Paradigm clash in the field of eating disorders: a critical examination of the biopsychiatric model from a sociocultural perspective

Sociology Health & Illness

2018

Eating disorders (EDs) have often been discussed as a risk to reproductive health. But existing research is quantitative in nature, paying no attention to issues of patient experience. In discussing data from 24 semi-structured interviews, this article draws on sociological approaches to medical 'risk' and feminist approaches to EDs to explore how women with experience of an ED responded to fertility warnings within treatment contexts. In doing so, it is suggested that responses to fertility warnings offer unique insight into the potentially damaging limitations of biomedical approaches to eating problems and their focus on EDs as individual 'pathologies' (rather than culturally embedded expressions of gendered embodiment). At best warnings are seen as making problematic assumptions about the aspirations of female patients, which may curtail feelings of agency and choice. At worst, they may push women further into destructive bodily and eating practices, and silence the distress that may be articulated by an ED.

Section: Methodsmentioning

confidence: 99%

Responses to warnings about the impact of eating disorders on fertility: a qualitative study

Sociology Health & Illness

2018

“…Although the relationship between the biomedical and feminist perspectives has been characterised as a 'paradigm clash' (Levine and Smolak, 2014), most of the participants did not see them as entirely antithetical. As one explained: 'I don't see the conflict about bringing gender into the treatment … I feel like we are just adding an important layer to how we … can explain our problems' (P2).…”

Section: Imagining Feminist Approaches In Treatment 26mentioning

confidence: 99%

‘Blindness to the obvious’? Treatment experiences and feminist approaches to eating disorders

2016

Feminism & Psychology

Eating disorders are currently often approached as biopsychosocial problems. But the social or cultural aspects of the equation are frequently marginalised in treatment – relegated to mere contributory or facilitating factors. In contrast, feminist and socio-cultural approaches are primarily concerned with the relationship between eating disorders and the social/cultural construction of gender. Yet, although such approaches emerged directly from the work of feminist therapists, the feminist scholarship has increasingly observed, critiqued and challenged the biomedical model from a scholarly distance. As such, this article draws upon data from 15 semi-structured interviews with women in the UK context who have experience of anorexia and/or bulimia in order to explore a series of interlocking themes concerning the relationship between gender identity and treatment. In engaging the women in debate about the feminist approaches (something that has been absent from previous feminist work), the article examines how gender featured in women’s understandings of their problem, and the ways in which it was – or was not – addressed in treatment. The article also explores the women’s evaluations of the feminist discourse, and their discussions of how it might be implemented within therapeutic and clinical contexts.

“…In its extensive review of treatments for Anorexia Nervosa (AN), for example, the NICE guidelines offer no suggestion as to how to address the ‘psychosocial’ elements they outline (simply suggesting that they pertain to ‘weight and shape’), and such perspectives are not even mentioned in the discussion of Bulimia Nervosa (BN), Binge Eating Disorder (BED) or Other Specified Feeding and Eating Disorder (OSFED). This is indicative of the fact that although sociocultural perspectives on EDs represent a visible area of study and have a significant empirical foundation (Culbert et al, 2015; Levine and Smolak, 2014), very little has been written about them in the context of ED treatment. The reasons for this are complex and multifaceted, and can only be understood in relation to the sociocultural approaches themselves and their intellectual, epistemological and clinical status.…”

Section: Introductionmentioning

confidence: 99%

“…The interest in exploring sociocultural perspectives on EDs has emerged from the overlapping fields of sociocultural and feminist approaches to eating and body distress. To take sociocultural models first, these have primarily focused on the idealisation of thinness in women (Levine and Smolak, 2014) and the stigmatisation of body fat in Western cultures. In demonstrating that the idealisation of thinness in women and the prevalence of AN and BN increased during the last century (Culbert et al, 2015: 5), it is suggested that exposure to Western ideals of appearance generates body dissatisfaction and dieting behaviours which elevate the risk of ED development.…”

Section: Introductionmentioning

confidence: 99%

“…The reasons for changing treatment paradigms are multifaceted and complex. However, it may be the case that the decreased visibility of the feminist perspectives has been accelerated by a climate which now foregrounds the features of EDs that translate into conceptions of mental illness (Levine and Smolak, 2014), as well as the emphasis on ‘scientific’ and quantitative evidence in debates about evidence-based treatment (LaMarre, 2015).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The role of sociocultural perspectives in eating disorder treatment: A study of health professionals

2017

Health (London)

Eating disorders (EDs) are now often approached as biopsychosocial problems, and are widely recognised as multifactorial in origin. But it has been suggested -particularly by feminist scholars -that all is not equal within this biospsychosocial framework, with the 'social' aspects of the equation relegated to secondary or facilitating factors in treatment contexts. Drawing on data from 12 qualitative interviews with health professionals in a UK region, this article examines the extent to which socio-cultural perspectives on eating disorders (EDs) are valued and explored in ED treatment, with a particular focus on questions of gender (and femininity).Given that girls/women are disproportionately affected by EDs, the article explores to what extent the relationship between EDs and cultural constructions of femininity is actively 2 addressed within treatment. The study revealed high levels of inconsistency in this regard, in so far as some health professionals thought that such issues should be central to treatment, whereas others had 'never really considered' them before. In addition, the study examines the potential limitations to the ways in which such socio-cultural issues are perceived and addressed. Not only was the onus often on the patient to flag the relevance of such issues (rather than these being anticipated and embedded within treatment), but socio-cultural perspectives on EDs were covered little in training, making it potentially difficult for health professionals to know when such concerns were being raised. Furthermore, in drawing on the interview data, the article explores why the often 'obvious' relationship between femininity and EDs may currently be marginalised in treatment, building on a feminist critique of what counts as 'evidence-based' treatment and why.