Relationship of Eating Disorders, Self-Esteem

¶ … relationship of eating disorders, self-esteem and depression amongst adolescents and teenagers. Both self-esteem and depression and their connection to eating disorder will be thoroughly studied. The aim of this paper is to highlight the major causes of self-esteem and depression on eating disorders in order to assist interventionists in formulating a more profound theory and strategy to tackle this growing social dilemma in the future. The paper will present a sound literature review on the connections between eating disorders, self-esteem and depression that have already been established. The methodology will present the steps that this study will take to formulate its own theories and will use the interview process to attain qualitative data from doctors who treat eating disorders and the patients who have eating disorders.

Literature Review

Problem statement

The numerous technological advancements in the field of healthcare are providing new and improved procedures to treat eating disorders; but still many patients are left wanting and disappointed from the healthcare system. Both depression and low self-esteem have been linked to higher levels of eating disorders amongst adolescents. The main goal of the depression and low self-esteem treatments is to efficiently increase the mental ability of the patient at the same as monumentally decreasing the degree of their levels of low self-esteem and depression. This evaluation study will thoroughly study factors causing low self-esteem and depression so as to provide a holistic view on both these issues and offer interventionists a better chance of dealing with eating disorders (Bailer et al., 2005).

Background of the study

In the past 3 decades, there has been an ever increasing interest in the link between eating disorders, depression and low self-esteem. Numerous studies have confirmed that the higher the levels of depression and low self-esteem, the higher the addiction to a certain category of eating disorder. This level of consistency between higher depression levels, lower self-esteem and the extreme condition of eating disorders has led many researchers to believe that there is a definite and interdependent relation between the three amongst the youth (Karwautz et al., 2003).

Research studies have studied social effects or influences, on eating disorders, depression and low self-esteem. Furthermore, studies have also looked at the impact of economic situation on eating disorders, depression and low self-esteem. When taken into consideration, all these socio-economic dynamics and peripheral factors have been proved to be decisive in the relation between depression, low self-esteem and eating disorders (Nagata et al., 2003; Ribases et al., 2005).

Background on eating disorders and depression

Numerous researchers have included these socio-economic factors and concluded that the association between eating disorders and depression varied with the variation within and amongst culture and gender. In their study they failed to find a significant association between depression and eating disorders amongst the youth of the blacks as well as the Puerto Rican states. On the contrary they found a very strong association between the two factors when researching the white youngsters, and that too amongst the girls more then the boys (Slopien et al., 2004).

Frank and colleagues (2005) in their study also concluded that there was a high amount of socioeconomic status (SES) differentiation between the adolescents who suffered depression due to eating disorders and impact of those disorders on their physical appearance. If the SES and eating disorder percentage was high amongst the white youngsters then they also exhibited a superior level of depression and dejection (the Children's Depression Inventory); whereas the opposite was true for those white youngsters who experienced lower SES and eating disorders levels. This study clearly shows that the social groupings and status play an integral part in the strength of the association between depression and eating disorders amongst the youngsters. Frank and colleagues (2005) also in their study explain that the failure to provide sufficiently successful tactics to solve the eating disorders problems is the lack of understanding of the reasons to indulge in the activity across different cultures and ethnic groups. So in conclusion they asserted that the eating disorders phenomenon is directly related to depression amongst the youngsters in the higher SES group but was not a significant relation amongst the youth in the lower SES group (Frank et al., 2005).

All the studies that have included the socio-economic factors in their analysis of the relation between depression and eating disorders have successfully found a strong relationship between multiple social and economic factors as strong mediators of depression, leading to eating disorders. They have also successfully examined the corresponding variations and degrees of depression. However, few studies have synthesized the research studies on depression so as to give a holistic picture of teenage depression (Bloks et al., 2004).

