Jaine Strauss

Correlates of Psychosocial Well-Being Among Overweight Adolescents: The Role of the Family

An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n = 667 male participants, and n = 684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.

Menstrual Cycle Abnormalities and Subclinical Eating Disorders: A Preliminary Report

&NA; Menstrual dysfunction is a common concomitant of anorexia nervosa and bulimia. Initial investigations emphasized the role of weight loss and lean/fat ratio in amenorrhea. Subsequent studies suggest a more complex interaction between eating disorders and menstrual status. However, in past investigations, menstrual abnormalities have been confounded with low weight. We conducted two studies to ascertain the prevalence of menstrual abnormalities in a group of women with subclinical eating pathology versus an age‐, education‐, and weight‐matched group of normal controls. In Study I, 93.4% of the subclinical subjects reported a history of menstrual abnormality as compared to 11.7% of the normal controls. In Study II, 100% of the subclinical subjects, versus 15.0% of the controls, reported an abnormal menstrual history. These data suggest that menstrual dysfunction often occurs in women with abnormal eating attitudes but without weight loss or diagnosable eating pathology. Several hypotheses for this finding are proposed.

Developing the Body: A Smorgasbord of Research:

treatment of psychiatric illness. Psychiatric Illness in Women: Emerging Treatments and Research provides a comprehensive summary of the biological, psychological, social, and developmental findings that represent the empirical state of the art in understanding mental illness in women, primarily from a medical model. The book contains five sections (25 chapters) covering anxiety disorders, mood disorders, schizophrenia and related disorders, dementia and related illnesses, and a section on special topics including gender differences in substance use disorders, the neurobiology of eating disorders, and pharmacological management during pregnancy. Each section explores gender differences in prevalence rates, symptom profiles, course, and duration of illness, incorporating hormonal and reproductive issues for women across the lifespan. The editors stated they wished to stimulate the development of ongoing research on women’s mental health, and to help in the diagnosis and management of psychiatric illness in women. In meeting the first purpose, the book succeeds by exploring the current state of research and the many unanswered questions that continue to plague mental health practitioners in their work with women patients. For example, despite the overwhelming anecdotal evidence to support the significant incidence and sometimes tragic consequences of postpartum mental disorders, surprisingly scarce research exists into the prevention and treatment as well as the prevalence and associated risk factors of postpartum mental illness. The book emphasizes the need for increased recognition of pregnancy and the postpartum period as times of possible psychiatric vulnerability for women. Similarly, we need further research into balancing the risks of continued pharmacotherapy treatment during pregnancy with the risks of untreated maternal psychiatric disorder. In addressing its second purpose, to help in the diagnosis and management of psychiatric illness in women, the book will probably be most useful to physicians. The chapters offer specific information about pharmacotherapy treatments but provide less in terms of psychosocial approaches to women’s illness. Several chapters note the unique therapeutic needs of women in relation to socialization that may foster issues around self-esteem, assertiveness, attitudes toward mastery, and dependency. The chapters also note sex-specific triggers such as history of sexual abuse or rape, reproductive events, relation of mood to menstrual cycle, exogenous hormone therapy, and stressful life events, all of which are important