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Title: The Scientific Status of Sociocultural Models for Eating Disorders: A Close Look at Controversy, The


1
The Scientific Status of Sociocultural Models for
Eating Disorders A Close Look at Controversy,
Theory, and Data
  • Linda Smolak, Michael P. Levine,
  • Sarah K. Murnen
  • Kenyon College, Gambier, OH, USA 43022-9623

2
Goals
  • Contentions and controversy
  • The meaning(s) of sociocultural perspective
  • What is scientific evidence?
  • Evidentiary bases for a sociocultural perspective
  • Conclusions and implications
  • Questions and discussion

3
Contentions and Controversies
  • Self-evident to some vs. ridiculous and dangerous
    to others
  • Biopsychiatric contentions (Bulik, 2004a, 2004b
    Kaye Strober, 1999)
  • Certainly, cultural attitudes towards standards
    of physical attractiveness have relevance to the
    psychopathology of eating disorders, but it is
    unlikely that cultural influences in pathogenesis
    are very prominent

  • (Kaye Strober, 1999, p. 891 emphasis added)
  • Research on the etiology of eating
    disorders has lagged behind other areas of
    psychiatry, in part due to the imminent
    plausibility of sociocultural theories about the
    illness. . . The face validity of these
    explanations has inhibited our progress due to a
    burden of plausibility. The sheer convenient
    believability of sociocultural explanations has
    influenced research directions and hindered
    recognition of the seriousness of eating
    disorders
  • (Bulik, 2004, p. 165 emphasis added)

4
What Is a Sociocultural Perspective?
The sociocultural model of eating pathology
posits that social pressure to be thin fosters an
internalization of the thin ideal and body
dissatisfaction, which in turn place individuals
at risk for dieting, negative affect, and eating
pathology . . .
----- Stice, 2002, p. 828
5
What A Sociocultural Perspective Is
  • Focuses on socially constructed or culturally
    endorsed variables
  • Involves socialization but may also involve
    active construction or use of schema cognitive
    social learning, reciprocal determinism, and a
    transactional approach
  • Culture will determine what is ideal for whom and
    how to attain it
  • Culture will determine what is normative (even if
    unhealthy) and pathological
  • There will be within- and across-group
    differences based on exposure to various
    sociocultural factors

6
Thus, According to a Sociocultural Perspective
  • There is a Culture of the Ideal Body A body
    that is desirable, attractive, attainable, and
    associated with success
  • If the body ideal is unrealistic or is rigidly
    enforced, self-perceived investment in and/or
    failure to achieve this body will result in a
    continuum of problems ranging from body
    dissatisfaction to full clinical syndromes.

7
A Sociocultural Perspective Does Not
  • Deny any role for genetics or neurobiology as
    important but not the only important sources
    of individual differences in vulnerability
  • Minimize the seriousness of full-blown eating
    disorders, nor fail to make any distinctions
    between different types or levels of disordered
    eating
  • Expect that one model will fit all cultures or
    both genders or all ages

8
Thus, According to a Sociocultural
Perspective Sociocultural variables are causal
factors in the development of eating problems and
eating disorders. For example J. K. Thompson
and colleagues Tripartite Influence Model of
Body Image and Eating Disturbance (Keery et al.,
2004 Shroff Thompson, 2006 Thompson et al.,
1999 van den Berg et al., 2002)
Sociocultural Factors
Restriction
Social Comparison
Parents
Bulimia
Body Dissatisfaction
Peers
Internalization
Psychological Functioning
Media
9
Thus, According to a Sociocultural
Perspective Sociocultural variables are causal
factors in the development of variable (causal?)
risk factors (Jacobi, 2005 Jacobi et al.,
2004 Stice, 2002) for eating problems and eating
disorders.
  • Negative body image
  • Weight concerns
  • Thinness and/or
  • muscularity/leanness
  • schema

Sociocultural Factors or Pressures
Continuum of Clinically Significant Disordered
Eating
Parents
Parents
Peers
  • Negative affect
  • Negative self-concept