Background on self-esteem and eating disorders

Numerous researchers have explained that self-esteem was the basic instinct of an individual to approve, like, dislike or value his own qualities as a person. The two diverse philosophies presented in studies on the concept of self-esteem are strongly supported in practical situations. The first philosophy of self-esteem brought forth was from William James. James defined self-esteem to be a direct relation of the success an individual has within a sphere and the priority that the individual attaches to the success achieved in that sphere. The other philosophy of self-esteem brought forth was from C. Horton Cooley. Cooley defined self-esteem as the significance that an individual laid on the social view, especially of the significant others like family and friends, on the acceptance of his personality.

Self-esteem too as been thoroughly studied and its connections with eating disorders amongst teenagers have been widely reported. The vast extents of researches that have been done on the concept of self-esteem have included numerous factors over a period of time. Some of these factors are the level of apprehension, dejection, discontent, anger, isolation and petulance. Tozzi and colleagues (2005) in their study also found a direct influence of high or low self-esteem with the strength of association or closeness with the parents as well as superior academic achievements. Other researchers have also found an encouraging view of the body image or level of self-appeal, domestic level and positioning of power as well as superior family revenues to be significant contributors to the level of self-esteem of an individual (Tozzi et al., 2005).

The process of self-analysis begins at a very young age like early childhood years and then follows through consistently into the adolescent and teenage years. Whatever priorities and decisions are made on what is important and what is not important, including eating patterns, to determine one's self-worth are all dependent upon the numerous differing views and philosophies of self-esteem. For William James, who is a founder of the self-psychology, has defined self-esteem to be a structure based on the opinion an individual has on his/her own capabilities (see Vervaet et al., 2004).

When considering the above definition, the actual decisive factor of one's self-esteem is the association of the perceived capability and the level of success in its application. This factor of capability is what causes the inconsistencies and differences between the objectives, ideals, aims, principles, morals and feats of individuals. The ideals of an individual mainly present the perception of what he/she believes he/she should be or should aim to be or wants to be. Most of these ideals of an individual are influenced by the expectations and targets of the parents during the early childhood years (Mikolajczyk et al., 2004).

Self-esteem, when defined as a weighing scale to measure the self-merit of an individual or as a self-analyzing process has been overtime related to a numerous amount of modification and welfare factors. Some of these factors are academic feats or accomplishments, despair/melancholy/dejection, communal contacts, probability or likelihood of suicidal characteristics or desperation (Wichstrom, 2000), consumption syndromes, behavior syndromes, flexibility to unexpected or hectic happenings, and eating disorders (Scheier, Botvin, Griffin, & Diaz, 2000).

Emler (2001) studied causes and effects of low self-esteem. She synthesized research on self-esteem and studied various factors by analyzing the allocation of the self-esteem ratios between and amongst different social groups like spiritual, socioeconomic, secular, familial structures, and varying interpersonal standpoints or choices. The results are not very good for individuals suffering from low self-esteem. She found that lower levels of self-esteem amongst adolescents, quite often, leads to eating disorders. Other studies too have confirmed these findings over the years.

Chapter 3: Methodology

This chapter will illustrate the methodology that will be used to perform this study. Furthermore, justifications will also be given for choosing this methodology. This chapter has been divided into eight subsections so that all relevant issues can be highlighted and tackled systematically. Cohen, Manion and Morrison (2000) in their book point out that dividing the methodology into subsections converts the general aims of the research into practical and feasible objectives (Cohen, Manion and Morrison, 2000). We begin this section by discussing the main assumptions of this study.

1. Research Philosophy

Researchers base their investigations on certain assumptions, which he/she consider to be true and therefore does not challenge them. These suppositions allow the researcher to view the world from a certain perspective while ignoring other perspectives. The researcher in this study assumes that his subjects are logical human beings who have a rationale point-of-view. Their thinking is valid and reasonable and their approach is more or less along the lines of scientific thinking. In addition, we assume that commonsense thinking and scientific thinking are more or less identical in nature. With these assumptions in mind, we take a post-positivism philosophical foundation; as in line with Trochim (2000) post-positivism is the outright denial of positivism (which argues that the laws of the nature are perfunctory and therefore deductive reasoning can be the only suitable approach to comprehend nature) and presupposes that day-to-day human and scientific reasoning are more or less the same and in order to understand reality, researchers have to use not only deductive but also inductive reasoning (Trochim, 2000). Therefore, it is believed that post-positivism philosophy will assist the researcher to achieve his objectives with precision, accuracy, clarity and relevance.

