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Self-esteem has recently been defined by Silverstone as "the sense
of contentment and self-acceptance that stems from a person's appraisal
of their own worth, significance, attractiveness, competence and ability
to satisfy their aspirations" (Silverstone 1992). Self-esteem is the
degree to which a person values and respects themselves, and is proud of
their accomplishments. Self-esteem begins to develop in childhood, but
it solidifies and gains momentum during the turbulent and trying years
of adolescence. The teenage years tend to be a crucial "make it or
break it" period when it comes to self-esteem because it is at this
time that youngsters are searching for an identity. If this process goes
awry, the teen is likely to have negative feelings about the self, leading
to a low sense of self-esteem. Many recent studies have provided evidence
that disruptions in the formation and stability of one's self-esteem can
lead to various psychological problems, such as eating disorders.
Although it is often thought of as only an "anecdotal contention that low selfesteem is a trait of eating disorders" (Wilfiams 1993), this fact has been empirically proven time and time again. With the use of various questionnaires and inventories, researchers such as Schupak-Neuberg, Rosen and Button have found that low self-esteem occurs very commonly in patients with eating disorders. In some cases, evidence for this relationship is so strong that it is even thought by some researchers that chronic low self-esteem is a necessary prerequisite for disordered eating (Silverstone 1992). A profile of self-concept components that are characteristic of low self-esteem are insecurity, negative mood and depression, poor body image, feelings of inadequacy, social and personal withdrawal, poor adaptation skills, and unrealistically high aspirations (Steinhausen 1993). All of these traits are seen fairly consistently in patients with eating disorders.
In addition, patients with eating disorders also exhibit other traits associated with low self-esteem, such as problems with their overall self-image, excessive concern over weight and shape, and globally negative attitudes about their self-control and discipline (Button 1997). The methodology for the research leading to these conclusions about low self-esteem and eating disorders typically involves elements such as questionnaires examining eating behavior, self-esteem and general psychological well-being (such as the Offer self-image questionnaire), depression and self-esteem scales (such as the Rosenberg self-esteem scale and the Hospital anxiety and depression scale), personal interviews with doctors, psychologists and researchers, and finally tests designed specifically for eating disorders (such as the Bulimia test and the EAT-40).
Low self-esteem plays a prominent role in many multifactorial theories of the etiology of eating disorders.
The formation of a concrete sense of self is one of the milestones of adolescence. However, this task is anything but easy. The teenage years are full of turmoil and changes that can have a detrimental affect on a girl's sense of identity and therefore her self-esteem. Without a positive and strong sense of identity, many teenagers suffer from low self-esteem and self-doubt. Identity formation involves many factors, among them solidifying ideas about morals and values, exploring the nature of one's own personality, and finding the peer groups that one will form relationships with. The process of identity formation is typically harder for girls than for boys, leading to "girls' greater identity instability, higher self-consciousness, greater concerns about popularity, lower body esteem, and lower selfesteem" (Fairbum 1993). Young girls are searching for positive things with which to identify, to make them feel like they fit in with a group, to make them feel confident. Identity formation will often involve making new friends, joining certain clubs or sports teams, getting involved with a church youth group, beginning to separate emotionally from one's parents or enrolling in certain classes at school. Ideally, the teenager will emerge from the process stronger and more confident, knowing who they are and thinking they know what they want out of life.
Unfortunately, this is not always the case. Studies reported by Fairbum
indicate that when adolescent girls are insecure, they become significantly
more self-conscious. Self-consciousness leads to increased self-criticism,
leaving the adolescent extremely vulnerable to disordered eating (Fairbum
1993). Rosen found that this phenomenon is due to a desire to decrease
self-consciousness by improving the physical appearance, especially through
dieting (Rosen 1993). Therefore, without a strong sense of identity, adolescent
girls begin to feel poorly about themselves, and the manifestation of this
self-consciousness is often a measure such as dieting and unrealistic expectations
for their physical appearance.
When the process of identity formation is disturbed, one is left with
a great amount of confusion and instability about the self. Many studies
have found that for young girls, the solution to this problem is to utilize
their physical bodies as a means of self-definition (Schupak-Neuberg 1993).
In other words, girls disregard their personalities, their morals and values,
and their intelligence and instead focus only on their physical appearance
as the source of their identity. Thus, the body becomes of the utmost importance,
the concrete notion of self, and making it beautiful and perfect is the
girl's primary priority. Girls who are insecure about their identity therefore
focus on their appearance, which they can change and have control over.
The first and easiest method that many girls choose of improving the
self is dieting. Girls assume that by losing weight they will become more
attractive, and thus create an adequate sense of self and acquire higher
self-esteem. But this is a vicious cycle that is doomed from the beginning.
Girls see the diet as the answer to all of their problems, and begin to
rapidly lose weight, either by fasting, exercising excessively, or purging.
According to Fairburn, "Self-deficits may intensify appearance-related
concerns; perceived deficits in one's attractiveness in turn may be a potent
source of anxiety, hence contributing further to self-dysfunction"
(Fairbum 1993). According to Schupak-Neuberg, food and fasting become the
only methods of self-regulation, both emotional and physical, for the adolescent
(1993). Any deviafion from the diet then, even for a moment, is seen as
a failure, thus perpetuating an even lower sense of self-esteem, and even
more severe restrictions. The adolescents dissatisfaction with their physical
appearance increases, elevating their concerns about eating habits, and
ultimately leading to greater levels of global dissafisfaction with the
self (Button 1997). Therefore, the diet that is meant to provide confidence
and security becomes part of the problem itself
Self-esteem is certainly not a static characteristic. Rather, it is
extremely dynamic, even changing from day to day during adolescence. Many
factors can influence selfesteem, either in positive ways or negative ways,
and can therefore have an affect on adolescent girls' eating behavior.
