Body image and eating disorders: adolescence and gender. (The Mortification of the Flesh).

This work forms part of a research project entitled "Gender, Development and Image Disorders: Psychosocial Bases for Social and Educational Action" National Research Plan, Sector Program, CICYT-Ministry of Labor and Social Affairs, Women and Gender Studies, 1997-1999, to be published by Spain's Instituto de la Mujer (Women's Institute). The authors are professors of psychology at the Instituto Universitario de Estudios de la Mujer (University Institute of Women's Studies) at the Universidad de Valencia.

1. Introduction

Body image and aesthetic norms affect the psychological development of both men and women, but preadolescent and adolescent girls are those most likely to suffer from eating problems and conflicts in the construction of their body image. Ninety-five percent of those who suffer from eating disorders are women. Although image conflicts are not exclusive to women, standards of beauty and thinness are especially rigid for females (Dolan and Gitzinger, 1995; Thompson et al., 1999) and condition them to strive for an exacting model of socially-accepted femininity.

Faced with inflexible indicators of femininity defining the "essence" of "a real woman," adolescent girls question the transformations of their bodies that distance them from the sexual ideal. Their concern is concentrated in the conflictive anatomical zones which embody sexual attractiveness according to the gender stereotype, which prevents them from constructing a comprehensive personal image.

Today, eating disorders have reached serious social and psychological dimensions. The number of people suffering eating disorders has increased and is reaching ever wider sectors of the population. Worrisome signs are found even in behaviors long-considered habitual and even desirable, such as dieting and excessive exercise. Although anorexia and bulimia are not new, the level of morbidity and mortality associated with these disorders is increasing. Epidemiological studies indicate that eating disorders affect roughly 1% of the population, with risk peaks at ages 13-14 and 17-18. According to Toro (1996), between 1% and 2% of adolescent girls suffer from anorexia nervosa, with a male-female ratio of 1:10. This author also estimates the prevalence of bulimia to be between 2% and 3% of the adolescent population, with a similar male-female ratio.

Although adolescence is a particularly critical period given the role played by body image in the formation of identity, these alterations occur during other life stages as well. Furthermore, the age of onset of eating disorders is dropping, and onset is occurring at increasingly later ages as well. Affected groups include not only those in the typically vulnerable occupations which require a "trim" personal appearance and bodies in top shape (stewardesses, models, athletes, dancers), but also populations and social classes previously considered immune, such as low-income groups and immigrants. Even citizens of underdeveloped countries have begun to suffer from these disorders under the growing influence of western consumer culture.

The rise of eating disorders can be understood as a "cultural disturbance" (Gordon, 1994) in which the "ideal of thinness" becomes not just an aesthetic norm but an ethical value, a component which defines the individual and his or her personal and social success. From this perspective, eating disorders are not just disturbances of the individual's alimentary function but culturally-modulated conflicts in the elaboration of body image. The factors which predispose individuals to eating disorders are not only personal but familial and socio-cultural. In addition to problems of development and maturation, conflicts in sexual, family and group relations also are involved, all occurring in a context of strong demands for control and assumption of cultural gender-model guidelines.

Current research has revealed that eating disorders spring from a multitude of determining factors involving all areas of the sufferers' lives. Psychological and social factors combine with biological and chemical alterations. The entire personal system is disturbed; thoughts, affections, emotions and relationship behaviors are transformed through a complex cycle which damages the most intimate areas of self-esteem and self-recognition and can even result in self-destruction.

A number of aspects interact to generate eating disorders: cultural obsession for thinness as a moral, physical, psychological and social value; conflicting meanings of femininity and masculinity; and some characteristics of psychological structure and development which are especially critical during adolescence when the core identifications which influence body image, self-conception, self-esteem and personal autonomy are expressed.

2. Identities and Bodies: The Importance of Gender

The individual enters into the world in a body and through a body. Psychosexual development is based upon the configuration of body image as the basic element in the construction of identity. The body is fundamental to the consistency and continuity of the social experience of identity construction. Through the body and its physical and relational development, individuals gain awareness of their physical, psychological and social positions in the world. A long process of progressive differentiation and individualization occurs which enables the individual to establish independence in relation to external social systems and to integrate his or her actions into a coherent biography (Benhabib, 1995; Woodward, 1997).The consolidation and expression of body image as a complete and separate entity is part of the process of existential separation between the ego and the world in which the individual's first identity is linked to the care and satisfaction of biological functions. Due to the initial dependence and defenselessness of the person, these activities are the focus of the primary socialization process (Badillo, 1998).

