Karen Carpenter and Christina Ricci,

¶ … Karen Carpenter and Christina Ricci, both who present with anorexia nervosa are similar in many ways. For the most part both young women experienced early exposure to fundamentally critical messages about their appearance and both were to some degree neglected by parents and conversely controlled by them. In the case of Carpenter parents were controlling and Karen was often subject to open favoritism of her brother. She was also confronted by her mother regarding the fact that her genetic history was for one of being overweight and that she would likely have to get used to it. Then as a young woman she became a performer, standing stage center at a time in history when physical appearance was openly criticized, and more often than not women were criticized for their appearance as overweight, even when their weight was perfectly natural. In Ricci's case she was exposed very early to images of herself as the young version of an overweight star, in a movie role and was given the impression by those around her that she was destined to be fat. This personal fear, supported by the casting of the younger version of an overweight woman, coupled with the divorce of her parents left her feeling vulnerable and dark. Both young women/girls resorted to anorexia nervosa, ranging between extreme denial and purging as well as over exercising.

Looking at the cases, together from a cognitive behavioral perspective, (after it is clear that the physical symptomology of the disease is under some semblance of control, i.e. some weight gain has been demonstrated and the individual is supported in her therapy) would seem very helpful as much of the disorder is clearly understood to be a symptom of negative thoughts driving destructive behaviors. Specialized cognitive behavioral therapy, in patient for most adolescents and/or young adults and potentially outpatient for adults suffering from the disorder would seem the logical choice of treatment regimen. From this perspective the cognition of the individual, Ricci and Carpenter was out of line with the real condition of her body. Both Carpenter and Ricci both expressed and/or were observed continuing to lose or try to lose weight after it was plain to see that they were already far too thin to be healthy. They both recognized having had a distorted body image, where they still believed that they were overweight but were alarmingly thin. Both women are of average to above intelligence and are therefore capable of having cognition altered to better allow them to redirect behaviors toward realistic images of self and to reduce the impact of their early exposure to negative self-image information. Nutritional therapy may have aided in both women having better understanding of the functional needs of their body. Social factors associated with the cognitive behavioral approach would include an address of comparing real, emaciated images of themselves, or others like themselves with images of women who are physically healthy in an attempt to cognitively address the skewed sense of their own physical image when severely underweight. Family, cognitive behavioral therapy might also be fundamentally important in Carpenter's case as the dynamics of the family, as well as the repetition of thematic preference for the other sibling and better familial understanding of issues of control and codependence would likely be appropriate. Both women were also likely predisposed to mental illness as a result of trauma (of parental divorce, and early exposure to primal scream therapy of father) in Ricci's case while in Carpenter's case such predispositions are unknown. Additionally, family history of mental illness is unknown for both these women.

Some aspects of the case that warrant further research include the development of anorexia nervosa as a result of over-controlling parents, perfectionism and dependence. Among the many research studies associated with anorexia nervosa, most of which are fairly old in research terms there were three works that really stood out on the above three issues. In adolescents with the disorder one research work stands out in favor of two variations of family therapy, one associated with conjoint family therapy (CFT) and the other supportive of separate family therapy (SFT), where individual's meet for CBT individually and hopefully apply the work to their family dynamic. This work contends that those who were most positively affected by therapy were those that did the (CFT) except in cases where the particular dynamic of the family, especially negative image messages was extreme especially between mother and daughter, in which case individuals were more improved with SFT which seemed to help the individual to feel more able to express concerns about negative messages and allow the therapist direct direction for CBT with the offending family member. The report also noted that the relationships' between parents were often strengthened by both types of family therapy and many couples reported greater warmth. (Eisler, Dare, Hodes, Russell, Dodge, & Le Grange, 2000, pp. 727-736)

A second work supports the idea that family therapy is often less helpful for older an patients, as family dynamics at an older age tend to be historical rather than current and that individual CBT stands out as the most affective psychological option for such individuals. This may have been the best option for Carpenter and at a later age Ricci as both were or should have been fundamentally separated from their origin family by the time they were recognized as in need of treatment, yet given the fundamentally challenging character of the known family dynamic between Carpenter and her small family, often together for work family therapy may have been a good choice to supplement individual CBT. The study also stresses that though general and family CBT seemed less effective on study participants for older an patients individualized and specialized (an specific) an treatment was the obvious statistical winner. Patients the last option in the study individualizes, specialized an CBT were most likely to report greater success and also less likely to relapse during the follow up periods. It is also noted by the study researchers that for older an patients either inpatient or outpatient individualized and specialized CBT was effective and given the resistance of many older patients to interrupt their lives by entering inpatient treatment the efficacy for outpatient treatment was supported. (Dare, Eisler, Russell, Treasure & Dodge, 2001, pp. 216-221)

Finally, the last article that spoke of an was a generalized article offering physiological explanations for the variations in a cases and the inability of family and historical/genetic histories to connect with the phenomenology of the disorder, or the lived experience of it, and especially the skewed body image associated with believing one was still overweight when their physical appearance was actually emaciated.

According to Guisinger, "Psychological and societal factors account for the decision to diet but not for the phenomenology of the disorder; theories of biological defects fail to explain euroendocrine findings that suggest coordinated physiological mechanisms." (2003, p. 745) This research or theory based article offers a completely novel approach to the disorder and stresses that even CBT or other interventions no matter how tailored to the individual case may not be addressing the entire situation and that more care needs to be taken to address the physiological adaptation of the disorder at various stages of development. The researcher offers a whole host of interesting questions regarding an and then also discusses possible comprehensive solutions to the problem.