2. Research Approach

Conceptualization of eating disorders is a relatively novel issue and as a result the theoretical frameworks available in its literature have not been completely explored. Therefore, the researcher plans to explore this issue in depth by utilizing an inductive approach. He plans to collect data by interviewing the subjects and examining the findings. The purpose is to uncover consistent and identical patterns in the thinking of the subjects so that some original results can be sketched, which can help other researchers in their study of eating disorders. Trochim (2000) points out that an inductive approach is highly accepted for studies that aim to develop a theory. He points out that in an inductive approach; the researcher employs a bottom up approach where he moves from specific and precise themes to general theories.

3. Research type and Time line

The researcher plans to utilize a cross-sectional point-of-view as this study analyzes the characteristics of eating disorders based on structured interviews conducted in a single point in time. Trochim (2000) points out that cross-sectional research studies take a small piece from the topic at a single point in time. This is in contrast with longitudinal studies which take on two (or sometimes even more than two more) measurements in different times (Trochim, 2000). After considering the time and budget of this study, the researcher chose a cross-section research perspective.

4. Data Collection Methods

It has already been pointed out that the current literature on eating disorders lacks empirical and observational studies. The researcher plans to end this disparity by carrying out in depth and formal interviews doctors who treat eating disorders and those patients who have an eating disorder. For that reason the data being collected for this study is going to be non-numeric and therefore qualitative. Trochim (2000) points out that a qualitative method is in contrast with a quantitative one as it takes into consideration wide-ranging data, that may include videos, sounds, photographs and alphabetical text along with other non-numeric data (Trochim, 2000). The researcher believes that the qualitative method will perfectly fit the aims of this study.

Data Evaluation

Evaluation of the data will be based on calculating the intended affect or the outcomes/results of the study. The method used to measure the results of the study will be the same as those found in other research synthesis studies. We will also look into the process with which the results have been obtained so that limitations in the methods can be determined and improvements can be suggested.

5. Qualitative Method

The researcher plans to carry out in depth and formal interviews with doctors who treat eating disorders and those patients who have an eating disorder. The qualitative method selected for this study is going to be a survey interview. The researcher will be directly involved in the data collection process, as well as, experience the thinking, rationale, acquaintance and understanding of reality by the subjects. Formal interview protocols will help the researcher by providing sufficient information to construct general theories. Trochim (2000) points out that despite the fact there are a number of methods to execute qualitative studies, the most commonly used method amongst scholars is the survey-interview as it gives flexibility to the researcher to fulfill his/her objectives (Trochim, 2000).

6. Qualitative Validity

Interviews are carried out by using identical procedures for all the subjects. In this way differences and dissimilarities in the subjects' responses are ascribed to genuine differences and dissimilarities in the studied sample. Furthermore, differences and dissimilarities in the results are not ascribed to attributes of either the instruments or the methodology. In order to facilitate reduction/elimination of such mistakes, all interviews are maximally standardized throughout the procedure (Cohen et al., 2000).

7. Sampling Strategy

All interviewees are selected through personal contracts. Therefore, non-probability purposive sampling is used to select the sample for this study. Trochim (2000) points out that non-probability purposive sampling assists the researcher in selecting the sample with a specific purpose in mind. The researcher can stay in line with his/her purpose and utilize the sample that he/she feels will generate the most accurate, in depth, precise, complete and reliable results (Trochim, 2000). After careful deliberation, the researcher believes that non-probability purposive sampling will go well with the aims of this study.