The progressive development of self-awareness--a product of maturation and the self's experience of its own sexed body--produces conflicts and contradictions. These are resolved through processes of identification beginning with the internalization of model figures--first parents and later others provided by society. These models are transformed into the ego's ideals and orient the motivations which activate the development of the individual. In this process of formation of subjectivity, the construction of difference by sexually-embodied subjects is decisive (Martinez Benlloch and Bonilla, 2000).

But corporeality is not constructed by physical coordinates and their biological nature alone. It is configured initially through the meanings which the culture attaches to sexual characteristics and functions. The perceptions and experiences of the subject are molded and imprinted with diverse rhythms which will be affected by social representations and practices (Bordo, 1993; Bunuelos Madera, 1994; Turner, 1989; Laqueur, 1990). The psycho-corporeal configuration is marked by the normative intervention of a variety of socializing agents, such as parents, teachers and the communications media.

Behind the norms governing the body (shapes, clothing, relationships, care, etc.) are ideals of femininity or masculinity which are particular to each age and each society. These historical guideposts determine the prototypes of sexed bodies which are to act as guides and norms of appearance and define the particular "essence" of woman or man. That is, not only nature, but appearance as well acquires its meaning as a function of the values and symbols of the group. Aesthetics and grooming are simultaneously a means of recognition and satisfaction of the individual and a means of social recognition, in which the ideals of the self and the normative principles of the group converge (Bourdieu, 1979, 1990; Jodelet, 1982; Maisonneuve, 1984; Pastor and Bonilla, 2000).

This convergence of the private and public dimension in the shaping of body image can be seen in the close relationship between the elaboration and experience of this image and notions of the sexually-attractive body. These ideals will be decisive in modeling the relationships between the sexes as well as in constituting normative models of beauty and sexual attractiveness which may be difficult to achieve. In our culture, the image of the body fomented by the biologistic and technocratic medical discourse, as well as by the consumer culture and communications media, not only produces a fragmented image within the subjects, but also introduces a gendered reading of bodies by establishing a difference between instrumental values and values of attractiveness directly linked to the different body standards for women and men.

The aesthetic ideal for women contains three basic ingredients: youth, thinness and beauty, which all depend on the relational/expressive/ornamental character of the stereotype of femininity. This combination implies the rejection of the body in its permanent experience of transformation and creates the need to erase the evidence of the passage of time, considered a sign of ugliness, lack of control and social failure. It also generates a tendency towards uniformity and the blurring of differential individuality under the command of a unique and rigid body development pattern. Rigidity and uniformity of the basic differences in the ideal models of attractiveness for women and men are measured in the asymmetric values of strength and potency versus youth and beauty.

The different aesthetic valuation which results from the social asymmetry between the sexes becomes an ethical value of differential social desirability and directly influences the differential elaboration of self-recognition, self-image and self-esteem of the subject (Pastor, 2000). At the same time, the sexualization of consumption--beginning with the aesthetic of the body displayed (transparencies, exhibition of the body and use of the body in advertising metaphors, etc.)--presupposes submission to the imperative to expose intimacy to view (Dio Bleichmar, 1998; Tubert, 1997). This constant demand to expose the body to the gaze of others, submitting the body to a permanent competitive examination, engenders insecurity in adolescents faced with the impossibility of fulfilling the normative demands of attractiveness.

Current research shows that the etiology of eating problems as "culturally-linked syndromes" is multifactoral, reflecting both social representations as well as personal conflicts. A bio-psycho-social perspective which considers the role of gender models on the construction of self-image is therefore required.

3. Method

3.1. Objectives: The objective of this research is to show the impact of gender models on image conflicts during the adolescent period and their repercussions in the appearance of eating disorders. Specifically, greater normative pressures with respect to women's bodies provoke an increased tendency in adolescent girls to internalize the standards of the female body image, leading to greater demands on their bodies, greater control, higher levels of objectification and body dissatisfaction and more frequent self-perceptions of incompetence and low self-control, which affects their self-image and self-esteem.

