Reconceptualizing causative factors and intervention strategies in the eating disorders: a shift from body image to self-concept impairments.

In this report, we argue that impairments in self-concept development function as a cognitive vulnerability that contributes to the formation of the eating disorders (ED) of anorexia nervosa (AN) and bulimia nervosa (BN). More specifically we argue that impairments in development of the total collection of identities that comprise the self-concept contribute to body image disturbances which in turn, motivate the eating and body-weight attitudes and behaviors that characterize the disorders. First, we review current understandings of the role of body image disturbances in the ED and discuss limitations of this approach. Then we review theories from psychoanalytic and feminist traditions that suggest that identity disturbances are a key factor in the etiology of the ED. Next, results of studies that examine identity disturbances in the ED are reviewed. Results of a study of women with AN and BN using the schema model of the self-concept as the theoretical framework showed that women with few positive and many negative self-cognitions are particularly vulnerable to cultural messages about body weight and form weight-related cognitions about the self that contribute to disordered eating attitudes and behaviors. Finally, the implications of these findings for primary and secondary level prevention of ED are addressed. Copyright 2003 Elsevier Inc. All rights reserved.