Media
10
Thus, According to a Sociocultural
Perspective Sociocultural variables are causal
factors in the development of eating problems and
eating disorders. For example OBJECTIFICATION
Theory Womens bodies or body parts are
treated as objects to be looked at and enjoyed by
men. There is a generalized, sexualized gaze that
constantly evaluates the attractiveness and
desirability of girls and women.
11
Objectification and Eating Disorders (Smolak
Murnen, 2004)
12
What Should Be ConsideredAdmissable Scientific
Evidence?
  • Correlates (e.g., from case control studies)
  • Experimental data
  • Prospective, longitudinal data
  • Retrospective reports?
  • Meta-analyses
  • Other statistical summaries

13
What Should Be Considered Scientific
Evidence?Key Methodological Issues
  • Criterion measures Cases, symptoms, or
    precursors?
  • Reliability and validity in risk factors and
    outcomes
  • Ecological validity
  • Sexual abuse, sexual harassment, rape, trauma
  • Specificity
  • Continuum of eating problems

14
Evidentiary Bases for a Sociocultural
Perspective Some Relevant Variables?
  • Gender The lived experience of being female or
    male
  • Media Exposure, social comparison,
    internalization,
  • and media literacy
  • Peers Teasing, comments, investment in
    ideal and its
  • attainment, social
    comparison
  • Parents Teasing, comments, investment in ideal
    and its
  • attainment for self and
    child

15
Evidentiary Bases for a Sociocultural
Perspective Gender Because gender is, for the
most part, an immutable characteristic, this
factor is categorized as a fixed maker according
to the taxonomy of Kraemer et al. (1997).
Because of the large effect size (101) female
status is a highly potent fixed marker for eating
disorders . . . - Jacobi, Hayward, DeZwaan,
Kraemer, Agras, 2004, p. 32 But But feminist
theorists have long argued that gender is
socially constructed and, hence, variable and
changeable.
16
Evidentiary Bases for a Sociocultural
Perspective Gender andThe Lived Experience of
Being Female
  • Objectification
  • Sexual Harassment
  • Rape
  • Sexual Abuse

17
Objectification Experimental Data
  • Fredrickson, Roberts, Noll, Quinn, Twenge, 1998
    (females gt males)
  • Tiggemann Lynch (2001) (females only)
  • Calogero (2004) (females only)
  • Harrison Roberts (2003) (females only)
  • Hebl, King, Lin (2004) (females males)

18
Evidentiary Bases for a Sociocultural
Perspective Objectification
  • Women show more trait self-objectification
  • than men
  • White and Hispanic women may be more self-
  • objectifying than Black women, especially if
  • thin bodies are the stimuli
  • Self-objectification is related to body shame
  • and body dissatisfaction
  • When manipulated into self-objectification
  • (Hebl et al., 2004), men behave similarly to
    women

19
Evidentiary Bases for a Sociocultural
Perspective Child Sexual Abuse
  • Methodological issues
  • Meta-analysis Smolak Murnen, 2002
  • Reviews of longitudinal data Jacobi et al.,
    2004 Thompson Wonderlich, 2004

20
Evidentiary Bases for a Sociocultural
Perspective Child Sexual Abuse
  • Smolak Murnen (2002) found small, heterogeneous
    relationships between CSA and ED. If ED was the
    IV, the effect size was half that when CSA was
    the IV. Studies using the EDI or EAT as the DV
    had a much larger effect size (r .28) than
    those using a measure of bulimia (r .13) though
    both were significant.
  • Thompson Wonderlich (2004) reported that in 7
    retrospective studies all found that CSA predated
    eating symptoms and disorders by 1-5 years.
  • Jacobi et al. (2004) assigned CSA as a low
    potency risk factor for ED generally and for AN
    and BN specifically.