Researchers have discovered that some factors that typically place the
self-esteem of adolescents at risk are puberty, life transitions, and stress.
Adjusfing to the biological changes that are involved in puberty is a huge emotional strain, especially for an adolescent girl that lacks self-esteem. While physical maturation for boys brings increased muscle tone, height, a deepened voice, and other desirable changes, puberty for girls often brings with it a dreaded and feared weight gain. Although the weight gain is natural and normal, girls see the extra pounds as ugly and disgusting. Girls bodies begin to acquire curves and a feminine shape that is different from today's standard of beauty: the Kate Moss stick figure. As their bodies grow, girls begin to see themselves as fat, and their increased dissatisfaction with their physical appearance can serve to damage or wipe out self-esteem. Button has found, through questionnaires and interviews of schoolgirls in England, that as early as age I I- 12, girls begin to be self-conscious about their body shape and size. Up to 43% were classified as having low self-esteem and were taking measures to improve their appearance. In a follow-up study, the researchers discovered that as puberty progresses, these same girls were at a much greater risk to exhibit symptoms of disordered eating by the time they were 16 years old (Button 1997).
During puberty, girls begin to develop a more feminine shape that
is drastically different from todays standard of beauty, the Kate
Moss stick Figure.
Adolescence brings with it many transitions that disrupt the stability of a young girl's life. For instance, the transition from elementary school to junior high or high school can be nerve-wracking. Studies have shown that during this period of time, girls often experience a decrease in academic performance, increased self-consciousness and lowered self-esteem (Fairbum 1993). Typically, this stage is mastered and girls adjust to their new envirornments without too much emotional strain. But in some cases, in order to fit in with the older teenagers and new peer groups, girls seek to change their physical appearance. The pressure to be thin and beautiful, like the models and stars, leads many girls to believe that if they look a certain way, everything will work out, they will be popular, and they will have lots of friends. Therefore, to these girls, success in their new environment depends solely upon their physical appearance. The girls are convinced that when they reach their physical goals like that of a goal weight, all of their problems will be solved, easing the pain and strain of the transition they are experiencing. But this is false hope, and by subscribing to such 'all or none' thinkimg, any minor defect in the physical appearance (such as an extra five pounds) becomes a global problem for all of the self.
During transitional periods such as the one from elementary school to junior high, adolescent girls often experience not only a decline in academic performance, but also increased self-consciousness and lowered self-esteem.
Even the most minor daily events, such as getting dressed in the morning,
can be stressful for an adolescent girl. Stress is often thought to be
one of the antecedents to eating disorders because it intensifies the preoccupation
with the body, which usually leads to lowered self-esteem (Rosen 1993).
However, stress is also a typical result of the psychological turmoil involved
with eating disorders. So, stress is both a cause and an effect of eating
disorders. Again, there is a cycle at work. Stressful events, such as a
test or a fight with a friend, lead to increased self-awareness and negative
feelings about the self, and thus low self-esteem. The solution to the
low self-esteem is, for many girls, to control eating and therefore improve
their physical appearance in order to feel better about themselves. Then,
the symptoms of disordered eating (such as tiredness, hunger, emotional
strain, struggles with control) become stressful in themselves, perpetuating
a bidirectional relationship between low self-esteem due to stress and
Stress is both a cause and an effect of eating disorders
Many different studies have been done on the relationship between low
self-esteem and eating disorders; all have concluded, through various measures,
that there is a strong relationship between the two. Often the result of
an inadequate sense of self, disturbances in puberty, stress, or life transitions,
low self-esteem serves to manifest itself in areas such as disordered eating.
Girls who are insecure see improvements in their physical appearance as
the answer to their problems. Thus, they diet and have unrealistic expectations
for the outcome, leading to further disappointment and more restrictions
on their behavior. Although there is substantial research on this issue,
all of the studies are about cause and effect. There seemed to be little
or no information regarding how eating disorders caused by low self-esteem
can be treated or even prevented. This direction, towards solutions rather
than mere analysis of the problem, is where future research should be headed.
Bastiani, Andrea M., Radhika Rao, Theodore Weltzin, and Walter H. Kaye. "Perfectionism in anorexia nervosa". International Journal of Eating Disorders. Vol. 17, (2), 147-152. 1995.
Button, Eric J., Philippa Loai4 Jo Davies, and Edmund Sonuga-Barke. "Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15-16- A questionnaire and interview study". International Journal of Eating Disorders. Vol. 21, (1), 39-47. 1997.
Fairbum, Christopher G., and G. Terrence Wilson. Binge EatingThe Guilford Press; New York, 1993.
Hewitt, Paul L., Gordon L. Flett and Evelyn Ediger. "Perfectionism traits and perfectionist self-presentation in eating disorder attitudes, characteristics, and symptoms". International Journal of Eating Disorders, Vol. 18, (4), 317-326. March, 1995.
Rosen, James C., Bruce E. Compas, and Barbara Tracy. "The relation among stress, psychological symptoms, and eating disorder symptoms: A prospective analysis". International Journal of Fating Disorders. Vol. 14, (2), 153-162. 1993.
Schupak-Neuberg, Erika, and Carol J. Nemeroff. "Disturbances in identity and selfregulation in bulimia nervosa: Implications for a metaphorical perspective of "Body as Self"'. International Journal of Eating Disorders. Vol. 13, (4), 335-347. 1993.
Silverstone, P.H. "Is chronic low self-esteem the cause of eating disorders?". Medical Hypotheses. Vol. 39, 311-315. 1992.
Steinhausen, Hans-Christoph, and Margarete Voltrath. "The self-image
of adolescent patients with eating disorders". International Journal
of Eating Disorders.. Vol. 13, (2), 221-227. 1993.
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