in the assessment of a women’s psychiatric well-being. Some chapters also highlight the sex differences in symptoms which may be relevant to the therapy practitioner, for example, persons with obsessive compulsive disorder who obsessively wash tend to be women, while men are more likely to have checking rituals. Despite the book’s cursory coverage of psychotherapeutically relevant issues, the primary focus on the medical model seems to ignore a richer exploration of women’s experience that may be more important to the psychotherapy practitioner. The chapters offer very limited if any coverage of the cultural and political context of women’s lives in relation to the development, assessment, and treatment of mental illness and the labeling of women’s emotional pain and suffering. With few exceptions, the authors assume that all women are essentially the same, regardless of race, ethnicity, sexual orientation, or socioeconomic status. In its favor, the book as a whole demonstrates sensitivity to the changing biological realities of women across the lifespan. From the menstrual cycle, to childbirth, to menopause, the authors explore various disorders in relation to women’s reproductive health. For example, they consider an exploration of the effects of menopause on the intensity of symptoms in schizophrenia as well as such topics as the use of estrogen replacement as a treatment for Alzheimer’s disease and the emergence of premenstrual dysphoric disorder as a diagnostic category. Because of this, the book might also prove a useful resource for physicians in the gynecological specialty who may be the first to hear about or witness a woman’s psychiatric symptoms. Conspicuously absent from the book is the subject of sex differences in personality disorders. Given that certain personality disorders such as Borderline, Histrionic, and Dependent are most often associated with women, it would seem relevant to the issue of psychiatric disorders in women to explore sex differences in personality disorders. A summary of any promising data towards an understanding of the development, course, and treatment of these disorders would have been useful to mental health practitioners. Because of its medical bias, the primary utility of this book, with its heavy emphasis on psychopharmacology, brain structure and function, and the biological role of hormones in women’s mental health, would be as a reference for physicians and researchers. Despite the wealth of empirical information, the utility of this book for the psychotherapy practitioner seems limited. Because of its focus on biological and physiological systems and processes that detract from its readability, this book better suits the needs of the medical practitioner or researcher than clinician. As a clinician first and a researcher second, I would not purchase this book for my own collection, but I would want my university library to carry it. Although the book does offer some research findings on the utility of psychotherapy treatments with women, it offers little beyond what is already apparent to most therapists who work with women’s issues; specifically, that women’s mental health is broadly influenced by social realities, reproductive life events, and the demands of multiple roles. This book might be useful to those psychotherapy practitioners who work closely with physicians, because it provides fairly clear information regarding the unique needs of women receiving psychopharmacological treatment. Additionally, the information on differing symptom profiles for women with mental illness may be useful in deciding the course and focus of psychotherapy. Despite its limited usefulness for the therapy practitioner, Psychiatric Illness in Women provides a comprehensive look at the medical and biological issues in the current treatment of women’s mental illness. For this reason, it stands out as a valuable resource for those physicians and researchers whose focus is to effectively diagnose and treat women patients.

