Eating Disorders and Abuse
Eating Disorders and Abuse
Academic Level: –
Volume of 1 page (275 words)
Assignment type : Research Paper
The paper for PSY 201 involves reading a journal article that is provided and writing a 3 page double spaced review/reaction paper about the attached article.
This means that you will write half the paper about what is in the article (in your own words) and then you will discuss what your thoughts are about the article. If you disagree with the article you are required to provide peer reviewed research (not personal experience) to support your assertions.
The paper is required to be a FULL 3 pages in length (not 2 ½ or 2 ¾ ) and in 12 point New Time Roman font. It is required to be in a Word document. If it is not in a Word document it will not be graded.
Break down of grading
Review of article – 200 points
Reaction to article – 100 points
Length of article – 100 points
Spelling Grammar – 100 points (indenting paragraphs, proper use of nouns/verbs, etc.)
Disorders: Implications for Treatment
This paper addresses the clinical links between emotional abuse and
the eating disorders. It is argued that the core feature of a range of
abusive experiences is emotional invalidation. Emotional abuse is
associated with problems in the development of emotional skills, manifesting
as alexithymia, poor distress tolerance, and emotional inhibition.
Cognitive-behavioral approaches are outlined for work with
eating-disordered patients with a history of emotional abuse. As well
as addressing the central concerns about eating, weight, and shape
(using existing evidence-based methods), the focus of treatment is on
addressing the conditional assumptions about the acceptability of
emotions and the core beliefs that underpin the emotional difficulties.
While there is substantial research into the role of sexual abuse in the eating
disorders (EDs; e.g., Fallon & Wonderlich, 1997), there has been far less study
of other forms of trauma, particularly emotional abuse. In part, this deficit is a
result of the difficulty in defining the experience in a clinically meaningful
way. Emotional abuse is not clearly marked by any specific behavior on the
behalf of a perpetrator, and definitions tend to depend on the victim’s perception
of the perpetrator’s intent and thought processes. Although there are
Address correspondence to Dr. Glenn Waller, Vincent Square Clinic, Osbert Street,
many ways in which emotional abuse can present in the EDs, the following
case illustrates the type of patient who might fall into this category:
Jilly is a 21-year-old woman who presented at her assessment with a
four-year history of bulimia nervosa and self-harm behavior. She
described a highly perfectionist personality style and poor self-esteem,
resulting in the restriction of her diet to feel more in control of her life.
Thereafter, she began to binge when she craved carbohydrates. After a
while, her binges also became driven by her intolerable emotional
states. Jilly described herself as uncomfortable with her emotional states,
as she was repeatedly told as a child that she was worthless and “in the
way.” When she tried to express herself, Jilly’s parents used to tell her
that she did not really mean what she was saying, and that she should
be grateful that they kept her. This pattern is repeated in her relationship
with her boyfriend, who insults her in front of his friends but
denies that this is anything to get concerned about.
In this paper, we adopt a relatively general definition of the term emotional
abuse as the “sustained, repetitive, inappropriate emotional response to
the. . . experience of emotion and its accompanying expressive behaviour”
(O’Hagan, 1995, p. 456). Although this definition was built around childhood
experiences, we extend it to encompass adult experiences since many patients
report that this form of abuse occurs in their adult years, either as a primary
experience or as a revival of childhood experiences (as in Jilly’s case).
In our clinical experience, emotional abuse results in two types of
beliefs that are clinically relevant—(a) conditional assumptions about the
acceptability of expressing one’s emotions (e.g., “If I say that I am upset,
there will be negative consequences”) and (b) negative core beliefs about
the self (e.g., “I am not loveable”). We will return to these levels of cognition
throughout this paper, arguing that both need to be considered in the
formulation of a case and addressed in treatment.
A BRIEF INTRODUCTION TO THE LITERATURE
Kent and Waller (2000) have reviewed the literature on the link between
emotional abuse and the EDs. They found that research shows little coherence
in definitions, measures used, or populations studied. Although the
methodological variance between studies makes firm conclusions difficult,
Kent and Waller concluded that there is some evidence of a phenomenological
link between such abuse and eating pathology. However, they could
find little evidence of causality and little understanding of the psychological
and physiological mediators that might explain such a link.
In one of the few studies (albeit in a non-clinical sample) that directly
compares the association between different forms of trauma and eating
Emotional Abuse in Eating Disorders 319
pathology, Kent, Waller, & Dagnan (1999) demonstrated that emotional
abuse might be the most powerful element of interpersonal trauma. That is,
when all three forms of trauma were statistically evaluated, neither sexual
nor physical abuse predicted levels of eating disturbance, whereas emotional
abuse did. Moreover, there was evidence that this association was
mediated by the subsequent development of anxiety and dissociation. However,
such research is preliminary and more work is needed in this area
(e.g., Hund & Espelage, 2006) before reaching definitive conclusions about
the comparative roles of different forms of trauma.
The research outlined above refers to eating pathology in non-clinical
samples. Among ED samples, there is similar evidence that emotional abuse
might be a more important antecedent than sexual abuse (Rorty, Yager, &
Rossotto, 1994). There is a small literature supporting the role of emotionally
abusive experiences in the development of EDs (e.g., Fosse & Holen, 2006;
Grilo et al., 2005), but far more understanding of the nature of this relationship
is needed. We will first consider clinical cases that help in developing
such an understanding. We will then present a theoretical framework that is
useful in understanding the role of emotional abuse in the EDs—one that
considers both levels of cognition (conditional assumptions and core beliefs)
that we have outlined as being important in such cases. Thereafter, we will
present a treatment approach that we find useful for such patients.