Anorexia nervosa in a woman totally blind since the age of two

Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.

Implicações da Cegueira Congênita na Imagem Corporal: Uma Revisão Integrativa

RESUMO Este estudo objetiva investigar, por meio de uma revisão integrativa, as principais implicações da cegueira congênita na imagem corporal. Um processo de buscas de artigos, sem limite de data de publicação, com os descritores “congenital blindness” e “congenitally blind”, nas bases SCOPUS, PsycINFO, Web of Science e PubMed, foi utilizado. Dentre as 3.612 publicações identificadas, 20 foram analisadas. Discutiu-se as implicações da cegueira em cinco áreas distintas: transtorno alimentar, representação do self, insatisfação corporal, experiência corporal e representação neural de autoconceito. Concluiu-se ser fundamental valorizar um complexo conjunto de fatores psicossociais no desenvolvimento da pessoa com cegueira congênita, que poderia impactar de modo positivo ou negativo a formação da imagem corporal.

Eating Attitudes of Women Living With a Vision Impairment

Internalization of cultural standards of attractiveness and subscription to gender-based discourses are significant predictors of disordered eating attitudes in fully sighted women. Yet, whether these variables predict the disordered eating attitudes of women who are legally blind is underexplored. In the current study, we examined how internalization of White European cultural standards of attractiveness and subscription to gender-based discourses (body surveillance and self-silencing) and body shame predicted the disordered eating attitudes of 80, primarily White, heterosexual, Australian women who are legally blind. Participants completed an online survey comprising existing validated measures of all variables. A path analysis was performed using the Hayes PROCESS approach. As predicted, in women living with vision impairment, body surveillance, self-silencing, and shame fully mediated the relation between internalization of cultural standards of attractiveness and disordered eating attitudes. Results showed that in much the same way as sighted women, women living with vision impairment are susceptible to internalizing harmful messages related to socio-cultural standards of attractiveness. We provide further support for including subscription to gender-based discourses in research on women’s body-image disturbances. Data will be available for other researchers from the author via email. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Development and validation of the self-acceptance scale for persons with early blindness: the SAS-EB

Investigations of self-acceptance are critical to understanding the development and maintenance of psychological health. However, valid and reliable instruments for measuring self-acceptance in persons with early blindness have yet to be developed. The current research describes three studies designed to develop and validate the Self-acceptance Scale for Persons with Early Blindness (SAS-EB). In Study 1, we developed the initial item pool. Thirty-three items were generated, based on data from specialized literature and from 2 focus groups. Items were organized in a three-factor structure, theoretically predicted for SAS-EB - (1) body acceptance, (2) self-protection from social stigmas, and (3) feeling and believing in one's capacities. In Study 2, information obtained from a panel of 9 experts and 22 persons with early blindness representing the target population was used to refine the initial item pool, generating a new pool of 27 items. In Study 3, 318 persons with early blindness (141 women and 177 men), between 18 and 60 years of age (M = 37.74 years, SD = 12.37) answered the new pool of 27 items. After the elimination of 9 items using confirmatory factor analysis, we confirmed the theoretical three-factor structure of the SAS-EB. Study 3 also provided support for the scale's internal consistency and construct validity. Finally, the psychometric properties of the SAS-EB, its utility, and its limitations are discussed along with considerations for future research.

Body image among eating disorder patients with disabilities: a review of published case studies

While individual cases of eating disorder (ED) patients with disabilities have been reported, there has been little synthesis of their experiences of body image and thin idealization. This study reviews 19 published clinical reports of ED patients with sensory, mobility-related, or intellectual disabilities and evaluates the extent to which their experiences align with or challenge current conceptions of body image in ED. ED patients with visual impairment reported a profound disturbance of body image, perceived intersubjectively and through tactile sensations. Reducing dependence in mobility was an important motivation to control body size for ED patients with mobility-related disabilities. ED as a way of coping with and compensating for the psychosocial consequences of disability was a recurrent theme for patients across a range of disabilities. These experiential accounts of ED patients with disabilities broaden current understandings of body image to include touch and kinaesthetic awareness, intersubjective dynamics, and perceptions of normalcy.

Initial evidence of the reliability and validity of a three-dimensional body rating scale for the congenitally blind

Research on body dissatisfaction has grown significantly. However, valid and reliable instruments for measuring body dissatisfaction in the congenitally blind have yet to be developed. In three studies, we report on development, test-retest reliability, and concurrent and content validity of the Three-dimensional Body Rating Scale (3BRS) for the congenitally blind. In Study 1, 58 people with congenital blindness (28 women, 30 men; M age = 36.7, SD = 13.1) numerically ordered models of the 3BRS and models of the Two-dimensional Body Rating Scale (2BRS), from very thin to the very fat. In Study 2, the construct validity and reliability of the 38RS was assessed. The same participants from Study 1 chose the 3BRS model that represented their ideal body and the 3BRS model that represented their actual body. Two weeks later, a re-test was done. In Study 3, 16 experts judged the content validity of the 3BRS. The psychometric properties of the 3BRS, its utility, and its limitations are discussed along with considerations for future research.

Sociocultural factors in the development of bulimia nervosa in a blind woman: a case report

BACKGROUND

Although several cases of eating disorders in visually impaired women have been reported, there has been little research on the development of body image and disordered eating in the blind. Overall, it is argued that blind women are protected from developing body dissatisfaction because of having had little or no exposure to thin-ideal images, and that if they do develop an eating disorder, this would be linked to other risk factors. In the one reported case of bulimia nervosa in a blind woman, body image concerns were even absent.

