What happens when individuals come to believe others’ critical views?
Reprinted from Eating Disorders Review
January/February 2011 Volume 22, Number 1
©2011 Gürze Books
Patients with binge eating disorder (BED) have a pattern of recurrent binge eating but lack the compensatory weight-control practices that mark bulimia nervosa. Although BED is still considered a research category in the DSM-IV, it is believed to be the most common eating disorder in the U.S., and currently affects about 2% of American adults.
A decade ago, Drs. Carlos Grilo and Robin Masheb reported that two forms of childhood maltreatment, emotional abuse and sexual abuse, were significantly linked to body dissatisfaction among patients with BED (Obes Res 2001; 9:320). David M. Dunkley, PhD, recently joined Drs. Grilo and Maseb to examine the role of self-criticism and its possible connection with depression and body dissatisfaction among 170 patients diagnosed with BED (Int J Eat Disord 2010; 43:274). The authors also sought to rule out other possible causes for body dissatisfaction, including depression or low self-esteem.
Adopting a critical self-view
The authors postulated that one possible reason that some types of childhood maltreatment can lead to body dissatisfaction and unhealthy eating patterns is that after years of excessive criticism, repeated insults, and some form of physical or sexual abuse, individuals may adopt a similarly critical view of themselves. This can lead to constant and harsh self-scrutiny and chronic concerns about others’ opinions and criticisms and may be expressed in a variety of dysfunctional attitudes and behaviors, according to the authors.
Participants in the study were a consecutive series of 170 treatment-seeking overweight adults who met DSM-IV research criteria for BED. Potential subjects were excluded if they had any concurrent treatment for weight or eating disorders or medical conditions that could influence weight or eating (such as diabetes or thyroid disease). The mean age was 43.49 years and the group was predominently female (78%) and Caucasian (88%). Mean body mass index was 36.6 kg/m2. The study participants filled out a series of questionnaires, including the Childhood Trauma Questionnaire, a 28-item self-report that assesses childhood maltreatment through emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect; the Depressive Experiences Questionnaire, a 66-item questionnaire that assesses self-criticism; the Rosenberg Self-Esteem Scales, the Beck Depression Inventory; and the Body Shape Questionnaire, a 254-item questionnaire that reports the frequency of preoccupation with and distress about body size and shape.
Two areas emerged: emotional and sexual abuse
Sexual and emotional abuse was significantly associated with body dissatisfaction among the adults; however, this was not the case for childhood physical abuse, physical neglect, or emotional neglect. When the authors considered potential mediators between childhood emotional abuse and body dissatisfaction, correlation analyses showed that self-criticism, self-esteem, and depressive symptoms were each significantly associated with emotional abuse and body dissatisfaction.
The authors note that although self-criticism has been mostly studied in the context of depression, it has a broader relevance that goes beyond depression-related problems to various forms of eating psychopathology. Fennig and colleagues also reported that self-criticism was an independent, robust, and strong predictor of eating disorder symptoms (Int J Eat Disord 2008; 41:762-5). Drs. Dunkley, Grilo and Masheb suggest that future research examine the possibility that self-criticism might reflect an important part of a cognitive-personality dimension in disordered eating.