8. Data Analysis

Since the data collected from in depth and formal interviews will be non-numeric; therefore, this study will use coding techniques to analyze the data. The researcher will compare and contrast the results of this study with the results of previous studies highlighted in the literature review (chapter 2). Identical patterns will be separated and revealed; similarly, new emerging patterns will also be illustrated and pointed out. This method will assist the researcher in (1) revealing the personal characteristics of people who have eating disorders; (2) understanding the factors that cause eating disorders amongst teenagers; (3) exploring the relationship eating disorders, depression and social / ethnic backgrounds. Cohen, Manion and Morrison (2000) point out that comparing the qualitative results with the results of previous studies allows the researcher to draw attention towards the emerging patterns amongst the population and provides incentives for additional research on the same topic.

Chapter 4: Findings

This chapter compares and contrasts the results of this study with the results of previous studies highlighted in the literature review (chapter 2). Identical patterns have been separated and revealed; similarly, new emerging patterns have also been illustrated and pointed out. This method has assisted the researcher in designing a general theory about (1) the personal characteristics of people who have eating disorders; (2) understanding the factors that cause eating disorders amongst teenagers; (3) exploring the relationship eating disorders, depression and social / ethnic backgrounds. The results will be highlight the eating disorder habits formed under the following influences: cultural belief and body image; anxiety; social settings; parental behavior; economic issues; emotional expression; ethnic identity; stress physical-self.

The impact of cultural belief and body image on eating habits

Many researchers have characterized body image as a subjective occurrence rather than an objective one. Body image is formed by customs and mores about the desired physical appearances of both males and females emanating from the society. By applying this definition, one finds that self-esteem and eating disorder habits are directly proportional to the level of cultural standards an adolescent believes he/she has attained. Practitioners studying body image and eating disorders have found that girls are increasingly becoming victims of severe eating disorders as they are surrounded by ideal images of women who not only depict physical perfection by being thin, sexual and inactive; but also portray social and economic success. Several research studies have confirmed that female adolescents who are at the beginning of menses are more likely to develop lower self-esteem as they end gaining nearly one third of additional fat. Furthermore, these girls are a higher tendency to develop negative eating habits in order to compensate for their weight gain. Other studies have also confirmed that post-menses adolescent females are also highly likely to develop higher levels of self-esteem due to (1) biological changes occurring in their body and (2) the media representation of an ideal body image. Similarly, numerous researches have also found that girls developed lower levels of self-esteem because they are constantly being told that they are imperfect regardless of how thin or beautiful they are. Other studies found similar results and concluded that the strong link between lower self-esteem, eating disorders and body image should not surprise anyone (Klump, 2004).

The impact of anxiety on eating disorders amongst adolescents

Byrne (2000) in his study found strong links between anxiety, eating disorders and low self-esteem amongst adolescents. He founded his study on two theories, namely (1) classical turmoil theory and (2) normality theory (Byrne, 2000). Bulik (2004) in his study found that these two theories have dominated most of the subject of study on the adolescents and their eating behaviors. The turmoil theory mainly concentrates on the psychodynamics of the adolescents, like issues of sexuality and personal characteristics. The normality theory tends to take the limelight away from factors like chaos, variances and disagreement. He points out that most researches that have been done in the past decade on the adolescents have concentrated on two facets: (1) psychobiological (2) psychosocial domains (Bulik, 2004). Byrne (2000) concluded that both these domains have a profound impact on adolescent eating disorder habits that are developed due to the resulting self-esteem structure.

The impact of social settings on teenage eating disorder habits

According to many researchers the social system is basically a personality or character structure. So when considering this system, self-esteem of adolescents get influenced by biological, personal as well as social elements like the family, contemporaries, and social institutions. All these elements can influence the eating disorders directly through joint contacts and/or personal dedication of the adolescent. Researchers also put emphasis on the how exo-systems (external social settings) can also at times influence the self-esteem of adolescents hence designing their eating habits.

