Stuvia 426190 Assignment 3 Eating Disorders Mark88

Assignment 3 - Eating disorders -
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Table of Contents
Introduction
Part A – Features of Anorexia Nervosa, Bulimia Nervosa and Binge-eating Disorder
Diagnostic Criteria and Hallmark features
1.1 Anorexia Nervosa

1.2 Bulimia Nervosa
1.3 Binge-eating Disorder
Diagnostic Criteria
2.1 Eating Habits
2.2 Fear
2.3 Compensatory Behaviors
2.4 State of mind
Hallmark Features
3.1.1 Excessive exercise
3.1.2 Depression, Obsessive Compulsive Disorder and Personality Disorders
3.1.3 Cessation of menstruation
3.1.4 Strong need for control
3.2 Comparison of Hallmark features
3.2.3 Cessation of Menstruation
Part B – Discussion of Black South African Females lack of “immunity” to eating disorders
4.1 What is body image satisfaction/dissatisfaction

4.2 Factors that influence body image satisfaction in black South African females
4.2.1 Cultural factors
4.2.2 Psychological factors
4.2.3 Social factors
4.3 Current research findings
4.4 Differentiation between Urban and Rural black females body image perception

4.5 Factors affecting the development of eating disorders

4.5.1 Socioeconomic Status
4.5.2 Ethnicity
4.5.3 Acculturation
4.5.4 Personality Traits
4.6 Recent research results
4.7Conclusion

Introduction
Eating disorders are a serious problem in our society. The chances are quite high that most people today
know or know of someone who has at some stage battled with an eating disorder of some sort. The
origin of eating disorders – Anorexia Nervosa in particular, date back to the Middle Ages. (Austin et al.
2016) The aim of this essay is to critically discuss and compare three eating disorders and how they
affect black South Africans in this modern day.
This essay is divided into two sections. The first topic to be discussed will be an analysis of the
differences between the diagnostic criteria and hallmark features of three different eating disorders,
namely Anorexia Nervosa, Bulimia Nervosa and Binge-eating disorder. Anorexia Nervosa will be fully
described as the main eating disorder with Bulimia Nervosa and Binge-eating disorder being contrasted
against it.
The second section of this essay will critically discuss how South African black females are no longer
perceived to be “immune” from eating disorders.
Finally, conclusions will be drawn as to the differences and similarities amongst the three eating
disorders as well as an in-depth discussion of how black females have become more susceptible to
disordered eating in today’s society.

Diagnostic Criteria and Hallmark features of Anorexia Nervosa,

Bulimia Nervosa and Binge-eating Disorder
The prevalence of Anorexia Nervosa is around 0.4%. Onset of Anorexia Nervosa is typically common
around the 14 – 18-year age range. There are two subtypes of Anorexia Nervosa, restricting type and
binge eating/purging type. As listed by Austin et al. (2015) those who suffer from the restricting type
restrict their food intake as well as engage in excessive exercise and those who suffer from the binge-
eating/purging type use purging techniques for example vomiting, laxatives and use of diuretics. These
purging techniques occur frequently. This eating disorder is diagnosed upon the presence of certain
criteria according to Austin et al. (2015)
1.2 Bulimia Nervosa
Bulimia Nervosa is more common than Anorexia Nervosa, with a prevalence of around 1% - 1.5% among
females from industrialized countries. (Austin et al. 2015) The age of onset of Bulimia Nervosa is
normally found in late adolescence to early adulthood.
1.3 Binge-eating disorder
Binge-eating disorder is an eating disorder whereby sufferers partake in binge-eating episodes which
causes them severe misery. The age of onset, unlike that of Anorexia Nervosa or Bulimia Nervosa, is
more prevalent at an older age. According to Miller and Mc Manus (2016, p.3) “Women are diagnosed
at higher rates than men; however, less of a gender gap in diagnosis exists between men and women
than in other eating disorders.” Also, according to Kessler (cited in Miller and McManus, 2015, p12)
“Binge-eating disorder is the most common eating disorder.”
2. Diagnostic criteria:

