Maintaining Factors for Fating' Disorders

Schmidt and Treasure (2006) have described four primary maintaining factors for EDs: the need to avoid negative emotion, perfectionistic and rigid temperamental traits, the responses of people in the individual's relational and cultural network, and pro-ED beliefs. The power of these factors is often quite different for male than for female clients.

Perfectionism and rule-bound thinking are risk factors for EDs among both men and women but may be less prominent among men (Elgin & Pritchard, 2006). Men also display less harm avoidance (Fernandez-Aranda et al., 2004). In addition, experience and articulation of emotional arousal and distress are influenced by both biology and cultural norms that inhibit emotional expression; men have less practice with and facility in the articulation of inner psychological experiences. Brain organization and emotional patterns reinforced by gender norms may insulate men from internalizing responses in the face of negative emotional experiences. The responses of family members to a boy or man with an ED can differ substantially from responses to female family members. According to conventional wisdom, boys and men do not get EDs, so they are less likely to be provided with validation and support. Finally, boys' and mens perceptions of the benefits of their EDs will often be quite different than the benefits perceived by girls and women. Although some of the benefits, such as a sense of discipline, control, strength, and uniqueness, are similar, men do not generally see themselves as enhanced by thinness. The goal is to defend against the fear of weight gain rather than to attain a particular level of thinness. Thinness for males is less socially desirable than it is for females. This critical difference may influence the male patients experience of treatment and recovery. Men and boys are often less ambivalent than women and girls about weight restoration (Bunnell, 2010), and their EDs are typically more ego dystonic (Olivardia, Pope, Borowiecki, & Cohane, 2004)

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