One of the examples of exo-systems is the occupational choices of the parents, these occupational choices will structure the overall parenting approach as well as the familial norms, principles and habits, which as a result will influence the path of the adolescent's mental growth. The exo-system can also influence the child's mental growth outside of the domain of the parental attitudes. Children can analyze the future contributions that they can make by analyzing the social structure that exists outside of their family like the gender differentiations within the social sphere. Researchers found that occupational choices made by parents and social structures surrounding the adolescents significantly impact their eating habits as they self-esteem (Fassino et al., 2003).

The impact of parental behavior on eating disorder habits

Numerous researches have shown enough authentic links between the adolescent self-esteem, eating disorders and parent personalities. All of the studies tend to agree with the fact that higher levels of self-esteem are evident when the parents are helpful and loving towards their children. To extend this, numerous studies have also shown that if the parents are able to manage the habits and behaviors of children while staying away from the negative emotions like apprehension, culpability, blame and alienation then the children or adolescents are more likely to have higher self-esteem and have a healthy diet as well as a good relationship with their parents; and children will feel of sense of pride through being, not doing i.e. realize that who they are is important and their overall physical appearance is not as important as good physical and mental health (Fassino et al., 2003).

The impact of economic issues on eating disorder habits

The economic conditions of the family are also of significance when we are considering the growth of self-esteem and eating disorders amongst the adolescents. There have been researches conducted on how the economic conditions affect the self-esteem and create eating disorders amongst teenagers and adolescents. Most of the time, studies have concluded that weak or poor economic conditions contribute to lower levels of self-esteem and higher eating disorder patterns. The studies have been able to successfully point out eating disorders as one of the dangerous outcomes of the stressful economic conditions on the adolescents. However, they need to detach the precise and restricting methods that have bridged the economic strain to the self-esteem of the adolescents. It is still the approach and attitude of the family that plays the decisive part in the construct of the diet and self-esteem of the individual (Fassino et al., 2003).

The impact of emotional expression on eating disorder habits

Emotional expression basically means an apparent or visible display of the sentiments of an individual. The concept of emotional restriction mainly explains how an individual finds it hard to comprehend, tackle and represent their sentiments. Numerous researches have been carried out to show how the gender differences influences the emotional expression of an individual. Most of the studies confirmed that women were more emotionally expressive then the men. The same pattern is seen amongst adolescents where the girls are more emotionally expressive then the boys. This free feel to be emotionally expressive tends to be pertinent when measuring the overall eating disorder patterns because most eating disorders are a direct result of an individual eating when he/she is depressed or angry or is feeling a strong emotion and instead of expressing it turns to food for comfort. This is so because the true analysis of the eating disorders and even self-esteem is done only when the participant can clearly and accurately relate their emotions, viewpoints and thoughts. Many studies of the eating disorder patterns and self-esteem amongst adolescents, confirmed that the gender difference is a direct prelude of the emotional expression of the adolescents (Fassino et al., 2004).

The impact of ethnic identity on eating disorder habits

The problem with the existence of different cultures all over the world is that it becomes extremely difficult for the migrants and/or minorities to strike a balance between their own cultural principles and standards while surviving amongst a majority group who has conflicting traditions. The adolescents in the minority have the difficult task of finding their identity within the framework of the culture that their parents are teaching them and the culture that they have to come across in their social interactions. This influence of the conflicting social culture is one of the reasons why the migrant children seem to have more clashes and disagreements with the standards of their parents' culture. A few studies conducted over a few generations have shown that the earlier generations showed higher adaptation and tolerance for their parents' culture while the later generations showed more openness towards the social or immigrant cultures. Other research studies came to the same conclusion (Knafo and Schwartz, 2001; Phinney et al., 2000). This is also one of the main reasons why one sees a rise in the detached parent-child relation and parent-child clashes or disagreements amongst minority ethnic groups. Also, this shows a shift in the overall eating patterns of children and they end up structuring their lifestyles along differing patterns from their parents and their inexperience on what works for their metabolism directly relates to the many health problems they face due to unsuitable diets.