The diagnostic criteria have been specified by the DSM-5 and ICD-10 classification systems. The ICD-10
defines which criteria are to be met for a definite diagnosis.
2.1 Eating habits
Sufferers of Anorexia Nervosa cut their calorific intake down to a level that cannot sustain their
energy requirements. As a result, they experience a very low body weight (which does not meet
the minimal healthy range) in comparison to the “norm” for their physiological features such as
their age, sex and their developmental level.
Those suffering from Bulimia Nervosa, on the other hand, eat very large amounts of food in
single sittings. These meals are much larger than what the average person would eat on a
regular occasion. Sufferers also experience a loss of control over what they are eating when
“bingeing.” In this sense they cannot stop themselves from eating. After the bingeing episodes,
the individuals will usually perform one or more of many different compensatory techniques to
avoid weight gain.
The eating habits differ when it comes to Binge-eating Disorder because although, like someone
suffering from Bulimia Nervosa, a patient of Binge-eating disorder will still eat large amounts of
food in single sittings, but will “not engage in the compensatory behaviors.” (Austin, et al. 2015
p.425) Therefore binge-eating disorder differs the most in comparison to the other two
disorders in the sense that it is the only one of the three eating disorders in which no
compensatory behaviors are practiced, resulting in the largest food intake of all 3 disorders.
Furthermore, according to a study completed by Burd et al (2009, p.373) “an eating episode that
may be considered a ‘‘binge’’ for a woman with [Anorexia Nervosa] is in general rather small in
comparison with those reported in [Bulimia Nervosa].” Which adds to the contrast between
eating patterns throughout these three disorders.
2.2 Fear
Anorexia Sufferers experience an extreme fear of weight gain, to such an extent that they will
focus solely on persistently keeping their weight as low as they can. According to Young et al.
(2013) Sufferers of Bulimia Nervosa tend to compensate for their “binge” through the use of
self-induced vomiting, abuse of laxatives, fasting or exercise.

Bulimia Nervosa sufferers also experience fear, but not fear of weight gain, rather fear of losing
control of eating. (Austin et al. 2015) So the obsession with food and “ox-hunger” as stated by
Austin et al. (2015) is constantly being challenged by the fear of loss of control by the individual.
In a sense this portrays a tug-of-war relationship between food and fear.
According to Fairburn (as cited by Chambers, 2009. Pp 15, 16) Those with Binge-eating disorder
experience “feelings of disgust during the binge episode, eating rapidly, experiencing agitation
or a sense of compulsion to eat, altered consciousness or dissociation during eating, and
secretiveness related to feelings of shame.”
2.3 Compensatory behaviors
Anorexia sufferers manage to keep their weight drastically low by practicing some of the
following techniques: fasting (8 hour windows without eating), restricting their calorific intake,
skipping meals, limiting fat and/or carbohydrate intake at meals and lastly eating as little as
possible.
In order to be diagnosed as such, Bulimia Nervosa patients perform the compensatory behaviors
of binging, vomiting, misusing laxatives and extreme exercise at least once a week for three
months.
Sufferers of binge-eating disorder do not partake in compensatory behaviors after they have
had a binge.
2.4 State of Mind
Those who suffer from Anorexia Nervosa also experience a warped visual image of their bodies.
They tend to judge themselves harshly according to what they perceive as excess weight as well
as seriously underemphasizing the dangerousness of their weight situation. As Izydorczyk, B
(2010) explains: “The sufferer perceives his or her emaciated body as ideal and with the so
called “normal proportions.” She further goes on to quote Schier, who “mentions the
phenomenon of the so called “abandoned body”, which she defines as the chronic
dissatisfaction with one’s body image” This situates us into an Anorexia Nervosa sufferer’s brain,
allowing us to comprehend somewhat how they view their body shape.

With Bulimia Nervosa patients, their state of mind is dependent on their body shape and weight.
If they perceive themselves as “fat” or “overweight” their self-evaluation will be low.
3. Hallmark features:
Hallmark features can also be described as the associated features that occur as a result of a disorder.
3.1. Anorexia Nervosa
The American Psychiatric Association has stated that “Attempts to aid weight loss can take the form
of…excessive exercise” as cited in Austin et al. (2015 p.418)
“Preoccupation with exercise in the eating disorders has long been associated with weight- and
body shape concerns. In view of the assumption that individuals with anorexia nervosa have
difficulties in identifying and regulating their emotions, it is assumed that the regulation and
neutralizing of negative emotions also makes an important contribution to compulsive
exercise.” Kolnes (2016 p.2) Kolnes goes on further to elaborate on the study being performed:
“This study illustrates the transformation of exercise from being balanced and enjoyable during
childhood into compulsive and rule-driven exercising during their illness” (2016 p.3)
The above quote portrays that exercise, to one suffering from Anorexia Nervosa, becomes more of an
obsession and un-enjoyable event compared to how others might enjoy exercise with a balanced diet
and lifestyle.
According to Weigel et al. (2016) there are greater impairments to the quality of life of the binge/purge
subtype of Anorexia Nervosa sufferers compared to the restrictive subtype. The study performed proved
that a lower Body Mass Index was associated with a greater Health Related Quality of Life Impairment.
The results of their study showed that “higher levels of depression and higher levels of somatic
complaints were associated with higher [Health Related Quality of Life] impairments.” P632
With regards to Obsessive Compulsive Disorder, according to Kanye et al. as cited in Salbach-Andrae et
al, p262: “the onset of OCD, social phobia, specific phobia, and generalized anxiety disorder most
commonly preceded the onset of [Anorexia Nervosa]”