METHOD

We report a single case of bulimia nervosa in a 28-year-old congenitally blind woman whose presentation was typical, including body dissatisfaction and drive for thinness.

DISCUSSION

The present case underscores the need to also consider an etiological role of perceived sociocultural pressure and thin-ideal internalization in promoting body dissatisfaction and eating disorders in visually impaired women.

Blindness and bulimia nervosa: a description of a case report and its treatment

OBJECTIVE

Blindness has rarely been described in the eating disorder (ED) literature. In case reports in which this condition has been reported before an ED, it was concluded that visual body image was not essential for the development of the ED. This is the first report in which bulimia nervosa (BN) and its treatment in a blind woman were described.

METHOD

We report a single diagnosed and treated case of BN in a blind, 47-year-old Spanish woman. This case presented as its main characteristics the late onset of the ED, restrictive dieting, binging, and consequent purging behavior characterized by vomiting and great difficulties of coping with stress. From the beginning, the woman's body image was not essential. The treatment consisted of 21 individual outpatient sessions, which followed a non-symptom-oriented cognitive-behavioral approach, in which problem solving and stress management strategies were employed.

RESULTS

Before, after the treatment, and at the 6-month and 1-year follow-up, the clinical evolution of the patient was assessed.

CONCLUSION

Although a few descriptions of single case reports on blindness in individuals with anorexia nervosa (AN) have already been reported in the literature, to the authors' knowledge, this is the first reported case in which this condition and its treatment have specifically been reported in an individual with BN.

Laparophobia: a cognitive perspective on appetite control in anorexia nervosa

Decades of research have demonstrated that anorexia nervosa (AN) may be associated with aberrant cognition, yet, its role in maintaining stringent dieting has received relatively little attention from mainstream researchers of eating disorders. The purpose of the present article is to highlight cognitive ('top-down') factors that are considered responsible for anticipatory anxiety of stoutness and frank fat-phobia (laparophobia). A cognitive model proposed departs from the formulation suggesting that phobia of over-eating is superimposed on avoidant tendencies ('environmental autonomy syndrome'), whereas excessive exercising becomes a natural coping strategy with laparophobia, an instrument of reward. AN ideation involves complex neuronal circuitries and multiple neurochemical components that may conceivably represent a mirror image of those underlying obesity. The emphasis on phobia and aberrant membrane excitability akin to channelopathies behoves the clinicians to be aware of potential uses of drugs acting at the gamma-aminobutyric acid and the N-methyl-D-aspartate/AMPA [2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl) propionic acid] receptors sites as the adjuncts to conventional agents in managing AN.

Body size, parental appraisal, and self-esteem in blind children

This study of self-esteem, body size, and parental views in 9-11-year-old blind children found positive views about self-presentation with no sex or weight differences. Lower self-esteem emerged in children who thought they were judged by parents as too thin but being fat, being appraised as fat, or believing they are thought of as fat by parents, showed no effect on self-esteem. Their responses to questions about the causes, characteristics, and psychosocial functioning of obesity suggest an innate desire and possible need for a more robust stature, a bigger presence, and a feeling of weight which appeared to supercede any acquired negative attitudes to fatness.

Anorexia nervosa and depression in a woman blind since the age of nine months

A woman aged 58 who has been blind since the age of nine months presented with major depression and a 40 year history of an eating disorder characterized by a restriction of food intake and body disparagement. The case is additional evidence that a specifically visual body image is not essential for the development of anorexia nervosa and supports the view that the concept of body image is unnecessary and unproductive in eating disorders. Greater emphasis should be placed on attitudes and feelings toward the body, and the possibility of an eating disorder should be considered in cases of older women with an atypical presentation.

The effects of loss of taste and smell in a case of anorexia nervosa and bulimia nervosa

A woman with a mixed eating disorder is reported. Her disorder did not remit after a head injury which caused her to lose her sense of taste and smell.

Blindness and anorexia nervosa

Two cases of anorexia nervosa in blind patients are reported. They demonstrate that blind children experience many developmental problems which are thought to be important in the etiology of anorexia nervosa. Similarly, blind children are unusually susceptible to misperceive their body size and weight. The apparent absence of a strong association between congenital blindness and anorexia nervosa challenges the presumed aetiological link between disturbed body image and identity diffusion, and anorexia nervosa.

Anorexia nervosa in Hong Kong. Why not more in Chinese?

Anorexia nervosa is a geographically distinct psychiatric disorder; it is rapidly increasing in incidence in Western countries, while being virtually unreported in China, or in the Chinese community of Hong Kong. This is surprising when the Chinese preoccupation with food and their reported readiness to somatise dysphoria are considered. Three Chinese anorectics born and living in Hong Kong and exhibiting mostly typical clinical features are reported. The rarity of the disorder in the East could be related to protective biological and socio-cultural factors specific to the Chinese, and while it may become more common, anorexia nervosa is unlikely to reach Western proportions.

Anorexia nervosa in a woman totally blind since birth

A 19-year-old woman, blind since birth, lost 26 kg over a 7-month period. This was achieved by restriction of food intake, excessive exercise, laxative abuse, and self-induced vomiting. Although the visual experience is often believed to be an integral component of body-shape perception and the overvaluation of thinness in contemporary society, it does not preclude the development of anorexia nervosa.