Posts Tagged ‘Psychology of Religion’

The Struggle Continues

February 1, 2009

Today I bring you the fourth and final part of my chapter on the relationship between religious belief and anorexia nervosa. For the earlier parts just click on the links, Part I, Part II, and Part III.

Many women who do recover from anorexia nervosa consider their faith and spirituality as major factors.  Several articles and books have been written containing firsthand accounts of spiritual influences on recovery.   For individuals who present with pre-existing religious beliefs, spiritual interventions are often recommended in the treatment of many mental disorders, including anorexia.   In some cases, it is necessary to address the content of an individual’s beliefs, particularly if they affect or reinforce the disorder.  For example, in a case series presented by Morgan, Marsden, and Lacey, three patients with anorexia nervosa discussed questions about their belief systems as part of their treatment.   Although the outcome in each case was different, the process of spiritual examination proved useful in continuing recovery.   It is difficult to draw broad conclusions from this study because of the small sample size.  It is useful, however, to augment the other studies discussed in this chapter.
A religious worldview can play a part in the treatment of eating disorders.  In their volume, Spiritual Approaches in the Treatment of Women with Eating Disorders,  Richards, Harrison, and Barret present a theistic model for treatment similar to Richards and Bergin’s  approach to psychotherapy.  The purpose of their approach is to foster a spiritual identity in the patient, and “affirm their…worth as creations of God.”  They particularly focus on the heart as a metaphor for spiritual healing and as a means of trusting themselves.   They recognize spiritual growth as a gradual process and not an immediate or quick fix treatment. Richards, Harrison, and Barret argue that a theistic model allows for change and healing of the whole person.   The theistic approach is intended to be flexible in order to address the specific needs of the patient. Much like other clinicians, Richards, Harrison, and Barret advocate a multi-dimensional approach that recognizes the importance of spirituality.  Their argument is supported by the evidence cited in this paper, and reinforces the necessity of a well-formed theology of the body.
In addition to the clinical approaches listed above, there have also been a number of books and articles written on the nature of anorexia and the role of spirituality in recovery.   Michelle Mary Lelwica argues that anorexia is particularly the result of spiritual emptiness.  This position is similar to Richards, Harrison, and Barret in that it recognizes a role for spirituality in anorexia. However, whereas Richards, Harrison, and Barret advocate using a theistic mode of treatment to heal the whole person, Lelwica focuses on the lack of an internal spiritual life as the primary cause of anorexia.  Her theory is related to feminist and sociological explanations for eating disorders.
There are three criticisms of this research. To start there is some difficulty in quantifying religious belief. There does not appear to be one definitive method for measuring religious belief, and as such, the various studies have used different tests to measure religiosity. The studies cited acknowledge the complexity of the task and all use more than one measure.
In 1999, Lelwica wrote that there was a lack of research into the relationship of religion and eating disorders.   This chapter has referenced some of the many studies that exist.  Bell’s book, which addressed the connection, was published in 1985. Although more research needs to be conducted, there is a large body of existing studies.
The final criticism concerns the size and composition of the sample groups used in the studies. For example, Macias et al. included a sample of only 44 nuns, while the larger studies did not exceed 500 participants. Since females are more likely to develop anorexia nervosa the majority of the cited studies focus on female populations. These sample sizes are quite acceptable for psychology studies. Despite these last two criticisms, the four broad conclusions asserted in this chapter are supported by the available research: 1) religious belief influences body image both positively and negatively 2) the “thin ideal” is not the only cultural cause of anorexia nervosa 3) being religious does not guarantee protection from anorexia nervosa 4) a deep spiritual life has the potential to assist in preventing the development of anorexia nervosa.
The final two conclusions above seem to contradict one another. This is not the case because while members of religious communities do develop eating disorders, there is evidence that suggests that explicit religious teachings about the body can influence body image both positively and negatively. This influences the incidence rates of anorexia nervosa.  The general findings, presented by the various studies, supported each other.
There are currently many clinicians incorporating spirituality into treatments for anorexia.  More research is needed to conclusively say what role spirituality plays at each stage of the illness, but there is little doubt that a relationship exists.  By understanding the role of religion in the prevention and development of anorexia, religious leaders can develop strategies for combating poor body image and disordered eating within their communities.

