Title: The Scientific Status of Sociocultural Models for Eating Disorders: A Close Look at Controversy, The
1The 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
2Goals
- 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
3Contentions 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)
4What 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
5What 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
6Thus, 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.
7A 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
8Thus, 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
9Thus, 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
10Thus, 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.
11Objectification and Eating Disorders (Smolak
Murnen, 2004)
12What Should Be ConsideredAdmissable Scientific
Evidence?
- Correlates (e.g., from case control studies)
- Experimental data
- Prospective, longitudinal data
- Retrospective reports?
- Meta-analyses
- Other statistical summaries
13What 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
15Evidentiary 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.
16Evidentiary Bases for a Sociocultural
Perspective Gender andThe Lived Experience of
Being Female
- Objectification
- Sexual Harassment
- Rape
- Sexual Abuse
17Objectification 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)
18Evidentiary 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
19Evidentiary 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
20Evidentiary 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.
21Evidentiary 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)
22Evidentiary 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
23Evidentiary 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.
24Evidentiary 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)
25Evidentiary 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
26Evidentiary 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.
27Evidentiary 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)
28Evidentiary 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)
29Evidentiary 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.
30Conclusions 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. . . .
31Conclusions 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
32Conclusions 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
33Conclusions 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
34Conclusions and ImplicationsCommon Ground? Do
sociocultural variables lead to eating disorders
only if there is a predisposition or a
vulnerability? and What is a
vulnerability?
35Conclusions and Implications What is a not
the Vulnerability?
- Predisposing factor innate or developed?
- Genetic
- Neurodevelopmental Serotonin sensitivity
36Conclusions and Implications What is a not
the Vulnerability? Genetic Vulnerability
X Culture of Ideal Body ?
Eating Pathology Sociocultural ? Dieting ?
Serotonin ? Eating Pathology Influences
Imbalance
37Conclusions and Implications Common Ground?
-
- ? Serotonin Reduction ? Bulimic
-
Pathology -
Trauma (CSA) Dieting
-- Based on Steiger, 2004
Genetic Vulnerability