How Girls with Eating Disorders Cope with Daily Sociocultural Pressures

The hard part is balancing perceived expectations while remaining true to self.

Reprinted from Eating Disorders Review
September/October 2011 Volume 22, Number 5
©2011 Gürze Books

Teenage girls with eating disorders work hard to find a balance between trying to live up to perceived expectations from peers while remaining true to themselves. This was one of the findings of a recent study of Swedish teens aged 15 to 19 (Journal of Multidisciplinary Healthcare 2011:103). Participants in the study also believed their eating disorder was partly a result of being unable to attain such a balance.

Dr. Sanna Aila Gustafsson and colleagues at the Psychiatric Research Center in Orebro, Sweden, designed a study to explore how girls with eating disorders manage sociocultural pressures in everyday life. The authors interviewed 18 girls between 15 and 19 who were being treated at an outpatient unit in a specialized eating disorder service. Eight of the participants had restrictive eating disorders (5 had anorexia nervosa [AN] and 3 had subthreshold AN, or EDNOS type 1 or type 2). Six other girls reported binge eating; 1 was diagnosed with bulimia nervosa [BN] and 5 with subthreshold BN, or EDNOS type 3). The 4 remaining normal-weight girls often purged after eating normal amounts of food in an effort to lose weight.

Interviews centered on perceptions

In interviews lasting from 35 to 65 minutes, the authors initially focused on the participant’s perceptions and how she was affected by expectations in daily life. During the interviews, the girls were encouraged to speak freely about each topic, and as the conversations continued, the girls began to spontaneously reflect upon the ways they dealt with everyday pressures from their peers.

All participants experienced difficulties dealing with pressures in their everyday lives and nearly all believed that their eating disorder was at least partly a result of these difficulties. Several described how, once their eating disorder was established, they found the eating disorder reduced anxiety and gave them a sense of control.

Three specific conceptions of dealing with everyday expectations emerged: striving to be oneself, adapting to various situations, and presenting oneself in a positive light. The first concept was the most desirable, but also the hardest for the girls to achieve. The second, which involved adapting to various situations, led the girls to put aside their own needs, if they felt this would give the best outcome for someone else. The third, presenting themselves in a positive light, was the most distasteful to the girls, who felt they were weak, false, or immature when they tried to achieve it.

Most participants thought that their eating disorder reduced anxiety and gave them a feeling of controlat least in the short term. Many of the girls said they thought they should set firmer limits for those around them, lower their high demands, and accept themselves as they were. When eating disorder symptoms worsened, feelings of guilt and negative self-evaluation reappeared.

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