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Anorexia Nervosa and Bulimia Nervosa

Updated May 13, 2021
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There are two major eating disorders occurring in the American population: anorexia nervosa and bulimia nervosa. The National Eating Disorders Collaboration defines anorexia nervosa as “the persistent restriction of energy intake, intense fear of gaining weight and disturbance in self-perceived weight or shape” (n.d.). They define bulimia nervosa as “repeated episodes of binge eating followed by compensatory behaviours” (n.d.).

These behaviors include but are not limited to vomiting, use of laxatives or drugs, and fasting (National Eating Disorders Collaboration). There are two key terms important for understanding the statistics associated with these disorders. The first is “incidence rate” which is the number of new cases of a disorder in a population over a particular period of time (“Incidence and Prevalence,” 2002). The second is “prevalence rate” is the “actual number of cases” of a disorder at a particular time (“Incidence and Prevalence,” 2002).

These two eating disorders are much more prevalent in women than in men. The lifetime prevalence rate of anorexia nervosa is 0.9% for women and 0.3% for men. The lifetime prevalence rate of bulimia nervosa is 1.5% for women and 0.5% for men (Hudson, Hiripi, Pope, & Kessler; 2006). Out of the Americans that have been formally diagnosed with anorexia nervosa, 90% are women (Silverstein, Perdue, Peterson, & Kelly; 1986).

The current ideal body shape for American women as portrayed by mass media is one characterized by thinness. Garner, Garfinkel, Schwartz, and Thompson (1980) used body measurements from 240 playmates that appeared in the Playboy magazines from 1960-1980 and found that “the yearly mean weight for the centerfolds was significantly less than the corresponding population means” (p. 485). When examining the Miss America Pageant winners from 1959-1978, they found a similar emphasis on low weight: the winners from 1970 onwards “weighed significantly less” than the rest of their fellow contestants (p. 486).

The media often portrays thinness in association with other positive benefits and successes, a phenomenon known as “attractiveness stereotyping” (Downs & Harrison, 1985).

Fouts and Burggraf (2000) investigated 18 sit-coms and noticed that heavier female characters “receive far fewer positive comments” from male characters and more audience laughter than the thinner female characters (p. 925). In a content analysis, Becker, Burwell, Giman, Herzog, and Hamburg (2002) found an association between thinness and “career prospects” (511).

Engeln-Maddox of Northwestern University (2006) conducted a study of 109 college females to investigate what associations women make with the “media ideal” (p. 260). She found that the most common associations were “positive psychological impact, positive social attention (nonromantic), romantic success, and employment/economic success” (p. 262). This study shows that women associate the “media ideal” of thinness with “a wide variety of rewards” (p. 263).

One tool that sociologists employ to examine the relationship between society and individuals is referred to as the structural perspective. The structural perspective can be defined as “the view that there are social structures that shape how individuals think and act” (Lecture #1). Social structures are “established ways of thinking and acting within social groups and/or society” (Lecture #1). These social structures can both “constrain” and “enable” individuals in their actions, thoughts, and emotions (Lecture #1).

Individuals are not typically conscious of the impact that social structures have on their lives or their behavior (Lecture #1). An important concept for understanding how social structures function is the idea of institutions. Berger (1963) defines an institution as “a distinctive complex of social actions” that “provide procedures through which human conduct is patterned” (p. 87). Like social structures, institutions are coercive in nature; they are so ingrained in individuals that to defy these “procedures” is “literally unthinkable” (Berger, 1963, p. 89). In the context of this paper, mass media is both a social structure and an institution.

The structural perspective involves two main processes: socialization and internalization. Berger (1963) defines socialization as “the process by which a child learns to be a participant member of society” (p. 99). Part of this process involves internalization in which society’s expectations of individuals influences their conception of selves to such an extent that “self” and “society” become “two sides of the same coin” (Berger, 1963, p. 99). Internalization is such a powerful process that it influences not only the individuals’ actions but their “identity,” “thought,” and “emotions” (p. 121).

These expectations of individuals are also known as social norms, which are socially accepted behaviors that are not formally written down but enforced through social control, “the various means used by a society to bring its recalcitrant members back into line” (Berger, 1963, p. 68). According to Berger (1963), “what happens in socialization is that the social world is internalized within a child” to the extent that “the structures of society become the structures of our own consciousness” (p. 121).

An important concept that involves the ability to use a structural perspective is the sociological imagination. Mills (1959) defines the sociological imagination as the ability to “grasp history and biography and the relations between the two within society” (p. 6). An essential part of the sociological imagination is the ability to distinguish between “the personal troubles of milieu” and “the public issues of social structure” (Mills, 1959, p. 8). Personal troubles are individualized, and they occur within an individual’s immediate interactions and milieu (Mills, 1959).

