The Prevention of Eating Disorders: Empirical, Methodological, and Conceptual Considerations

Franko, D. L. and Orosan‐Weine, P.  (1998),  The Prevention of Eating Disorders: Empirical, Methodological, and Conceptual Considerations. Clinical Psychology: Science and Practice, 5: 459-477.  doi:10.1111/j.1468-2850.1998.tb00167.x

Recent studies suggest that the prevalence of eating disorders in young women is increasing and that the number of preadolescent girts who engage in weight loss efforts is on the rise. Greater efforts directed toward the prevention of eating disorders are needed to reverse this trend. Although prevention research is still in its formative years, much is known about risk factors in the development of eating disorders. Several prevention studies have been empirically tested; however, only minimal results have been obtained. This review examines and critically evaluates risk factor research and prevention programs. Suggestions for future research include clearer definitions and standardization of terms related to the level of risk and type of prevention; an empirical foundation to support the use of proposed risk factors and intervention methods; the exclusion of participants with any diagnosable eating disorder from preventive interventions; more sustained, stepwise research analyzing the component parts of prevention; and further research into innovative, creative, and rigorous programs that have sufficiently large sample sizes and lengthy follow-up periods in which to detect effects. 

Critical Experiences in the Development of Body Image

James C. Rosen, Pam Orosan-Weine & Tricia Tang(1997)Critical experiences in the development of body image, Eating Disorders, 5:3,191 204,   DOI: 10.1080/10640269708249225

Body image development is influenced by experiences and feedback related to physical appearance. Some experiences, such as teasing, have been reported in previous research. This study was designed to generate a larger set of body image influences by using nominations directly from a diverse sample of clinical and non-clinical subjects. In Study 1, content analyses of open-ended interviews of normal subjects, ages 13 to 64, and clinical subjects seeking help for eating or body image problems, led to an objective inventory consisting of 128 critical experiences,” divided into 19 categories. In Study 2 with college undergraduates, critical experiences predicted body image and psychological symptoms. Some of the experiences that were frequent or predictive of adjustment have received little attention in the literature. Women reported more negative body image experiences, but the sexes did not differ in the type or importance of the experiences. Identifying critical body image experiences can be useful in therapy for body image problems. 

The Swan: The Fantasy of Transformation versus the Reality of Growth

Orosan-Weine, Pamela. “The Swan: The Fantasy of Transformation versus the Reality of Growth.” Configurations, vol. 15 no. 1, 2007, pp. 17-32. Project MUSE, doi:10.1353/con.0.0024

 The reality television show The Swan is a show partly about beauty and partly about change. The creator of the show, Nely Galán, envisioned portraying a journey of “self-transformation” in which each participant, with the aid of specialists, challenges herself to overcome her “stuckness” and to put into action the dream of “how wonderful life could be if only she could look, feel, and perform her best.” 1 During each segment of the show, two women, who have applied to be participants, engage in a personal makeover program including very extensive plastic surgery, cosmetic dental work, personal coaching, weekly psychotherapy, fitness training, and nutritional counseling. The women live on location, away from their homes and families, for three months. Throughout the program they have no access to mirrors or reflective surfaces. At the end of three months, they are rigorously groomed and exposed to themselves, the experts, and the audience in a climactic moment called “the reveal.” The premise of the show pits the two women against each other, with one woman in each segment moving forward to participate in a beauty pageant against all the other segment winners for that season. One contestant, who best embodies the transformative potential of The Swan, is ultimately crowned America’s Swan.

I apply a psychoanalytic perspective on the construction, participation, and viewer process of this show. Using the children’s story of “The Ugly Duckling” and the ideas of agency and action, narcissism and exhibitionism, work and change, and grief and resolution, I try to identify the ingredients that support an effort of self-change and the factors that limit it. I explore how becoming an active agent for oneself is facilitated by the responsive presence of an “other.”

Gender Differences in College Students’ Definitions and Perceptions of Intimacy

Pamela Orosan & Karen Maitland Schilling (1992) Gender Differences in College Students’ Definitions and Perceptions of Intimacy, Women & Therapy, 12:1-2, 201-212, DOI: 10.1300/J015V12N01_16

 In a study of gender differences in the definition, perception, and experience of intimacy, 30 white undergraduate students were interviewed regarding their intimate interactions and intimate relationships. The framework used to analyze participants’ descriptions was informed by participants’ own definitions of intimacy, and incorporated both affective and instrumental aspects of intimate interactions. This constitutes a break with much previous research on intimacy which defines intimacy narrowly, in terms of verbal expressiveness. Significant gender differences appeared in the ways in which women and men spoke about their intimate relationships. Implications for therapy are discussed, with the admonition that the broader cultural context in which intimate interactions are shaped should underlie any recommendations for intervention.

Cognitive-Behavioral Body Image Therapy for Body Dysmorphic Disorder

James Rosen, Jeff Reiter and Pam Orosan, Journal of Consulting and Clinical Psychology, 63, 263-269, 1995

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at post-treatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

Cognitive Behavior Therapy for Negative Body Image in Obese Women  in Special Series: Body Dissatisfaction, Binge Eating, And Dieting As Interlocking Issues In Eating Disorders Research

James Rosen, Pam Orosan(-Weine) and Jeff Reiter, Behavior Therapy, 26, 25-45, 1995

Negative body image is a major concern of overweight persons, yet current obesity treatment programs have not addressed this problem. In the present study, 51 obese women were randomly assigned to cognitive behavioral body image therapy (CBT) or no-treatment. Patients were treated in small groups for 8 two-hour sessions. Therapy included information to challenge negative stereotypes of obesity, modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. No assistance was provided to change eating or exercise behaviors. CBT subjects showed significantly improved body image. Psychological symptoms, self-esteem, overeating, and eating guilt also improved. Weight was unchanged for most subjects and unrelated to treatment outcome overall.

Gender differences in academic and social behavior of elementary school transfer students

Pamela G. Orosan, Andrew M. Weine, Leonard A. Jason, Joseph H. Johnson, October 1992, Psychology in the Schools 29(4):394-402

This study describes a tutoring program designed to help children in grades 3 through 5 who underwent an unscheduled school transfer. We examined gender differences in self‐concepts, academic performance, teacher evaluations, and peer ratings. Gender differences were found in several measures, although gender did not substantially interact with the intervention. As expected, female transfer students reported lower self‐concepts than males; teachers reported that boys were more popular; peers also rated boys as more aggressive and girls as more likable. Findings suggest that preventive interventions for transfer students need to account for effects of gender.