Personality disorders also are prevalent among individuals with Anorexia Nervosa. Lojewski, Fisher and
Abraham (2012 p.421) state that “research has shown that the prevalence of [personality disorders] is
higher in populations diagnosed with an [eating disorder] compared to normal controls
“Amenorrhea is prevalent in adolescents with eating disorders, and is one of the diagnostic criteria for
anorexia nervosa.” (Sterling et al. 2009 p658)
Sufferers of Anorexia Nervosa, especially the binge/purge subtype are at risk of a battle between gaining
and losing control. They lose control when they binge and gain control back when they purge according
to Goldschmidt et al (2015)
3.2. Comparison of Anorexia Nervosa Hallmark features with those of Bulimia Nervosa and Binge-eating
Disorder
Bulimia Nervosa shares this characteristic with Anorexia Nervosa. “The appropriate compensatory
behaviors to avoid gaining weight involve…excessive exercise.” Austin et al. (2012, p422)
Binge-eating disorder “the person does not engage in compensatory behaviors.” Austin et al. (2012,
p425)
With regard to Bulimia Nervosa, Austin et al (2012) explains that the purging type of Bulimics experience
depressive symptoms and that overall, a dependency on alcohol and stimulants is present. They go on to
further elaborate that “a significant number of people…diagnosed with Bulimia Nervosa meet the
criteria for one of the personality disorders.” (p424)
In a similar vein, Binge-eating disorder is also associated with depression and personality disorders
according to Austin et al. (2012)
However, unlike Anorexia Nervosa, individuals with Binge-eating disorder and Bulimia Nervosa do not
display the same obsessive compulsiveness.
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The majority of sufferers of Bulimia Nervosa and Binge-eating disorder do not typically suffer from
Amenorrhea, however, according to Pinheiro et al. (2007, p425) “Although body weight is kept within a
normal range in [Bulimia Nervosa], amenorrhea has been reported in 7– 40% of patients” So, although
not as prevalent as with Anorexia Nervosa, disruption/cessation in menstruation occurs within Bulimia
Nervosa but less so with Binge-eating disorder.
Individuals with Bulimia Nervosa also experience the need for control just like those of Anorexia
Nervosa, but sufferers cannot seem to control themselves during a binge. Austin el al (2012, p422)
elaborates: “As the disorder progresses, a lack of control of behavior, such as irresistible impulses to
binge or inability to stop the course of the binge, appear to become evident.”
In the same sense, during a binge, those with binge-eating disorder experience the same problem with
lack of control.
Therefore, it is those with Anorexia Nervosa who maintain a stronger sense of control over what they
eat.
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Black South African Females are no longer “immune” to eating

disorders
4.1 What is body image satisfaction/dissatisfaction?
In order to critically discuss whether black South African females are no longer invulnerable to
eating disorders or not, body image satisfaction first needs to be elaborated on.
According to Halliwell & Dittmar (cited in Mwaba and Roman, 2009) body image dissatisfaction
can be described as “a psychologically salient discrepancy between a person’s perceived body
appearance and their ideal body appearance.” This shows that there is a difference between
how one sees themselves in the mirror to how they hope to look. It is an unhappiness with the
way one perceives their own body.
A study conducted by Mwaba and Roman in 2009 showed that the majority of the 150 black
female participants interviewed reported feeling content with their body shape (76%) but 56%
of participants reported concern with becoming fat or putting on additional weight. This shows
that although the majority of females were happy with their body weight, they were not
completely unconcerned about putting on additional weight.
4.2 The history of eating disorders in South Africa
The presence of eating disorders amongst white people South Africa is not a new phenomenon.
According to Szabo and Allwood (2004), eating disorders were first noted in black South African
females in 1995 – this is fairly recent if you contrast it to when eating disorders were first noted
in South Africa, 1970s according to Szabo and Allwood (2004)
Szabo and Allwood further explain that the acculturation started in the mid to late 1990’s when
black females started entering previously white only schools. Through residing in the boarding
house with white females, the black females became more familiar with westernized society
and its ideals. “In this regard, private schools were viewed as institutions dominated by
12

