My mother told me: the roles of maternal messages, body image, and disordered eating in maladaptive exercise

Disturbed families or families disturbed: a reconsideration

BACKGROUND

The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades.

OBJECTIVE

The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years.

METHODS

A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied.

RESULTS

This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation.

CONCLUSION

The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty.

EMB RATING

Level V.

LEVEL OF EVIDENCE

Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Mumbod? A comparison of body image and dietary restraint among women with younger, older, and no children

Pregnancy and the postpartum period are times of significant body, and body image changes for women. Adult women (N = 885) aged 21 to 47 years old completed an online questionnaire. Mothers of young children (0-5 years) had significantly lower levels of body shame, self-objectification, and dietary restraint than women without children, and women with school-aged (6-10 years) children had significantly lower self objectification than women without children, once we controlled for age. BMI predicted body shame more than motherhood status. This research has implications for the development of appropriate body image interventions for adult women.

Morbid exercise behaviour and eating disorders: A meta-analysis

BACKGROUND AND AIMS

This study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques.

METHODS

We systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time.

RESULTS

Sixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint.

CONCLUSIONS

The identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.

"It's Better to Be Depressed Skinny than Happy Fat:" College Women's Memorable Body Messages and Their Impact on Body Image, Self-Esteem, and Rape Myth Acceptance

This study investigated the content of memorable body messages that college women recall receiving in their childhood, and the relationship of those messages to state body image satisfaction, self-esteem, rape myth acceptance, and likelihood to report rape or sexual assault. Memorable messages were mostly about body size, body type, body parts, haptic messages, body positivity, and development. Mothers were the most frequent source of memorable body messages during childhood. Although there was no difference in any of the dependent variables based on the content of the message, there was a relationship between perceived message valence with body image, self-esteem, and rape myth acceptance. Messages that participants interpreted as more positive and beneficial were associated with higher body image satisfaction, higher self-esteem, and increased rape myth acceptance.

Effect of parental criticism on disordered eating behaviors in male and female university students in Mexico City

PURPOSE

The aim of this study was to analyze the effect of parental criticism of their offspring's bodies in the development of disordered eating behaviors (DEBs) in university students in Mexico City.

METHODS

A sample of 892 freshmen (502 women and 390 men) was included. The prevalence of the internalization of the aesthetic thin ideal, body dissatisfaction, self-esteem, depressive symptoms, and body mass index was estimated by sex. For each sex, the effect of parental criticism on DEBs, together with that of the other covariates, was measured through ordinal regression models.

RESULTS

It was found that women received more criticism from their mothers than men. Among the participants, the likelihood of DEBs is increased in the presence of criticism from both parents (OR = 2.5), criticism from the mother alone (OR = 2.0), overweight (OR = 1.7), obesity (OR = 2.1), wanting a slimmer body (OR = 8.3), and depressive symptoms (OR = 3.3). Among men, this risk is increased in the presence of criticism from both parents (OR = 2.7), being obese (OR = 2.4), wanting a slimmer body (OR = 3.4), and depressive symptoms (OR = 2.8).

CONCLUSIONS

It is essential to include issues linked to parental criticism of their bodies in interventions to prevent eating disorders in college students. Level of evidence V, cross-sectional descriptive study.

Obligatory exercise and coping in treatment-seeking women with poor body image

PURPOSE

Obligatory exercise is characterized by continued exercise despite negative consequences, and intense negative affect when unable to exercise. Research suggests psychosocial differences between individuals that exercise in an obligatory manner and those that do not. It also has been speculated that obligatory exercise may serve coping and affect regulation functions, yet these factors have not been routinely examined in community women with poor body image. The purpose of the current study was to investigate psychosocial differences between obligatory and non-obligatory exercisers, and to examine the use of obligatory exercise as an avoidant coping strategy in a sample of women with poor body image.

METHODS

Women (n = 70) seeking treatment for body dissatisfaction were divided into obligatory and non-obligatory exercise groups based on their scores on the Obligatory Exercise Questionnaire. Participants then completed an assessment battery about eating pathology, body image, reasons for exercise, coping strategies, and negative affect.

RESULTS

Independent t test analyses indicated that obligatory exercisers had significantly greater eating disorder symptomatology, avoidant coping, and appearance- and mood-related reasons for exercise than non-obligatory exercisers. Multiple regression analyses revealed that eating disorder symptomatology and avoidant coping were significant predictors of obligatory exercise.

CONCLUSIONS

There are distinct psychosocial differences between women with poor body image who exercise in an obligatory fashion and those who do not. The current study suggests that obligatory exercise may serve as an avoidant coping strategy for women with poor body image. Enhancing healthy coping strategies may be an important addition to body image improvement programs.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program

PURPOSE

The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score.

METHODS

A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated.

RESULTS

The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26 %. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group.

CONCLUSIONS

Results indicate that the self-image of adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.