Anorexia Nervosa: Case Study of Carpenter and Ricci

Comparative Background: Carpenter and Ricci

Karen Carpenter and Christina Ricci, both of whom presented 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 their parents and, conversely, controlled by them.

In Carpenter's case, her parents were controlling, and Karen was often subject to open favoritism toward her brother. She was also confronted by her mother regarding her genetic predisposition to being overweight and was told she would likely have to accept it. As a young woman she became a performer, standing center stage at a time in history when physical appearance was openly criticized — and women, more often than not, were criticized for their weight even when it was perfectly healthy.

In Ricci's case, she was exposed very early to images of herself as the younger version of an overweight star in a film role, and was given the impression by those around her that she was destined to be heavy. This personal fear — reinforced by being cast as the younger version of an overweight woman — coupled with her parents' divorce left her feeling vulnerable and emotionally dark. Both young women resorted to anorexia nervosa, engaging in behaviors ranging from extreme dietary restriction and purging to compulsive over-exercising.

Cognitive Behavioral Therapy as a Treatment Framework

Examining both cases together from a cognitive behavioral therapy (CBT) perspective would appear highly beneficial, particularly once physical symptomology is under some degree of control — that is, once some weight gain has been demonstrated and the individual is supported in her therapy. Much of the disorder is clearly understood to be a symptom of negative thoughts driving destructive behaviors. Specialized CBT — inpatient for most adolescents and young adults, and potentially outpatient for adults with the disorder — would appear to be the logical treatment choice.

From this perspective, the cognition of both Ricci and Carpenter was out of line with the actual condition of their bodies. Both women expressed, and were observed, continuing to lose weight or attempting to do so even when it was evident they were already far too thin to be healthy. Both recognized having had a distorted body image — still believing themselves to be overweight while appearing alarmingly underweight. Both women are of average to above-average intelligence and are therefore capable of having their cognition restructured to better redirect behaviors toward realistic self-images and to reduce the impact of early exposure to negative self-image messages.

Nutritional therapy may also have helped both women develop a better understanding of their body's functional needs. Social components of the cognitive behavioral approach could include presenting real, emaciated images of themselves or others similarly affected alongside images of physically healthy women, as a means of cognitively addressing their skewed sense of physical self-image. Family CBT would also be particularly important in Carpenter's case, given the controlling dynamics of her family, the repeated pattern of preferential treatment toward her sibling, and the broader need for familial understanding of issues of control and codependence. Both women were also likely predisposed to psychological difficulties: in Ricci's case, through trauma associated with parental divorce and early exposure to her father's primal scream therapy; in Carpenter's case, such predispositions remain less clearly documented. Family history of mental illness is unknown for both women.

Family Therapy Research for Adolescent Anorexia

Some aspects of these cases warrant further research, including the development of anorexia nervosa in relation to over-controlling parents, perfectionism, and dependence. Among the many research studies associated with anorexia nervosa, three works stand out as particularly relevant to these issues.

For adolescents with the disorder, one study compares two variations of family therapy: conjoint family therapy (CFT), in which the family attends sessions together, and separate family therapy (SFT), in which individuals meet for CBT individually and apply that work to their family dynamic. This research found that those most positively affected by therapy were generally those who received CFT — except in cases where the particular family dynamic, especially the transmission of negative body-image messages from mother to daughter, was particularly severe. In those cases, individuals showed greater improvement with SFT, which appeared to help them feel more able to express concerns about harmful messages and allowed the therapist to work directly with the offending family member. The study also noted that parental relationships were often strengthened through both types of family therapy, with many couples reporting greater warmth between them (Eisler, Dare, Hodes, Russell, Dodge, & Le Grange, 2000, pp. 727–736).

Conclusion and Directions for Further Research

Several aspects of these cases warrant further research, including the development of anorexia nervosa as a result of over-controlling parents, perfectionism, and dependence. The cases of Karen Carpenter and Christina Ricci illustrate how personal history, family dynamics, societal pressures, and biological vulnerability can combine to produce and sustain an eating disorder. A comprehensive treatment approach — one that integrates individualized CBT, nutritional therapy, family intervention where appropriate, and attention to physiological mechanisms — would appear most suited to addressing the full complexity of anorexia nervosa as it manifests in real clinical cases.

References

Dare, C., Eisler, I., Russell, G., Treasure, J., & Dodge, L. (2001). Psychological therapies for adults with anorexia nervosa. British Journal of Psychiatry, 178, 216–221.

Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., & Le Grange, D. (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 41, 727–736.

Guisinger, S. (2003). Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa. Psychological Review, 110(4), 745–761.