Western values… it was hypothesized that black females (constituting a minority group in an
alien cultural milieu) in such a setting may demonstrate an inclination towards the
development of eating disorders.” Szabo and Allwood (2004) Ultimately, the aim of their study
was to prove that black adolescents, when placed in urban living arrangements would
eventually adopt the same eating habits as their white peers.
4.3 Current research findings on South African black females’ body dissatisfaction
A recent study conducted by Pedro et al. (2016) tested the body image satisfaction of rural
school children under the age of 15. The results from the study showed that “The majority
85.6% of mid to post pubertal girls were dissatisfied with their body size.” This shows quite a
stark contrast to the study previously mentioned that was conducted in 2009 by Mwaba and
Roman where 76% of participants displayed content with their current body shape.
This study conducted by Pedro et al. further shows us that it is not only teenager females that
are becoming increasingly concerned with their body shape but also the pre and mid pubescent
females too. As stated by Pedro et al., the age at which women or girls start becoming
dissatisfied with their bodies is decreasing. They go on further to elaborate that this
dissatisfaction could lead to disordered eating - which could, in turn, have harsh effects on the
physiological development as well as the psychological development of these women.
4.4 Differentiation between Urban and Rural black females body image perception
When assessing whether black females are satisfied with their body shape, one has to also take
into account that there is a big difference between rural and urban black females. Black rural
females are not as easily influenced by the westernized ideal body image as the Urban women
are. Szabo and Allwood (2006) claim that “Urban white girls had the greatest level of body
dissatisfaction, black rural girls the least with black urban girls closer to their white
counterparts.”
13

According to Senekal et al. (2001) urban woman are more likely to be more restrained in their
eating and are also more likely to have attempted dieting of some sort compared to rural
women. They also state that some black woman view obesity as normal and healthy. “These
obesity-tolerant attitudes could protect black female adolescents and women from developing
eating disorders.” This shows that urban women are more likely to be affected by eating
disorders because they the most likely to be unhappy with their weight. Senekal also states that
acculturation of the westernized ideal of thinness into those from different cultural
backgrounds can lead to body dissatisfaction and therefore disordered eating
Therefore, although not completely void of risk, rural black females are less likely to be affected
by body image dissatisfaction as their urban counterparts are.
4.5 Factors affecting the development of eating disorders
4.5.1 Socio-economic Status
Previous research shows that the majority of those affected by eating disorders hailed
from a higher Socio-economic status. As Le Grange, Louw, Breen and Katzman (2004)
explain, “eating disorders have historically been described as illnesses that befall young,
white, educated females with high SES living in the Western world.”
This is clearly not the case anymore as there are more and more cases of black females
being diagnosed with eating disorders.
4.5.2 Ethnicity
As mentioned earlier, the previous stereotype listed only young, white educated
females as those afflicted with eating disorders. This is no longer the case, as the
number of black woman diagnosed with eating disorders is increasing annually.
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4.5.3 Acculturation
As South Africa is growing and changing, so is the dynamic of the relationship between
the black woman and their social setting. Le Grange et al. (2004) found that “many black
adolescents have adopted an identity that represents a shift from African collectivism to
a more Western individualism and competitiveness.” Proving to us that black
adolescents are growing and changing with the trends of westernized culture. Stevens
and Lockhart (as cited by Le Grange et al. 2004) goes on further to explain that whilst
the black South Africans are changing toward the westernized trends, they are leaving
their own culture and traditions behind. These traditions embrace a fuller figure and
healthy appetite.
Senekal et al. explains how acculturation has an influence on black women’s body image
perception, “This acculturation process can occur in ethnic minorities in Western
countries and also during the westernisation and/or urbanisation of total populations,
especially through the increased exposure to Western advertising, marketing, electronic
media, entertainment and fashions.” With the ethnic minorities being women have
moved to urbanized areas to look for work from rural settings, this shows us how they
can easily be influenced by westernized ideals.
Under the same category, the idealization of thinness comes into play. According to
Culbert, Racine and Klump (2015) “Leading sociocultural models of risk for eating
disorders have predominantly focused on factors related to the idealization of thinness
in women.” From TV adverts to mannequins in clothing store windows, the thin woman
is idealized globally. One would be hard pressed to find a woman that is immune to the
effect that this has on one’s self image and self-perception. They go on further to back
their claim about the relation between the idealization of thinness and its relation to
eating disorders by stating: “In Western cultures, the idealization of thinness in women
and the incidence of [Anorexia Nervosa] and [Bulimia Nervosa] increased during the
15

