Blindness and bulimia nervosa: a description of a case report and its treatment

Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.

Differences in the Body Images of Blind and Sighted Women

Abstract. This study addresses aspects of body image in blind versus seeing women. Eighty-nine congenitally blinded and 153 sighted women completed questionnaires to demographic, health-relevant data, and body image. The two groups did not differ significantly with regard to demographic and health-relevant data. However, significantly more women have children among the sighted group. All women generally presented as clinically inconspicuous in all factors of the body image. A group comparison does not reveal differences with regard to physical contact, vitality, and self-exaltation. However, a significantly lower sexual fulfillment among the blind persons in comparison to the seeing persons, but a significantly higher self-acceptance, is demonstrated. The results are discussed in the context of the previous scarce findings with regard to body image disorders in blind women and finally questioned whether they could benefit the therapy of body scheme disorders in seeing women.

Implicações da Cegueira Congênita na Imagem Corporal: Uma Revisão Integrativa

RESUMO Este estudo objetiva investigar, por meio de uma revisão integrativa, as principais implicações da cegueira congênita na imagem corporal. Um processo de buscas de artigos, sem limite de data de publicação, com os descritores “congenital blindness” e “congenitally blind”, nas bases SCOPUS, PsycINFO, Web of Science e PubMed, foi utilizado. Dentre as 3.612 publicações identificadas, 20 foram analisadas. Discutiu-se as implicações da cegueira em cinco áreas distintas: transtorno alimentar, representação do self, insatisfação corporal, experiência corporal e representação neural de autoconceito. Concluiu-se ser fundamental valorizar um complexo conjunto de fatores psicossociais no desenvolvimento da pessoa com cegueira congênita, que poderia impactar de modo positivo ou negativo a formação da imagem corporal.

Low Energy Availability, Menstrual Dysfunction, and Low Bone Mineral Density in Individuals with a Disability: Implications for the Para Athlete Population

Low energy availability, functional hypothalamic amenorrhea, and low bone mineral density are three interrelated conditions described in athletic women. Although described as the female athlete triad (Triad), males experience similar health concerns. The literature suggests that individuals with a disability may experience altered physiology related to these three conditions when compared with the able-bodied population. The goal of this review is to describe the unique implications of low energy availability, low bone mineral density, and, in females, menstrual dysfunction in individuals with a disability and their potential impact on the para athlete population. A literature review was performed linking search terms related to the three conditions with six disability categories that are most represented in para sport. Few articles were found that directly pertained to athletes, therefore, the review additionally characterizes literature found in a non-athlete population. Review of the available literature in athletes suggests that both male and female athletes with spinal cord injury demonstrate risk factors for low energy availability. Bone mineral density may also show improvements for wheelchair athletes or athletes with hemiplegic cerebral palsy when compared with a disabled non-athlete population. However, the prevalence of the three conditions and implications on the health of para athletes is largely unknown and represents a key gap in the sports medicine literature. As participation in para sport continues to increase, further research is needed to understand the impact of these three interrelated health concerns for athletes with a disability, accompanied by educational initiatives targeting athletes, coaches, and health professionals.

Eating Attitudes of Women Living With a Vision Impairment

Internalization of cultural standards of attractiveness and subscription to gender-based discourses are significant predictors of disordered eating attitudes in fully sighted women. Yet, whether these variables predict the disordered eating attitudes of women who are legally blind is underexplored. In the current study, we examined how internalization of White European cultural standards of attractiveness and subscription to gender-based discourses (body surveillance and self-silencing) and body shame predicted the disordered eating attitudes of 80, primarily White, heterosexual, Australian women who are legally blind. Participants completed an online survey comprising existing validated measures of all variables. A path analysis was performed using the Hayes PROCESS approach. As predicted, in women living with vision impairment, body surveillance, self-silencing, and shame fully mediated the relation between internalization of cultural standards of attractiveness and disordered eating attitudes. Results showed that in much the same way as sighted women, women living with vision impairment are susceptible to internalizing harmful messages related to socio-cultural standards of attractiveness. We provide further support for including subscription to gender-based discourses in research on women’s body-image disturbances. Data will be available for other researchers from the author via email. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Development and validation of the self-acceptance scale for persons with early blindness: the SAS-EB