3.2. Sample: The sample was comprised of 155 girls from 13 to 15 years of age in the second, third and fourth years of high school in either public or state-subsidized schools in three towns in Valencia.

4. Instruments:

Body Esteem Scale (BES) Franzoi and Shields (1984)

* Number of items: 35

* Subscales:

Women: I. Sexual Attractiveness; II. Weight Concern; III. Physical Condition

Men: I. Physical Attractiveness; II. Upper Body Strength; III. Physical Condition

* Point scale: 1 to 5

Objectified Body Consciousness Scale (OBCS) McKinley and Hyde (1996)

* Number of items: 24

* Subscales:

I. Surveillance; II. Body Shame; III. Appearance Control Beliefs

* Point scale: 1 to 7

Eating Disorder Inventory (EDI) Garner, Olmstead and Polivy (1983)

* Number of items: 64

* Subscales:

I. Pressure to be Thin; II. Bulimia; III. Body Dissatisfaction; IV. Inefficacy; V. Perfectionism; VI. Lack of Interpersonal Trust; VII. Intraceptive Awareness; VIII. Fear of Maturity.

* Point scale: 1 to 3.

Multidimensional Self-Esteem Inventory (MSEI) O'Brien and Epstein (1983)

* Number of items: 116

* Subscales:

I. Global Self-Concept; II. Competence; III. Lovability; IV. Likability; V. Self-Control; VI. Personal Power; VII. Moral Self-Approval; VIII. Body Appearance; IX. Body Functioning; X. Identity Integration; XI. Defensive Self-Enhancement. (Factors IV, VIII and X were not used in this study because of their low scores as relevant factors.)

* Point scale: 1 to 5

5. Analysis:

We used Regression Analysis with the Windows 6.1 SPSS statistical package for data processing. The Multiple Regression Analysis included the Stepwise procedure to reduce variables.

6. Hypothesis and prediction:

Hypothesis

Based on our research, we believe that because adolescent girls face greater demands with respect to physical appearance and to the ethical/social "ideal of thinness"--which are linked to gender role imperatives--their problematic food attitudes and behaviors (evaluated through the EDI) will be intimately related to body image distortions (BES)--especially sexual attractiveness and concern about weight--with a greater objectification of the body (OBCS), which implies the internalization of social norms and alienation from their own experiences, leading to lower self-esteem.

Prediction

According to the theoretical suppositions, the high point scores in the EDI factors should correspond to high scores in BES factor I and low scores in BES factor II. Similarly, high scores in the OBCS factors I and II should correlate with low scores in the eight MSEI factors.

7. Results

7.1 Description of Results

To verify the predictions of the general hypothesis, a series of regression analyses were realized, taking each of the EDI factors as a dependent variable and using in each case the three BES factors, the eight MSEI factors and the three OBCS factors as independent variables.

7.2. Interpretation of the Results

Consistent with our hypothesis, the results indicate that the variables which predict "Pressure to be Thin"--excessive concern for dieting and weight -(55.4% variance, F=28.93, p=0.00005) are associated with a high valuation of those parts of the body related to sexual attractiveness, an excessive concern for weight control, alienation in body image recognition and strong internalization of the cultural standards regarding the body. In this sense, the internalization of social ideals and the fragmentation of the feminine body as an object of sexual attraction--the belief that "thinness" will produce the desired perfection and increase physical attractiveness--make young women more vulnerable to food disorders (Button, 1990; Stein and Reichert, 1990).

The variables that predict the factor "Intraceptive Awareness"--the capacity to recognize sensations of hunger and thirst as well as one's own emotions--(36.4% variance; F=25.477 p=0.00005) are related to low overall self-esteem associated with physical attractiveness and a low level of self-recognition and interpersonal acceptance. These variables show that, even in aspects related to private sensations, the corporeal experience is influenced by normative cultural meanings which regulate interpersonal relations (Pastor, 1993). Women's awareness of their bodies is more closely related to personal worth, merit and acceptance by others. Other authors have highlighted this as illustrating the greater social and physical anxiety which women experience by being continuously judged based on their bodies (Franzoi et al., 1989; Hart et al., 1989; Miller et al., 1981). The results of our research confirm that this constant observation may be partly responsible for the objectification of the female body: alienation from one's own body as a result of being constantly reduced to one's external appearance. In girls, this is associated with alterations typically related to eating disorders, especially bulimia, body dissatisfaction and inefficacy.

