-schemas and self-guides is crucial for treating eating disorders. Interventions that focus on aligning self-schemas with ideal and ought self-guides may help reduce body dissatisfaction and disordered eating behaviors.
Characteristics of Self Concept
Research has identified several key characteristics of self-concept that contribute to eating disorders. These characteristics include:
- Absence of Positive Self-Schemas: Individuals with eating disorders often lack positive self-schemas, leading to negative self-perceptions and maladaptive behaviors.
- Presence of Negative Self-Schemas: A high number of negative self-schemas, particularly related to body image and self-worth, contributes to eating disorder symptoms.
- Interconnectedness of Self-Schemas: The linkages between negative self-schemas can exacerbate eating disorder symptoms by reinforcing negative self-perceptions and behaviors.
- Discrepancies Between Self-Schemas and Self-Guides: Significant discrepancies between current self-schemas and ideal or ought self-guides are associated with increased body dissatisfaction and disordered eating behaviors.
These characteristics support the hypothesis that disturbances in the structure of the self-concept are core vulnerabilities contributing to eating disorders. Addressing these disturbances through therapeutic interventions can help promote long-term recovery and improve overall well-being.
Implications for Treatment and Intervention
The research on self-concept disturbances and eating disorders has important implications for treatment and intervention. Traditional treatment approaches often focus on modifying weight-related cognitions and behaviors. However, the findings discussed above suggest that interventions should also target the overall structure of the self-concept.
Therapeutic approaches that aim to:
- Build Positive Self-Schemas: Enhancing positive self-schemas can help counteract negative self-perceptions and promote healthier body image and self-worth.
- Modify Negative Self-Schemas: Addressing and restructuring negative self-schemas can reduce the impact of negative self-perceptions on eating behaviors.
- Align Self-Schemas with Self-Guides: Interventions that help individuals align their self-schemas with their ideal and ought self-guides can reduce body dissatisfaction and disordered eating behaviors.
By focusing on these aspects of self-concept, treatment approaches can address the underlying cognitive vulnerabilities that contribute to eating disorders. This comprehensive approach may lead to more effective and sustained recovery for individuals with eating disorders.
Conclusion
Self-concept disturbances play a significant role in the development and maintenance of eating disorders. Research has demonstrated that disruptions in self-schemas, body image, and self-esteem contribute to maladaptive eating behaviors and attitudes. Understanding these disturbances through cognitive models and self-schema theories provides valuable insights into the etiology of eating disorders and informs treatment approaches.
Addressing self-concept disturbances in therapeutic interventions can help individuals with eating disorders achieve long-term recovery and improve their overall well-being. Future research should continue to explore the complexities of self-concept and its role in eating disorders to develop more effective and targeted treatment strategies.