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Awake and Cold At Night

January 29, 2009

I am on a roll with these thesis related posts so I’m going to continue today. Tomorrow is  a link day because of the podcast.  The following selection contains a number of summarized studies with accompanying discussion. If you’d like more details about any of the studies please contact me at the alderfork@gmail.com. Click if you missed Part I and/or Part II.

There are similarities between fasting and anorexia nervosa, such as restricted food intake and attempts to control the body. It appears that strict ascetic codes and other religious restrictions on food, paired with an emphasis on the human body as inherently sinful or evil, could lead to more cases of anorexia among the devoutly religious.  This does not mean that ascetics share the other psychological symptoms of anorexics, such as anxiety disorders, perfectionism, or obsessive compulsive disorder, but rather that their attitude towards eating and the body may be similar. Harold Koenig points out in his brief survey of the literature, that there is no empirical support that belonging to an ascetic community increases the likelihood of anorexia.  In fact, research into ascetic and other religious communities has shown virtually no difference between eating attitudes and body image within the group or the controls. For example, in 2003 Macias, Leal and Vaz conducted a study of 44 women living in open communities in Spain.  The results of the study indicate that the distribution of body satisfaction and dissatisfaction was similar to a control group of university-aged women.  The study showed that 50% of the nuns either perceived that they had a high weight or were fat.    In addition these women exhibited disordered eating behaviour that was also comparable to the control.  Although religious women may not be at an increased risk of developing eating disorders, such as anorexia, as outlined above, a growing body of research indicates that religious and spiritual beliefs do not guarantee protection against the development of this illness. A significant level of dissatisfaction with body shape and size, while often assumed by the public at large to be a problem of middle-class teenage girls, has been documented in communities of nuns in Spain,  an Old Order Amish community,  and among extrinsically religious university students.   It has also been noted in case studies that some anorectics who have a strong Christian affiliation will justify their condition as a type of “spiritual starvation.”
Macias, Leal and Vaz speculate that the source of the nuns’ discomfort could come from the pressure to maintain regimented eating practices or a specified state of holiness.   The daily pressures of ascetic life might create an environment conducive to anorexia.  The challenge of controlling ordinary human desires and urges could lead some to control body weight and food intake.  Despite the author’s initial hypothesis that a cloistered community would insulate the nuns from negative body image and disordered eating, the research showed that the conditions necessary for anorexia to develop exist in an ascetic community.  Other studies of cloistered religious communities have had similar results.   In their study of an Amish community, Platte, Zelten and Stunkard, found that while the young people exhibited a healthy view of their own bodies, the elders often did not.  The authors proposed that this resulted from the focus on physical labour in the farming community.   When members of the community became unable to contribute to the work of the farm, satisfaction with their bodies decreased. It is important to note that the community was mostly shielded from secular media, and as such, these cases of negative body image are unlikely to be connected to the “thin ideal”.
In neither the Spanish study of cloistered nuns, nor the Amish study, did the authors identify a single case of anorexia in those communities.  They did, however, measure the incidence of disordered eating, which in both cases was the same as the general public.  While the sample sizes of these studies are too small to draw general conclusions, they do present the possibility that even strongly religious communities need to address body image because their current theology is not creating a significant difference from the general public. In addition, because both groups were isolated from the influence of the “thin ideal”, these studies demonstrate that this is not the only factor influencing women towards poor body image and disordered eating.