With regard to the factor "Bulimia," 23.7% of the variance (F=10.2, p=0.00005) results from the variables surveillance, personal power and self-control, showing a direct relation with objectification of the body expressed through the alienation of one's own perceptions; a positive valuation of personal assertiveness and capacity for leadership; and an inverse relationship with self-control. In addition, other factors also appear to have a role in increasing anxiety and feelings of guilt related to the difficulty of achieving the ideal body model.

With respect to the factor "Body Dissatisfaction"--self-esteem factors explain 69% of the variance (F=40.08, p=00005). The predicting variables refer fundamentally to poor opinion of one's body, considerable objectification of the body and poor relationships of interpersonal recognition. These results were consistent with the theory that women's perceptions about their bodies bear heavily on the differential prevalence of eating disorders. Gender models mediate this perception and define the body either as a process--in accordance with the "masculine instrumental ideal"--or as an object--in accordance with the "feminine ornamental ideal" (Feingold, 1992; Franzoi, 1995; Freedman, 1990; Karraker et al., 1990). Women's greater propensity to body dissatisfaction--resulting from the application of these models--also makes them more liable to perceptive and attitudinal disorders around body image and increases their vulnerability to eating disorders (Bruch, 1962; Fernandez Aranda, 1997; Wichstrom, 1995).

Body dissatisfaction can emerge in women as a generalized point of reference in social contexts in which external appearance and the ideal of thinness are emphasized (Chesters, 1994; Snyder and Hasbrouck, 1996; Rodin et al., 1985). Our data appear to confirm this relation.

The factor "Inefficacy" (63% of variance; F=31.29, p=0.00005) is also related mostly to body variables: strong internalization of the criteria of social desirability; distance from the valuation of one's own body; low overall self-esteem; poor self-control; and a lack of recognition of self with respect to others in addition to the feeling of a lack of recognition by others. As a result, a sense of personal inefficacy seems to be consistent with previous studies of food pathologies (Bruch, 1973). The results obtained in this study suggest that this feeling is strengthened in women by the assumption of cultural norms about the body which, when unfulfilled, generate guilt and a low sense of personal worth and interpersonal acceptance.

The variance in the factor "Fear of Maturity" (24.3%; F=15.56, p=0.00005) is explained by the inverse relation observed between this factor and the degree of self-esteem in the factors personal power and competence. The fear of growing up which accompanies food pathology seems associated with difficulties in taking on the appropriate degree of assertiveness and capacity for personal influence (Lask and Bryant-Waught, 1992; Ussher, 1989).

The factor "Perfectionism" is positively associated with the variables of psychological self-esteem (14% of the variance, F=15,53, p=0.0002) and is related to a high valuation of efficacy, skills and the capacity to face new situations.

Finally, low levels of lovability--acceptance of oneself and of others and recognition by others--explained 32.5% of the variance (F=44.62, p=0.00005) of the factor "Lack of Interpersonal Trust."

8. Discussion

The inverse relationship between body esteem and objectification of the body constitute one of the central hypotheses sustained by McKinley and Hyde (1996). As this relation demonstrates, cultural constructions of the ideal feminine body have a negative impact on women's opinions of their own bodies. Although the pressure of cultural standards and the internalization of gender models affect both sexes, women experience greater alienation with respect to their bodies and pay more attention to the opinions of others, turning them into severe and implacable judges. Similarly, research demonstrates the relationship between body esteem, other self-esteem variables (perception of self-competence, self-approval and recognition, both by oneself and others) and eating disorders, including sub-clinical manifestations. An exaggerated concern for weight and fat emerges from the profound internalization of social prescriptions and increased self-awareness of an objectified body. At the same time, the impossibility of satisfying the social normative demands (Basow and Kobrynowicz, 1993; Harris, 1990; Koff and Rierdan, 1991) have repercussions in the degree of perception of personal efficacy and control, generating a deep feeling of guilt.

According to several authors (Brenner and Cunningham, 1992; Dolan and Gitzinger, 1995; Lask and Bryant-Waught, 1992; Sanchez-Planell, 1980), fear of weight gain is associated with the distortion of body image which accompanies eating disorders. This distortion is made worse by the discrepancy between the real and the ideal body and the resulting poor self-image. This maladjustment is also observed more broadly in the population when individuals demonstrate little regard for their physical attributes, which are not abnormal according to the Index of Body Mass (IBM) but rather are judged according to the perceived discrepancy between the real body and the ideal body. Likewise, in our sample of adolescent girls in which the average IBM values are found within the normal range, the fear of weight gain stemming from the demand for thinness is fundamental to the female body ideal.

