into smaller clothes (slim cultural ideal) and feelings
of power, control, and even superiority over others by
losing weight.
The need to develop a unique identity, or a sense
of who one is as a person, is another essential task
of adolescence. It coincides with the onset of puberty,
which initiates many emotional and physiologic
changes. Self-doubt and confusion can result if the
adolescent does not measure up to the person she or
he wants to be.
Advertisements, magazines, and movies that
feature thin models reinforce the cultural belief that
slimness is attractive. Excessive dieting and weight
loss may be the way an adolescent chooses to achieve
this ideal. Body imageis how a person perceives his
or her body, i.e., a mental self-image. For most peo-
ple, body image is consistent with how others view
them. For people with anorexia nervosa, however,
their body image differs greatly from the perception
of others. They perceive themselves as fat, unattrac-
tive, and undesirable even when they are severely
underweight and malnourished. Body image dis-
turbanceoccurs when there is an extreme discrep-
ancy between one’s body image and the perceptions
of others and extreme dissatisfaction with one’s body
image (Gardner, Friedman & Jackson, 1999).
BULIMIA NERVOSA
Self-perceptions of the body can influence the de-
velopment of identity in adolescence greatly. Self-
perceptions that include being overweight lead to
the belief that dieting is necessary before one can be
happy or satisfied. Brewerton, Dansky, Kilpatrick
& O’Neil (2000) found that severe dieting (with a
goal to lose 15 pounds) preceded binging behavior in
46% of the clients, 37% reported binging behavior
before beginning any serious dieting, and 17% began
binging and dieting at the same time. Clients with bu-
limia nervosa report dissatisfaction with their bodies
as well as the belief that they are fat, unattractive,
and undesirable.
Family Influences
Girls growing up amid family problems and abuse are
at higher risk for both anorexia and bulimia. Mazzeo
& Espelage (2002) found that response to family con-
flict and problems was strongly associated with dis-
ordered eating. Girls growing up in families without
emotional support often try to escape their negative
emotions. They place an intense focus outward on
something concrete: physical appearance. Disordered
eating becomes a distraction from emotions.
Childhood adversity has been identified as a sig-
nificant risk factor in the development of problems18 EATINGDISORDERS 441
with eating or weight in adolescence or early adult-
hood (Johnson, Cohen, Kasan & Brook, 2002). Ad-
versity was defined as physical neglect, sexual abuse,
or parental maltreatment that included little care,
affection, and empathy and excessive paternal con-
trol, unfriendliness, or overprotectiveness.Sociocultural Factors
In the United States and other Western countries,
the media fuels the image of the “ideal woman” as
thin. The culture equates beauty, desirability, and
ultimately happiness with being very thin, perfectly
toned, and physically fit. Adolescents often idealize
actresses and models as having the perfect “look” or
body even though many of these celebrities are under-
weight or use special effects to appear thinner than
they are. Books, magazines, dietary supplements,
exercise equipment, plastic surgery advertisements,
and weight loss programs abound; the dieting indus-
try is a billion-dollar business. The culture considers
being overweight a sign of laziness, lack of self-control,
or indifference; it equates pursuit of the “perfect” body
with beauty, desirability, success, and will power.Body image disturbance