21
Evidentiary Bases for a Sociocultural
Perspective Mass Media
  • Meta-analyses
  • Internalization of media ideal, perceived
    pressures from
  • media and other sources (Cafri et al., 2005)
  • Experimental manipulations of cultural ideal
    (Groesz,
  • Levine, Murnen, 2002)
  • Extent of exposure (cross-sectional) (Levine,
    Murnen, Smith,
  • Groesz, this conference, and in progress)
  • Longitudinal
  • Prospective (Field et al., 1999, 2001 Harrison
    et al., in press McKnight Investigators, 2003)
  • Experimental (Stice, Spangler, Agras, 2001)
  • Experimental prevention (see Levine Smolak,
    2006)

22
Evidentiary Bases for a Sociocultural
Perspective Mass Media
  • Meta-analysis of correlational research shows
    moderate effect size for fashion magazine
    exposure and internalization of thin ideal (d
    .42) and weight concerns (d .40) with smaller
    effect sizes for TV exposure. (ethnicity may be a
    moderator)
  • Meta-analysis of experimental research shows
    moderate effect size (d .31) of viewing thin
    media images on body image with prior history of
    body dissatisfaction an important moderator (d
    .50)
  • Recent research mediators moderators include
  • activation of appearance-focused schema,
  • internalization of thin ideal
  • social comparison

23
Evidentiary Bases for a Sociocultural
Perspective Mass Media
  • Prospective, longitudinal
  • McKnight investigators (2003) Over a 3-year
    period, media modeling was part of a
    multidimensional factor that predicted the onset
    of bulimia nervosa, subclinical bulimia nervosa,
    or binge eating disorder in adolescent girls.
  • Field et al. (1999, 2001) Over a 1-year-period,
    and independent of age and BMI, trying to look
    like same-sex figures in the media was a
    predictor of the development of weight concerns,
    chronic dieting, and monthly purging (girls only)
    in large samples of boys and girls ages 9 through
    14.
  • Harrison et al. (in press) Over a 1-year
    period, television exposure (but not magazine
    exposure) predicted significant increases in
    disordered eating and in endorsement of a
    thin(ner) future body ideal for girls in 2nd
    4th grade (mean age 8-9)
  • BUT studies with older children and young
    adolescents (e.g., McCabe and Ricciardelli (2005)
    and with older adolescents (e.g., Presnell et
    al., 2004 Stice (1998) found that perceived
    media influence and media modeling were not
    significant predictors of a variety of body
    dissatisfaction and variety of risky eating and
    unhealthy weight/shape management behaviors,
    whereas, in general parental influences and
    same-sex peer influences were.

24
Evidentiary Bases for a Sociocultural
Perspective Mass Media
  • Prospective, experimental
  • Stice et al. (2001) For girls with initial lower
    levels of social support, a 15-month subscription
    to a fashion magazine lead to increased body
    dissatisfaction, dieting, bulimic symptoms.
  • Experimental prevention challenging media
    ideals and internalization of the slender beauty
    ideal (see Levine Smolak, 2006, in press, for
    reviews)

25
Evidentiary Bases for a Sociocultural
Perspective Peers
  • Experimental data (Stice, Maxfield, Wells,
    2003)
  • Prospective longitudinal data (Jones, 2004
    McKnight Investigators, 2003)
  • But longitudinal findings re teasing are
    inconsistent

26
Evidentiary Bases for a Sociocultural
Perspective Peers
  • Stice et al. (2003) In an experimental setting
    fat talk by an ultra-thin confederate
    increased body dissatisfaction in college women
    independently of initial levels of thin ideal
    internalization, body dissatisfaction, or social
    support
  • McKnight Investigators (2003) As part of a
    broader factor, peer concern with thinness and
    peer teasing predicted the onset of BN,
    subclinical BN, BED, and subclinical BED in
    adolescents over a 3- year period
  • Appearance conversations among adolescents may be
    an important contributor to body dissatisfaction,
    especially among girls who are high on social
    comparison.

27
Evidentiary Bases for a Sociocultural
Perspective Parents
  • Shepherd Smolak (in progress) meta-analysis of
    maternal modeling
  • Longitudinal data on Modeling Stice (1998),
  • Attie Brooks-Gunn (1989), Abramovitz Birch
    (2000)
  • Longitudinal data on Social Reinforcement
    Stice (1998)

28
Evidentiary Bases for a Sociocultural
Perspective Parents
  • Shepherd Smolak (in progress) found a
    small-moderate, heterogenous effect (r .15) of
    maternal modeling and daughter eating problems
  • While effect sizes did not differ by age,
    clinical status, and whether or not standard
    measures were used, the effect was homogeneous
    when the analysis was limited to (a) studies
    using older, non-clinical samples (r .22, k
    12) or (b) studies using standardized measured
    (e.g., EDI or DEBQ r .11, k 8)

29
Evidentiary Bases for a Sociocultural
Perspective Parents
  • If mothers diet, 5-year-old daughters have higher
    weight concerns and are twice as likely to have
    dieting knowledge.
  • Some studies (but not all) find that maternal
    body image predicts (longitudinally) problem
    eating in adolescent girls.
  • Some longitudinal research has reported that
    familial modeling of bulimic behavior predicts
    adolescent bulimic symptoms, as does perceived
    familial reinforcement of thin ideal.