The impact of stress on eating disorder habits

A section of the research studies that have been conducted in the past 3 decades have concentrated solely on the effect that the social settings and social interactions can have on the growth, (physical, mental and social) of an individual. The main structure that has been used for research in most of these studies has been the "stress process" prototype. The stress process configuration is structured in a way that helps us analyze the causes of the social stress as well as the most likely conditions that control or motivate stress and the aftermath of the social strain on the mental and physical health of the individual. Some researchers have even used the stress process prototype to outline or highlight the main procedures that might arbitrate or differentiate pure stress from the consequences of stress on the overall eating habits of individuals. The most fascinating and factual part of the social stress model is that it understands that the causes of stress and the consequences of stress on eating habits are both an aftermath of the holes or deficiencies in the social structures that inadvertently yet directly cause the disturbances in the phenomenon of social standing (Fassino et al., 2004).

The impact of the physical-self on eating disorder habits

There are researches that have proved that not all the females go through depression or lower cerebral or confidence growth in their adolescence. Most studies have highlighted that the boosters or aggravated causes of depression could be due to the social status, social acceptance, parental attitude, eating habits, parental support and cooperation, individuals' own maturity and developed attitude towards puberty or menstruation (Fassino et al., 2005).

The background of all social associations and exchanges can influence the way an adolescent deals with onset of puberty and menstruation and the resulting eating patterns that emerge. Here again, the education and awareness of the family plays a part, a less educated family might not be able to provide the female adolescent with enough knowledge of menstruation hence hindering the whole process of the coping strategies that the female will develop, resulting in the female delving into unhealthy eating habits.

Most of the females are reported, in numerous studies, to experience the retraction of motherly love (Fassino et al., 2005), irritation and clashes within their relations with their parents as well as a decline in the understanding and cooperation from the parents before the reach the age of menstruation. Three of the most important causes of eating disorders brought about by depression are parent-child clashes, social constraints or misdemeanors as well as overly protective and authoritative parenting.

Interview Transcripts:

This chapter will illustrate the results of the interview. The first 3 questions were addressed to doctors who treat eating disorders and the next 3 were addressed to those patients who have an eating disorder. We begin our analysis by reviewing the first question:

1. How did you discover, evaluate, and exploit opportunities to create future treatments of eating disorders?

We found that doctors understood the importance of the history of the patient as being an integral part of their eating habits. They chose casual and one-on-one conversations mostly with their patients to understand the complete dynamics of the situation that the patient was in. This, one of the doctors explained, usually helped the patient to be more candid and forthcoming with details about their life knowing that the information was not necessarily going to be forwarded to their family. Other doctors explained the importance of the knowledge and acceptance of the archaic treatments for the phenomena and how they could help in treating the patient with respect and curiosity.

2. What were the normal reactions that you would get from parents of patients as well as patients experiencing eating disorders and what would your reaction be?

One of the main internal factors that guided most of the doctors were the overall ambience and attitude of the family towards one of the teenage members experiencing an eating disorder. In some cases, the attitude was a little harsh and the treatment demanded was not the same as the one needed, which is when the doctors had the hardest time in communicating the importance of what was right for the patient. In other cases, the parents came forth with a whole set of ideas for treatments that they had found in books or in the internet, in those cases, the overall time was wasted more so in discussing why a treatment wasn't useful for a particular disorder instead of discussing the treatment that would actually be useful. In yet other cases, the overall knowledge of the parents and the patients was lacking and when treatment was offered, the overall reaction was that of apprehension and fear. felt like he was working too hard to attain the goals of his employer and wasn't getting appreciated or getting as much as he deserved in return. In other cases, he felt like the job wasn't exciting or interesting enough to keep his incentive or motivation at a higher level. In these cases, he not only felt bored but frustrated as well. He also, in some cases felt that his employers were biased and were not treating him at the same level as other employees because he belonged to an ethnic minority group (Turkish). He, hence, felt that if he were his own boss then he could do what he wanted to do and enjoy the fruits of his hard work.