In our study, the various factors that explain the differences in the range of eating disorder evaluations (EDI) support recent hypotheses about the causes of the greater vulnerability of young girls to this type of disorder: greater social pressure regarding their appearance; fragmentation of the female body by fashion and consumer models; and, above all, internalization of the value system through socialization by the sex/gender system which dichotomizes the instrumental and process aspects for men versus the expressive and appearance aspects for women.

Although these results come from a non-clinical population, they confirm the conclusions of the 1965 Gottingen Symposium which related eating disorders to changes in puberty, bodily conflicts, body image perception and self-esteem (Button, 1990; Frederick and Grow, 1996; Deci and Ryan, 1995). In addition, our results also provide insight on how to influence the socialization of gender models which aggravates women's vulnerability to this type of problem. This socialization not only encourages an over-emphasis on the value of appearance, but also perpetuates patterns of dependency which limit the development of personal autonomy and the elaboration of independent judgment, all of which can have repercussions on self-esteem and personal satisfaction (Stein et al., 1995; Vandereycken et al., 1991).

The above occurs in a cultural context in which the ideals of femininity generate contradictory messages, especially during critical moments of identity construction such as adolescence. It is paradoxical that thinness, indissolubly associated with physical attractiveness in women, should be simultaneously both an ultra-feminine characteristic and its negation, that is, that the curvaceous body produced by supposedly unattractive fat should at the same time define sexual attractiveness and "the essence of woman" (Orbach, 1993;Thornton et al., 1991; Ussher, 1989). Meanwhile, in the pursuit of "freedom" and "independence," the many conflicts which emerge from the social and personal demands to develop multiple roles (housewife, professional, mother, spouse) are added to the physical ideals which further increases dissatisfaction with one's own body and intensifies stress. The difficulties of realizing the social ideal of femininity fuel feelings of insufficient autonomy and lack of control, damaging self-esteem and encouraging a propensity towards abnormal behavior around food.

We share the view of authors such as Caille (1989), Gordon (1994), Guillemot and Laxenaire (1993), Toro (1996) and Walters et al. (1995), who argue that gender attitudes must be modified to reduce the incidence of eating disorders. Prevention policies should address socio-cultural risk factors that influence the psychological development of self-esteem, the value placed on one's body, gender roles and the dominions of self-awareness and autonomy (Franzoi, 1995; Garner, et al., 1990; McKinley and Hyde, 1996; Striegel-Moore, 1992). Prevention policies must focus on the family, the school and the communications media, as well as formulators of public health policy. The interventions must break with cultural myths about the thin body and focus on the development of autonomy and a critical capacity among adolescents. A critical framework must be established to encourage a profound re-signification of the sexed subject, free of the tyranny of fashion and gender stereotypes.

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CRITERIA                                      PREDICTORS

EDI. 1.-Pressure to be Thin           Sexual Attractiveness (BES)
                                      Weight Concern (BES)
                                      Body Shame (OBCS)
                                      Surveillance (OBCS)

EDI. 2.-Intraceptive Awareness        Global Self-Concept (MSEI)
                                      Lovability (MSEI)

EDI. 3.-Bulimia                       Surveillance (OBCS)
                                      Personal Power (MSEI)
                                      Self-Control (MSEI)

EDI. 4.-Body Dissatisfaction          Sexual Attractiveness (BES)
                                      Weight Concern (BES)
                                      Body Shame (OBCS)
                                      Surveillance (OBCS)
                                      Lovability (MSEI)

EDI. 5.-Inefficacy                    Body Shame (OBCS)
                                      Surveillance (OBCS)
                                      Global Self-Concept (MSEI)
                                      Self-Control (MSEI)
                                      Lovability (MSEI)

EDI. 6.-Fear of Maturity              Personal Power (MSEI)
                                      Competence (MSEI)

EDI. 7.-Perfectionism                 Competence (MSEI)

EDI. 8.-Lack of Interpersonal Trust   Lovability (MSEI)