For a solution, we examine the character, skills, opportunities, and decisions of the individual (Mills, 1959). Public issues, on the other hand, exist beyond an individual’s immediate interactions and milieu and are a “public matter” in which one or more of “some value cherished by publics is felt to be threatened” (Mills, 1959, p. 8). Because issues transcend the level of the individual, the solution cannot be found through an examination of the individual or his immediate milieu. Rather, “the very structure of opportunities has collapsed,” and so it is necessary to examine the institutions themselves (Mills, 1959, p. 9).

The sociological imagination makes it clear that eating disorders are not a personal problem but rather a consequence of the mass media’s portrayal of the ideal body. A personal trouble implies that the individual is ultimately responsible for the problem and therefore an explanation can be found by examining their choices, skills, and opportunities.

In this case, some might attribute an eating disorder to a person’s social anxiety, lack of self confidence, depression, etc. However, when almost 1.5 million American women have been diagnosed with anorexia nervosa and almost 2.5 million with bulimia nervosa, it is clear that eating disorders are not an individualized issue (Howden & Meyer, 2011). As a result, a solution cannot be found simply by looking on the individual level; it is necessary to zoom out and look on the institutional level, which is the very definition of the sociological imagination.

The first step in internalization is the establishment of a norm, or a socially accepted idea that influences the behaviors of individuals within a society. Mass media has accomplished this step through the sheer number of portrayals of the ideal body. The typical American woman is “confronted with over 5,620 attractiveness messages per year” just by means of the television (Downs & Harrison, 1985, p. 17).

These messages not only include a portrayal of the ideal female body but also involve attractiveness stereotyping. As mentioned previously, the media associates “positive stereotypes of beauty, success, and health” that are associated with the ideal body (Myers & Biocca, 1992, p. 109). Therefore, a second norm is established which is that if a woman hopes to achieve these rewards, she must also have the ideal body that mass media has established as a prerequisite. As Berger (1963) describes, internalization is such a powerful process that it influences an individual’s thoughts and actions.

In a study that used nine drawings of figures, findings highlighted that women expected men to prefer a skinnier body than the men reported they preferred (Fallon & Rozin, 1985). This study indicates that women have internalized the emphasis on female thinness to such an extent that they overestimate how thin is considered beautiful. Society’s idea of female beauty has become women’s idea of female beauty, which is the definition of internalization (Berger, 1963).

In order to identify the institutions that are part of the problem, it is necessary to identify the population(s) that are most affected. While 2,355,000 women have been diagnosed with anorexia nervosa and/or bulimia nervosa, only 1,214,4000 men are affected even though the populations of men and women in the United States are fairly equal (Howden & Meyer, 2011). Almost twice as many women than men have been diagnosed with these eating disorders.

This significant difference can be made sense of by looking at how the media emphasizes thinness in women much more than in men. A 1986 study done by Silverstein, Perdue, Peterson, and Kelley, examined the content of magazines and televisions and found that of the 33 shows they looked at, “69.1% of the female characters were rated as thin while only 17.5% of the male characters were so rated” and conversely 25.5% of the male characters were “rated as heavy” compared to only 5% of the female characters (Myers & Biocca, 1992, 110).

In their examination of four women’s and four men’s magazines, the number of diet-related advertisements numbered 63 for women and only 1 for men. Similarly, they found 96 articles on “nonfood, figure-enhancing products” in the women’s magazines and only 10 in the men’s (110). Considering that various platforms of mass media including television, magazine articles, and advertisements all promote thinness it women, it makes sense that more women than men feel the pressure to be thin, translating to a much higher percentage of women than men with anorexia nervosa and bulimia nervosa.

Mass media influences the socialization of adolescents by shaping their conception of the ideal body during a time when they are especially vulnerable. While women are more likely than men to develop anorexia nervosa or bulimia nervosa, teenage females are even more susceptible. The mean onset age for both disorders is quite close: the mean onset age is 18.9 for anorexia nervosa and 19.7 for bulimia nervosa (Hudson, Hiripi, Pope, & Kessler; 2006).

Females within the age group 15-19 have the highest incidence rate for anorexia nervosa and account for 40% of cases (Hoek, 2006). While the lifetime prevalence rate for bulimia nervosa in females is 1.5%, this number rises to 3% for adolescent females (le Grange, Loeb, Van Orman & Jellar; 2004). During their adolescent years, individuals are still developing a sense of self and a “general conception of society,” which means that the process of socialization is still taking place (Berger, 1963, p. 99). As a result, when adolescents are overwhelmed by “images of a particular body type in appealing scenarios,” they are “more apt to absorb the idea that that body type is ideal” (Howard, 2018).

Additionally, younger individuals are more likely to believe what is being portrayed on television as reality, and so “attractiveness messages may go unchallenged by the viewing audience” (Downs & Harrison, 1985, p. 10). In other words, because adolescents are still developing a sense of society and therefore a sense of self, they are more likely to believe the attractiveness associations that are so commonly conveyed through mass media.

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Anorexia Nervosa and Bulimia Nervosa. (2021, May 13). Retrieved from https://samploon.com/anorexia-nervosa-and-bulimia-nervosa/

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