A new University of Western Sydney study has given a fresh insight into how teenage girls with anorexia nervosa really feel about themselves, paving the way for more effective treatments for the potentially fatal eating disorder.
Anorexia nervosa is a chronic illness that involves a morbid fear of fat and gaining weight. Sufferers have a distorted image of what their body looks like, and either refuse or are unable to maintain a healthy body weight.
It is the third most common illness among adolescent girls (after asthma and obesity), and only around 50 per cent of those diagnosed with the condition are expected to fully recover.
My Trinh Ha, a PhD student with the SELF Research Centre at UWS, and co-authors Professor Herb Marsh and Associate Professor Christine Halse have for the first time used a multi-dimensional psychological assessment, instead of the standard one-dimensional assessment, to determine which aspects of anorexia sufferers' self-concept are worst-affected by the condition.
The 65 teenage girls who took part in the study rated how they felt about their physical abilities; their physical appearance; their relations with the opposite sex, other girls and their parents; their emotional stability; and their academic skills and abilities. The results were compared to an existing database sample of 'normal' adolescent girls.
"Low self-esteem is seen as one of the major risk factors of anorexia nervosa, and most hospitals or clinics use a general self-concept scale when they assess the condition," Trinh says.
"But this study proves that, for teenage girls, those traditional tests aren't specific enough, and that anorexia nervosa is a far more complex condition than many people realise.
"Using this kind of multi-dimensional psychological scale gives us a far more accurate look at exactly which aspects of their self-concept or self-esteem are affected by the eating disorder, and which areas we should be targeting in treatment."
While questions about physical ability and physical appearance resulted in the expected low scores, Trinh says some of the findings came as a surprise.
"Relationships with other girls and parents seem to be points of contention with anorexic girls, with their scores far below the normal range. This might be the result of social comparison processes or competition between girls, and increasing conflict between girls and their parents as they enter adolescence," she says.
"Despite this, anorexic girls seem to demonstrate relatively normal relationships with the opposite sex - their self-concept for social relationships seems more influenced by other girls than the boys around them during their teenage years."
She says the study also found no real differences in the academic self-concept of anorexic girls compared to normal girls, and that as school self-concept scores increased, the scores related to the symptoms of their eating order decreased.
"These girls remain confident about their school work and their academic abilities. This is a surprise because many anorexic girls tend to miss a lot of school because of illness," Trinh says.
"They feel comfortable and confident in the school environment, and that might provide new options in the treatment of the condition. The findings will allow clinicians to develop tailored treatment responses that work on the specific areas of low self-concept."
Trinh says the findings, which were presented recently at a major international self-concept conference in Berlin, also open the door to future research into adolescent anorexia.
"These results highlight areas of concern in the self-concept of anorexic girls. More studies are needed to investigate the links between the findings and the eating disorder," she says.
"Anorexia can last for decades, and sufferers can often have relapses. The disorder also has serious health consequences, including potentially life-threatening changes in blood pressure, heart function and bone and spine degeneration.
"Understanding how anorexia nervosa patients really feel about themselves and others is the first step to developing a tailored, and more effective, treatment."
The research has been funded through the Australian Research Council, Centre for Digestive Diseases and the Children's Hospital Education Research Institute.