20th century, indirectly supporting the notion that increases in the idealization of
thinness results in increased risk for eating disorders.”
Cogan et al. (As cited by Senekal et al.) also explain how the younger girls in particular
are more vulnerable to disordered eating patterns in a westernized society because
“young women in the process of establishing their identity are especially vulnerable to
dissatisfaction with their shape and the pursuit of thinness through dieting, and
consequently the development of eating disorders.”
4.5.4 Personality Traits
Another variable that influences ones’ presupposition to having an eating disorder is

ones’ personality traits. According to Culbert et al. (2015) these particular personality
traits effect ones’ presupposition to disordered eating: “negative
emotionality/neuroticism, perfectionism, and impulsivity/negative urgency”
It is quite clear that these personality traits can be found in any person, globally, black
or white.
4.6 Recent research results
 Research conducted by Mwaba and Roman in 2009 showed that overall, the majority of
black females were content with their body perception although 56% of the research
participants indicated a concern about gaining weight.
 According to the research conducted by Pedro et al. in 2015, 58% of the girls questioned
desired to lose weight, whereas 25.5% desired to put on weight. This shows an
unhealthy body image perception on both ends of the spectrum.
 A 2001 study conducted by Senekal et al showed that more than 80% of research
participants who were underweight thought that they were in a healthy weight range
16

and of those in a normal weight range, one quarter of them felt that they were
overweight.
 A study conducted by Le Grange et al. in 2004 yielded results that proved that certain
black high school learners “demonstrated signiﬁcantly greater eating disorder
psychopathology.” They go on to elaborate that they eating disorder psychopathology is
emerging more drastically than they thought.
4.7 Conclusion
Black women are very clearly not “immune” to eating disorders as research very clearly proves.
There is work and research to be done with a preventative aim to eating disorders affecting all
South Africans, black and white. Although the research on black South Africans and eating
disorders is a relatively new topic, it is in need of some adjusting and rectifying.
As mentioned by Le Grange et al. (2004) after completion of their study, some concerns were
raised about the method behind the research into this matter and the manner in which it was
completed. They raised concerns about the cultural differences of rural black girls that they had
not taken into account – such as purging for cleansing rituals as well as the problems caused by
using the English language to interview the rural girls.
Therefore, between the gaps in communication and the cultural differences, which lead to their
research being inaccurate and somewhat misplaced. Moving on from this, future research on
this topic needs to consider the cultural differences and language barriers. Questions need to
take into consideration the cultural practices of rural black families.
17

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Stuvia 426190 Assignment 3 Eating Disorders Mark88

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Assignment 3 - Eating disorders -

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Part A – Features of Anorexia Nervosa, Bulimia Nervosa and Binge-eating Disorder

Diagnostic Criteria and Hallmark features

1.1 Anorexia Nervosa

4.1 What is body image satisfaction/dissatisfaction

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4.5 Factors affecting the development of eating disorders

4.6 Recent research results

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Diagnostic Criteria and Hallmark features of Anorexia Nervosa,

1.1 Anorexia Nervosa

1.2 Bulimia Nervosa

1.3 Binge-eating disorder

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2.1 Eating habits

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2.3 Compensatory behaviors

2.4 State of Mind

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3.1. Anorexia Nervosa

3.1.1 Excessive exercise

3.1.2 Depression, Obsessive Compulsive Disorder and Personality Disorders

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3.1.3 Cessation of Menstruation

3.1.4 Strong need for control

3.2.1 Excessive exercise

3.2.2 Depression, Obsessive Compulsive Disorder and Personality Disorders

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3.2.3 Cessation of Menstruation

3.2.4 Strong need for control

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Black South African Females are no longer “immune” to eating

4.1 What is body image satisfaction/dissatisfaction?

4.2 The history of eating disorders in South Africa

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4.5 Factors affecting the development of eating disorders

4.5.1 Socio-economic Status

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4.5.4 Personality Traits