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Section 3
Early Eating Disorder Onset

CEU Question 3 | CEU Test | Table of Contents | Eating Disorders CEU Courses
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On the last track, we discussed three social implications related to anorexia nervosa. These three social implications included:  economic demographics; the diet fad; and conflicting media images.

On this track, we will examine three aspects of early development in clients diagnosed with anorexia nervosa. These three aspects of early development in anorexic clients include:  prematurely matured; identity development; and parental messages.

3 Aspects of Early Development

Aspect #1 - Prematurely Mature
The first aspect of early development in anorexic clients is a client who prematurely matured. As you are aware, certain family situations as well as biological tendencies can interfere with the development of basic trust and the consistent flow of nurturing and structuring behavior. Without the support of certain family members, many children will learn how to become independent on their own. 

They do not trust their authority figures to place boundaries on them or trust them to keep them from harm. Many times, this prematurely matured child deals in black and white viewpoints, resulting in perfectionism. Because these children are so ambitious and thus successful in their endeavors, parents see nothing wrong in their behavior. In fact, a perfectionist child may be seen as a gift. Obviously, this perfectionist child is at a high risk for anorexia.

Courtney, age 14 and weighing a frightening 52 pounds, lost her mother at the age of 7. Since then, she has had to raise two younger siblings and take care of an alcoholic father. Forced into this situation, Courtney was also forced to give up her childhood. After so much responsibility had been placed on her shoulders, Courtney left no room for failure.

She stated, "If I let my family down or I make a mistake, the whole thing will fall apart. I am the screw keeping everything together! If I am not home to make dinner, no one will eat. If my dad is left by himself, he starts drinking and can’t watch my brothers!" This unattainable ideal Courtney, as set out for herself, translated into an eating disorder. The same perfection she demanded in her housework she also demands in herself. 

Think of your Courtney. Was he or she a prematurely matured child?

Aspect #2 - Identity Development
The second aspect of early development in anorexic clients is identity development. As the prematurely matured client reaches puberty, he or she may feel that he or she must turn away from his or her family to seek some sort of an identity. The client who has never successfully developed a healthy dependence in the early years of development has nowhere to go for emotional support or to fulfill the need to develop a sense of identity.

Instead, these clients turn to mass culture and its messages. As examined before, this can include mixed messages of image and fashions that can be dangerous to a client’s self-image. Unable to reach parents for refuge, these clients are left to their own devices when choosing particular routes to identity and security. 

Delia, age 12, emulated movie stars and models and weighed-in at about 67 pounds. Like Courtney discussed earlier in this track, Delia had had no mother growing up. As a result, Delia had no positive female role model. Instead, she looked to magazines and movie stars to provide an example of womanhood. As you might have guessed, Delia saw in these women unspeakable beauty and tiny waists. Delia stated, "I kind of wish these women were my mother. They could cook for me and then we would do each other’s nails and go running together." 

Delia had placed these skinny figures up on pedestals and used them as an expectation for her own development of womanhood.  Think of your Delia.  Is his or her anorexia a result of a lack of a model of adulthood?

Aspect #3 - Parental Messages
In addition to the prematurely matured client and identity development, the third aspect of early development in anorexic clients is parental messages. I have found, like you, that families are constantly communicating "identity messages" to each other. Although children may receive these messages from siblings, they more often receive identity messages with the most impact from parents. 

Sometimes, these messages are spoken and other times the message must be inferred which can result in miscommunication.  For example, if a child is never told that he or she is pretty or smart, he or she will always believe that they are ugly or unintelligent. Mistakenly, parents believe that children will just assume they have positive attributes without verbal confirmation.

Jenna, age 19, could easily bring up negative attributes about herself.  She stated, "If I had to make a list of the top three things wrong with me, it would be that my hips are too wide, my nose is crooked, and I could use an undershirt instead of a bra!" When Jenna had left one of our sessions, I asked her mother, Tricia, to come into my office. 

I asked Tricia if she thought Jenna was a pretty girl.  Tricia stated, "Of course she’s pretty! Why, she’s beautiful!" I then asked Tricia if she ever told Jenna she was pretty, to which she replied, "No, I never wanted her to get a swollen head."  I told Tricia, "Jenna will never believe she is pretty until you support that concept yourself. Without that sort of confirmation, she has no other reason not to believe she is ugly. Children and teens are rarely, if ever, spoiled by compliments that are sincere. They need all the support they can get, whether it’s about their appearance, intelligence, character or personality." 

Think of your Jenna. Could his or her parents be sending the wrong identity message?

Technique:  Positive Recollections Letter
To help clients like Jenna whose parents rarely sent her a clear positive message, I ask that Jenna's parents write her a "Positive Recollections Letter."  I asked Tricia to remember all of Jenna’s positive attributes that she had when she was just a child and to give this letter to Jenna. 

The next week, Tricia showed me the letter for review.  It included the following passage:
You were always so bright and friendly. Everyone at work would tell me what a beautiful and vivacious daughter I had and I knew they were right. I remember when you could count to ten at the age of two!  I was so proud of you, and I’m still proud of everything you’ve accomplished.

By saying what she never said in the past, Tricia can begin to heal the identity messages she had never before conveyed.  Think of your Tricia.  Would a "Positive Recollections Letter" benefit his or her anorexic son or daughter?

On this track, we discussed three aspects of early development in clients diagnosed with anorexia nervosa.  These three aspects of early development in anorexic clients included:  prematurely matured; identity development; and parental messages.

On the next track, we will examine four similarities between anorexic and phobic clients.  These four similarities between anorexia and phobia include:  mental distortions; stress; destructive emotions; and rituals.

Fostering a Healthy Body Image: Prevention and Intervention
with Adolescent Eating Disorders

- Giles, M. and Hass, M. Fostering a Healthy Body Image: Prevention and Intervention with Adolescent Eating Disorders. Chapman Unidersity.

Peer-Reviewed Journal Article References:
Christian, C., Perko, V. L., Vanzhula, I. A., Tregarthen, J. P., Forbush, K. T., & Levinson, C. A. (2020). Eating disorder core symptoms and symptom pathways across developmental stages: A network analysis. Journal of Abnormal Psychology, 129(2), 177–190.

Criscuolo, M., Marchetto, C., Chianello, I., Cereser, L., Castiglioni, M. C., Salvo, P., Vicari, S., & Zanna, V. (2020). Family functioning, coparenting, and parents’ ability to manage conflict in adolescent anorexia nervosa subtypes. Families, Systems, & Health, 38(2), 151–161.

Groth, T., & Hilsenroth, M. (2019). Psychotherapy techniques related to therapist alliance among adolescents with eating disorders: The utility of integration. Journal of Psychotherapy Integration. Advance online publication.

Naumann, E., Tuschen-Caffier, B., Voderholzer, U., Caffier, D., & Svaldi, J. (2015). Rumination but not distraction increases eating-related symptoms in anorexia and bulimia nervosa. Journal of Abnormal Psychology, 124(2), 412–420.

Pearson, C. M., Combs, J. L., Zapolski, T. C. B., & Smith, G. T. (2012). A longitudinal transactional risk model for early eating disorder onset. Journal of Abnormal Psychology, 121(3), 707–718. 

Stice, E., Telch, C. L., & Rizvi, S. L. (2000). "Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder": Correction to Stice et al. (2000). Psychological Assessment, 12(3), 252.

Online Continuing Education QUESTION 3
What are three aspects of early development in clients diagnosed with anorexia nervosa? To select and enter your answer go to CEU Test.

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