Contextualizing the “Student Body”: Is Exposure to Older Students Associated With Body Dissatisfaction in Female Early Adolescents?

Research on teens’ body dissatisfaction documents the role of proximal social influences (e.g., peers and family) and distal social influences (e.g., mass media) but largely ignores intermediate contextual factors such as school environment. Is there a link between individual body image and student body? We assessed drive for thinness, body dissatisfaction, thin-ideal internalization, and body objectification in an ethnically diverse sample of 1,536 female students educated in U.S. school districts varying in the degree to which younger students (fifth and sixth graders) are educated alongside older students (seventh and eighth graders). We studied three different grade groupings: junior high (Grades K–6 housed together/Grades 7–8 housed together), middle school (K–5/6–8), and extended middle school (K–4/5–8). As predicted, fifth and sixth graders attending schools with older students reported more negative body experiences than their age peers attending schools with younger students; similar effects were evident among seventh graders who had been educated with older peers during fifth and sixth grade. Our findings highlight the importance of considering contextual factors in understanding young women’s body image.

Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment, J. KEVIN THOMPSON and LINDA SMOLAK (Eds.)

treatment of psychiatric illness. Psychiatric Illness in Women: Emerging Treatments and Research provides a comprehensive summary of the biological, psychological, social, and developmental findings that represent the empirical state of the art in understanding mental illness in women, primarily from a medical model. The book contains five sections (25 chapters) covering anxiety disorders, mood disorders, schizophrenia and related disorders, dementia and related illnesses, and a section on special topics including gender differences in substance use disorders, the neurobiology of eating disorders, and pharmacological management during pregnancy. Each section explores gender differences in prevalence rates, symptom profiles, course, and duration of illness, incorporating hormonal and reproductive issues for women across the lifespan. The editors stated they wished to stimulate the development of ongoing research on women’s mental health, and to help in the diagnosis and management of psychiatric illness in women. In meeting the first purpose, the book succeeds by exploring the current state of research and the many unanswered questions that continue to plague mental health practitioners in their work with women patients. For example, despite the overwhelming anecdotal evidence to support the significant incidence and sometimes tragic consequences of postpartum mental disorders, surprisingly scarce research exists into the prevention and treatment as well as the prevalence and associated risk factors of postpartum mental illness. The book emphasizes the need for increased recognition of pregnancy and the postpartum period as times of possible psychiatric vulnerability for women. Similarly, we need further research into balancing the risks of continued pharmacotherapy treatment during pregnancy with the risks of untreated maternal psychiatric disorder. In addressing its second purpose, to help in the diagnosis and management of psychiatric illness in women, the book will probably be most useful to physicians. The chapters offer specific information about pharmacotherapy treatments but provide less in terms of psychosocial approaches to women’s illness. Several chapters note the unique therapeutic needs of women in relation to socialization that may foster issues around self-esteem, assertiveness, attitudes toward mastery, and dependency. The chapters also note sex-specific triggers such as history of sexual abuse or rape, reproductive events, relation of mood to menstrual cycle, exogenous hormone therapy, and stressful life events, all of which are important in the assessment of a women’s psychiatric well-being. Some chapters also highlight the sex differences in symptoms which may be relevant to the therapy practitioner, for example, persons with obsessive compulsive disorder who obsessively wash tend to be women, while men are more likely to have checking rituals. Despite the book’s cursory coverage of psychotherapeutically relevant issues, the primary focus on the medical model seems to ignore a richer exploration of women’s experience that may be more important to the psychotherapy practitioner. The chapters offer very limited if any coverage of the cultural and political context of women’s lives in relation to the development, assessment, and treatment of mental illness and the labeling of women’s emotional pain and suffering. With few exceptions, the authors assume that all women are essentially the same, regardless of race, ethnicity, sexual orientation, or socioeconomic status. In its favor, the book as a whole demonstrates sensitivity to the changing biological realities of women across the lifespan. From the menstrual cycle, to childbirth, to menopause, the authors explore various disorders in relation to women’s reproductive health. For example, they consider an exploration of the effects of menopause on the intensity of symptoms in schizophrenia as well as such topics as the use of estrogen replacement as a treatment for Alzheimer’s disease and the emergence of premenstrual dysphoric disorder as a diagnostic category. Because of this, the book might also prove a useful resource for physicians in the gynecological specialty who may be the first to hear about or witness a woman’s psychiatric symptoms. Conspicuously absent from the book is the subject of sex differences in personality disorders. Given that certain personality disorders such as Borderline, Histrionic, and Dependent are most often associated with women, it would seem relevant to the issue of psychiatric disorders in women to explore sex differences in personality disorders. A summary of any promising data towards an understanding of the development, course, and treatment of these disorders would have been useful to mental health practitioners. Because of its medical bias, the primary utility of this book, with its heavy emphasis on psychopharmacology, brain structure and function, and the biological role of hormones in women’s mental health, would be as a reference for physicians and researchers. Despite the wealth of empirical information, the utility of this book for the psychotherapy practitioner seems limited. Because of its focus on biological and physiological systems and processes that detract from its readability, this book better suits the needs of the medical practitioner or researcher than clinician. As a clinician first and a researcher second, I would not purchase this book for my own collection, but I would want my university library to carry it. Although the book does offer some research findings on the utility of psychotherapy treatments with women, it offers little beyond what is already apparent to most therapists who work with women’s issues; specifically, that women’s mental health is broadly influenced by social realities, reproductive life events, and the demands of multiple roles. This book might be useful to those psychotherapy practitioners who work closely with physicians, because it provides fairly clear information regarding the unique needs of women receiving psychopharmacological treatment. Additionally, the information on differing symptom profiles for women with mental illness may be useful in deciding the course and focus of psychotherapy. Despite its limited usefulness for the therapy practitioner, Psychiatric Illness in Women provides a comprehensive look at the medical and biological issues in the current treatment of women’s mental illness. For this reason, it stands out as a valuable resource for those physicians and researchers whose focus is to effectively diagnose and treat women patients.