Investigations of self-acceptance are critical to understanding the development and maintenance of psychological health. However, valid and reliable instruments for measuring self-acceptance in persons with early blindness have yet to be developed. The current research describes three studies designed to develop and validate the Self-acceptance Scale for Persons with Early Blindness (SAS-EB). In Study 1, we developed the initial item pool. Thirty-three items were generated, based on data from specialized literature and from 2 focus groups. Items were organized in a three-factor structure, theoretically predicted for SAS-EB - (1) body acceptance, (2) self-protection from social stigmas, and (3) feeling and believing in one's capacities. In Study 2, information obtained from a panel of 9 experts and 22 persons with early blindness representing the target population was used to refine the initial item pool, generating a new pool of 27 items. In Study 3, 318 persons with early blindness (141 women and 177 men), between 18 and 60 years of age (M = 37.74 years, SD = 12.37) answered the new pool of 27 items. After the elimination of 9 items using confirmatory factor analysis, we confirmed the theoretical three-factor structure of the SAS-EB. Study 3 also provided support for the scale's internal consistency and construct validity. Finally, the psychometric properties of the SAS-EB, its utility, and its limitations are discussed along with considerations for future research.

Body image among eating disorder patients with disabilities: a review of published case studies

While individual cases of eating disorder (ED) patients with disabilities have been reported, there has been little synthesis of their experiences of body image and thin idealization. This study reviews 19 published clinical reports of ED patients with sensory, mobility-related, or intellectual disabilities and evaluates the extent to which their experiences align with or challenge current conceptions of body image in ED. ED patients with visual impairment reported a profound disturbance of body image, perceived intersubjectively and through tactile sensations. Reducing dependence in mobility was an important motivation to control body size for ED patients with mobility-related disabilities. ED as a way of coping with and compensating for the psychosocial consequences of disability was a recurrent theme for patients across a range of disabilities. These experiential accounts of ED patients with disabilities broaden current understandings of body image to include touch and kinaesthetic awareness, intersubjective dynamics, and perceptions of normalcy.

Initial evidence of the reliability and validity of a three-dimensional body rating scale for the congenitally blind

Research on body dissatisfaction has grown significantly. However, valid and reliable instruments for measuring body dissatisfaction in the congenitally blind have yet to be developed. In three studies, we report on development, test-retest reliability, and concurrent and content validity of the Three-dimensional Body Rating Scale (3BRS) for the congenitally blind. In Study 1, 58 people with congenital blindness (28 women, 30 men; M age = 36.7, SD = 13.1) numerically ordered models of the 3BRS and models of the Two-dimensional Body Rating Scale (2BRS), from very thin to the very fat. In Study 2, the construct validity and reliability of the 38RS was assessed. The same participants from Study 1 chose the 3BRS model that represented their ideal body and the 3BRS model that represented their actual body. Two weeks later, a re-test was done. In Study 3, 16 experts judged the content validity of the 3BRS. The psychometric properties of the 3BRS, its utility, and its limitations are discussed along with considerations for future research.

Sociocultural factors in the development of bulimia nervosa in a blind woman: a case report

BACKGROUND

Although several cases of eating disorders in visually impaired women have been reported, there has been little research on the development of body image and disordered eating in the blind. Overall, it is argued that blind women are protected from developing body dissatisfaction because of having had little or no exposure to thin-ideal images, and that if they do develop an eating disorder, this would be linked to other risk factors. In the one reported case of bulimia nervosa in a blind woman, body image concerns were even absent.

METHOD

We report a single case of bulimia nervosa in a 28-year-old congenitally blind woman whose presentation was typical, including body dissatisfaction and drive for thinness.

DISCUSSION

The present case underscores the need to also consider an etiological role of perceived sociocultural pressure and thin-ideal internalization in promoting body dissatisfaction and eating disorders in visually impaired women.