Correlation between high religiosity and positive body image has been found in several studies that have attempted to quantify this relationship.  Based on their own prior research, Mahoney et al. hypothesized that “greater sanctification of the body” would lead to a “great investment in maintaining one’s physical well-being.”   Body sanctification refers to an individual’s view of her body that recognizes its value in religious terms.  It should also be noted that studies by Levin  and Strawbridge et al.  have shown that general religiousness leads to health-protective behaviour.   The Mahoney study was comprehensive, examining a wide range of experimental factors including manifestation of God in the body, sacred qualities of the body, general health-protective practices, as well as physical fitness and asceticism.  The sample included 289 university students 77.5% of which were female.   The study participants were predominately Christian (74%), which makes the results particularly useful for this thesis.   The results of the study supported the authors’ initial hypothesis.  Of particular note they found that higher levels of body sanctification were associated with greater satisfaction with the body.   Thus those participants who attributed religious meaning to their bodies were more likely to have a positive body image.
A study by Boyatzis, Kline and Backof specifically investigated written religious affirmations and their effect on body image.   The authors attempted to establish causality through pre and posttests dealing with body image and the viewing of “thin ideal” photos.    The women were divided into three groups: a control group that read random statements not related to body image, a “spiritual group” that read positive secular body image statements, and a “religious group” that read similar theistic statements.   The religious group showed the greatest improvement in body image on the post test, while the control group saw a decline in their body image.  This study supports Mahoney’s findings about religious beliefs and body satisfaction.
The results of the studies cited above demonstrate a connection between the content of religious belief and body satisfaction. The authors’ conclusions focused on the positive effects of religious belief on body image.  Research into small religious sects has shown that religious beliefs can also have a negative influence on body image.   Although new religious groups are typically small, their experience represents the extreme of devout religious belief, much as anorexia represents an extreme of either the “thin ideal” or fasting.  The Church Universal and Triumphant provides an example of use of restrictive diet in a new religious movement and the consequences of this practice.  The leader of the group, Elizabeth Clare Prophet, dictated all aspects of eating among her followers and framed her directives in a religious context.    She dictated the content and quantity of her follower’s food intake and to avoid “the appetites of the physical body and the appetites of death.”   Members of the community ate primarily rice and vegetables while Prophet had a fridge stocked with “exotic food.”   This last point implies that the food restrictions were related to control rather than a theology of eating practice.  The Church Universal and Triumphant is an unusual example because it does not represent the normal practice of the majority of religious believers. Anorexia, too, is an extreme behaviour. This particular case, along with others cited by Paolini and Paolini,   shows the negative effects of religious teachings on body image. As noted, some care must be taken in considering followers of new religious movements that are, by their nature, part of smaller tight-knit communities. These results, however, support the findings of other studies cited in this thesis, that religious beliefs can influence body image.
In addition to the studies of people or groups who have developed positive or negative relationships with food or their bodies due to religious affiliation and belief, research has been conducted to discover if certain types of people are more susceptible to poor body image or eating disorders due to their religious beliefs.  A notable study by Smith, Richards, and Maglio examined religious orientation and eating attitude in both clinical and sub-clinical anorexic populations.   They defined four types of religiousness based on the commonly used religious orientation scale (ROS).  Intrinsic religiousness is associated with orthodox practice and personal belief, while an extrinsically religious person often belongs to a community for social purposes.  On the two extremes are the pro-religious and nontraditional groups.  The former scored high on both intrinsic and extrinsic scales, and the latter scored low on both and could be considered non-religious.  In simplest terms the difference lies in the extent to which religiousness is an internal or external commitment on the part of the person.  Although the study sample was small, no correlation was found between the intrinsically religious group and anorexia.  As predicted eating disorder symptoms were most prevalent in the pro-religious and nontraditional groups.  Therefore, those for whom religion was an internal commitment were least likely to develop eating disorders.  From this study it can be concluded that there is no connection between religiousness and eating disorder pathology since the most traditionally religious group and the intrinsically religious group did not demonstrate a connection with anorexia nervosa. Based on the research cited above, the promotion of a healthy body image, in religious terms, has positive effects on people. This conclusion will return in Chapter 3.