Book Reviews: The Appeal of a Broader Body (of Knowledge)Body Image: Understanding Body Dissatisfaction in Men, Women, and Children, GroganSarah. New York: Routledge, 1999, 225 pp.,

During the past several decades, researchers and theorists from many diverse fields have produced an immense array of information on body image, especially as it is experienced by (young adult, white, heterosexual, affluent) women. In this book, Sarah Grogan seeks to review this vast literature while highlighting (sometimes through data gathered specifically for this book) the experience of men; she also seeks to identify how age, social class, ethnicity, and sexuality affect body image. Her preface indicates that this volume is geared toward students studying psychology, sociology, women’s studies, men’s studies, and media studies. Grogan delivers on her promise in several key ways. First, she summarizes a wealth of studies (with an emphasis on, and an even-handed approach to, research conducted in the US and UK). A student with minimal prior exposure to the field of body image research will get a solid introduction to the key concepts and current controversies. There are a few surprising omissions (e.g., body dysmorphic disorder; Joan Brumberg’s The Body Project, 1997), yet the overall scope of the volume is exceptional. Second, her book is organized into fairly autonomous chapters. While this can produce some redundancies and organizational problems across chapters, it allows instructors to assign only selected sections of the book. Students may also appreciate the bullet-point summaries that conclude each chapter. Additionally, Grogan often includes incisive critiques of past investigations; not only will students benefit from her astute analysis, they will also, I suspect, develop their own antennae for methodological and theoretical flaws in future studies they read. I can even imagine students feeling inspired to gather their own data as they witness Grogan’s efforts to fill gaps in the field. Finally, Grogan successfully conveys the tensions that pervade the field. Her descriptions of the contradictory feminist positions concerning plastic surgery and female body building are stimulating and provocative; it is easy to imagine dynamic class discussions sparked by these sections. Although we rarely hear her own theorizing (this book does not have a central, overarching thesis), Grogan does a splendid job of articulating the theories of others, especially Wolf (1991), Bordo (1993), Bartky (1990), and Davis (1995). The book, however, suffers from several shortcomings that limit its usefulness, especially for a more advanced audience. At the most minor level, there are just enough editorial gaffes (e.g., misspelled names, tables without legends, an oddly organized appendix) to irritate the obsessive reader. A significantly more troubling problem involves Grogan’s efforts to “broaden the body” of body image research. Her chapter on age, social class, ethnicity, and sexuality appears quite late in the volume; these important themes barely appear before page 117. Even within this chapter, there are problematic omissions. For instance, Grogan presents her own data from a focus group with eightyear-old girls, but she never identifies the positionality of these girls (e.g., their ethnicities, their social classes). Despite some exceptionally strong writing within this chapter (e.g., her synthesis of the research on body image and social class), Grogan’s message is muted by her failure to infuse these vital issues throughout her book. Some might even argue that the prevailing definition of “body image”—focusing primarily on dissatisfaction with hips, thighs, stomachs, and chests/pectorals—omits key concerns for certain populations of color (e.g., hair, skin tone). Another sticking point involves Grogan’s decision to include new data. As I note above, these studies can be inspiring. Ultimately, however, I found them more vexing than informative. The studies’ methodologies are not covered in sufficient detail to allow the reader to interpret the results. For example, Grogan includes a lengthy list of brief quotations from several interview studies without informing the reader about the context of these quotations. The critical attention that she applies to others’ work is largely absent from her analysis of her own data, and there are times when she appears to undermine her participants’ contributions (e.g., raising the specter of social desirability biases selectively, such as when participants describe themselves as content with their bodies). In general, I think the motives for including these new studies were sound, but limitations in how they were reported pose problems for the reader. For those of us who have been working in this field for some time, it is daunting to see the challenges that still lay ahead; despite the enormous strides associated with feminism, body dissatisfaction remains a Gordian knot for many men, women, and children. Grogan’s book concludes with a few ideas for how to help instill strong, positive body images, but she eschews poppsych nostrums. By crafting a book that helps students learn to think critically about a wide range of body image research and theory, perhaps Grogan is offering just the tools to help unravel this knot for future generations.