30
Conclusions and ImplicationsThe Biopsychiatric
Critique
  • Reinforcing the need for well-articulated models,
    careful attention to methodology (including
    outcome variables), and an evidentiary basis
  • Emphasizing the disorder in eating disorders
    and the importance of specificity in risk
    factors and outcomes
  • Emphasizing the fact that some families and thus
    some individuals are at high risk due to genetic
    vulnerability (whatever that may turn out to mean
    in term of gene-environment interactions and
    transactions)
  • Reinforcing the importance of selective and
    targeted prevention for those at high risk
  • Reinforcing a contention at the heart of feminist
    and community- oriented approaches to research
    and prevention Perspective, power, politics are
    always in play in defining, researching, and
    treating a disorder. . . .

31
Conclusions and Implications A Critique of The
Biopsychiatric Critique
  • Point 1 Research on the etiology of eating
    disorders has lagged behind other areas of
    psychiatry due to the imminent plausibility of
    sociocultural theories about the illness. . .
  • Point 2 sociocultural explanations have
    hindered recognition of the seriousness of eating
    disorders
  • Point 3 The sheer convenient believability of
    sociocultural explanations has influenced
    research directions

32
Conclusions and Implications A Critique of The
Biopsychiatric Critique
  • Point 3 The sheer convenient believability of
    sociocultural explanations has influenced
    research directions. . . .
  • We cant ignore, as is the case for depression
    and for alcohol abuse and dependence, what is
    believable and apparent based on lived
    experiences of
  • patients, professionals, and people in general
  • The sociocultural perspective and specific models
    (e.g., Thompson et al.s Tripartite Model or
    Stices Dual Pathway Model or Ricciardelli
    McCabes Biopsychosocial Model) are not based
    on believability or convenience or face
    validity They are based on a very scientific
    and compelling blend of theory, methodology, and,
    for the most part replicable (robust) convergent
    findings that point to small-to-moderate effects
    for sociocultural factors (Stice, 2002)
  • The sociocultural perspective has a theoretical
    and empirical foundation that is at least as
    strong, if not much stronger, than the
    biopsychiatric perspective and its emphasis on
    very limited behavior genetic models (see Jacobi
    et al.s, 2004, review) and on a model of
    temperament which has little or no connection
    with developmental psychology or developmental
    psychopathology

33
Conclusions and ImplicationsCommon Ground
  • Advancement of the field in recognized and
    legitimate ways
  • Effective understanding, treatment, and
    prevention of eating disorders equifinality and
    equipotentiality (and the challenges of
    nonspecificity and co-morbidity)
  • Prevention or modulation of those variable
    factors (whether they be shared or unshared
    environ-ments) that constitute and/or activate
    various forms of individualand
    socioculturalvulnerability

34
Conclusions and ImplicationsCommon Ground? Do
sociocultural variables lead to eating disorders
only if there is a predisposition or a
vulnerability? and What is a
vulnerability?
35
Conclusions and Implications What is a not
the Vulnerability?
  • Predisposing factor innate or developed?
  • Genetic
  • Neurodevelopmental Serotonin sensitivity

36
Conclusions and Implications What is a not
the Vulnerability? Genetic Vulnerability
X Culture of Ideal Body ?

Eating Pathology Sociocultural ? Dieting ?
Serotonin ? Eating Pathology Influences
Imbalance
37
Conclusions and Implications Common Ground?
  • ? Serotonin Reduction ? Bulimic

  • Pathology

Trauma (CSA) Dieting
-- Based on Steiger, 2004
Genetic Vulnerability
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