Should We Forget Ourselves

January 25, 2009

As I was walking through a life one morning the sun was out, the air was warm, but oh I was cold, and though I must’ve looked a half a person, to tell the truth in my own version, it was only then that I felt whole.

Ted Leo and the Pharmacists

Me and Mia

Long time readers of The Alder Fork Blog will know that I don’t always write about music, art, film, and theatre because my mind likes to wander.  I wrote my Master’s thesis on the connections between Anorexia Nervosa and religious belief, with an aim towards exploring pastoral options for treatment and prevention.  Many people asked to read it, and some have.  The second and third chapters of my thesis (when I was discussing the pastoral elements) are not as well written as I would have liked. I kind of tired of the process and allowed myself to make some leaps in the writing. In the end it was good enough to pass, but could have been better. The first chapter, however, is one of my proudest pieces of writing.  In that chapter I reviewed the relevant literature and drew some conclusions of my own about the existing and potential roles for religious interventions, and poastoral education.  Over the next little while I will be featuring that chapter in its entirety,obviously broken up into smaller parts. It begins today with the Part I. Please don’t hesitate to contact me about it, I love to discuss my research. If you or someone you know might have an eating disorder please seek professional help.

Anorexia Nervosa and the “Thin Ideal”
The purpose of this chapter is to present research on the relationship between anorexia and religion.  It will focus on defining anorexia nervosa, and on research about religion and anorexia.  Although there are few empirical studies related to this topic, some hypotheses can be drawn from the available literature.   Notably, the evidence suggests that a religious worldview can influence an individual’s relationship with his/her body. For example, fasting and the valuing of spirit above body have been correlated with poor body image.  As well, spiritual interventions have been useful in the treatment of anorexia nervosa.
Anorexia nervosa is an eating disorder characterized by an individual’s efforts to control her body weight through eating, exercise and other means.   The Diagnostic and Statistical Manual of Eating Disorders IV presents the following four criteria for a diagnosis of anorexia:

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.
(A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Based on the clinical criteria for a diagnosis of anorexia nervosa, it is apparent that the condition is a mix of psychological (B, C) and physiological (A, D) concerns.
There are two subtypes of anorexia, “restricting type,” and “binge eating/purging type,” which reflect two different methods of controlling food intake and body size.  Restricting anorexia could be considered the extreme dieting model where the individual limits her food intake to the point that she starves herself.  Binge eating/purging type is similar to bulimia nervosa in that the individual eats large quantities of food and then attempts to expunge them through vomiting, or laxative abuse. When a person stops eating, her body first reacts by storing as much energy as possible, entering what is called starvation mode.  Without enough food energy the body shuts down organs and wastes away. For anorexics this extreme weight loss is considered a mark of achievement of body control. If untreated, anorexia can lead to death.
Although persons of any age are at risk for developing anorexia nervosa, this eating disorder is most common among young females between 12 and 25 years of age.  It is estimated that 1 out of every 8 adolescent girls displays eating disorder symptoms (including bulimia and eating disorders not otherwise specified).  The prevalence of anorexia, specifically, ranges between 0.5% and 3.7% in females, and 0.05% and 0.37% in males, with the number of new cases continuing to increase.   Up to 20% of all patients diagnosed with anorexia will eventually die from their condition.
Those who suffer from anorexia come from a wide range of socio-economic backgrounds.   Anorexia occurs most often in industrialized nations that have an abundance of available food.  Eating disorders are common in North America, Europe, Australia and New Zealand, and Japan, although research in other areas of the world is currently limited.
As this eating disorder affects a diverse population, the root causes of anorexia are complex.  There is evidence to suggest that certain psychological stresses, such as dysfunctional family life, a sense of helplessness, or even genetics have a role in many cases.   There are two prominent explanations for the proliferation of eating disorders in North America.  The first can be termed controlling the body, and relates specifically to personality variables such as perfectionism, low self esteem, fear of maturation, and familial/cultural variables that leave an individual feeling out of control or dominated (primarily known as the psychodynamic explanation).  The second explanation deals with cultural and peer pressure to achieve and maintain a certain appearance, a misunderstanding of the concepts of body type and development, and fear of obesity.
A negative consequence of the social stigma associated with anorexia is the proliferation of “pro-Ana” (short for anorexia) movements among teenage girls that promote anorexia as a lifestyle choice and ideal.   This situation is perhaps the most extreme outcome of a society that values physical beauty, in the form of thinness, as a high ideal.   The glamourization of anorexia as a celebrity disease and a path to acceptance can be seen in the content of these sites.   This type of online community provides anonymous support for girls that they cannot find in the “real world,”  partly due to the fact that anorexics do not speak openly about their condition, as well as the stigma associated with the illness.  The community fostered on these sites is dangerous for those at risk of developing an eating disorder.   This issue will be addressed as part of the discussion of the theology of the body because it relates to the community of those at risk.