نقش تصویر ذهنی از جسم در پیشگیری از اختلالات تغذیه ای

This article reviews theory and research pertaining to prevention of negative body image and eating disorders. Research derived from the social cognitive model (SCM) and non-specific vulnerability-stressor (NSVS) model indicates that sustained prevention effects for attitudes and behaviors are possible, but not easy to achieve or explain. These limitations are considered in the context of promising research derived from a third model, critical social perspectives (CSP). We conclude that (1) research on practice should aim beyond the examination of efficacy in order to clarify the active ingredients contributing to prevention; and (2) research informed by each of the divergent perspectives can be used to enrich theory and practice in the field of eating disorders prevention.

Negative body image is an important component of a variety of prevalent health problems in females such as depression, obesity, and the spectrum of disordered eating (Cash & Pruzinsky, 2002). This spectrum encompasses varying combinations and degrees of binge-eating and unhealthy forms of weight management such as restrictive dieting and self-induced vomiting. At the extreme end of the spectrum are the well-known syndromes of anorexia nervosa, bulimia nervosa, and binge-eating disorder. Not only are the problems along this continuum widespread and serious, they are very difficult to treat effectively. Consequently, prevention of negative body image is a very desirable goal. Negative body image refers not only to body dissatisfaction but also to excessive cognitive and behavioral investment in one’s physical appearance in defining one’s sense of self (Cash, 2002a and Cash, 2002b). This article reviews theory and research pertaining to three prominent models of prevention and then offers specific recommendations for application of a critical social perspective in promoting positive body image in females. There is increasing concern about negative body image in boys and men (Pope, Phillips, & Olivardia, 2000), but this article concentrates on females because the link in boys between body image and disordered eating or unhealthy muscle-building strategies is not at all clear.

Prevention research to date has aimed at answering one question: Does prevention of disordered eating work, comparing intervention to no intervention? We are starting to come up with somewhat promising answers to this question. Targeted (secondary) prevention programs such as Cash’s CBT and the Student Bodies CAPP for college students can indeed improve body image, reduce drive for thinness, and affect eating attitudes and behaviors. Universal-selective (primary) prevention programs in the form of classroom curricula or activities for Girl Scouts can certainly affect more than knowledge. Many programs have produced changes in attitudinal and motivational variables. This is particularly true in (1) programs for children ages 6–11; (2) programs for youth ages 12–14 that include significant aspects of the critical perspectives model; and (3) the Student Bodies CAPP for college students. Further, several universal-selective programs have demonstrated longer term (6–12 months) prevention effects in the eating attitudes and behaviors of youth ages 8–18. That said, the limited size of universal-selective and targeted prevention effects (Stice & Shaw, 2003) and the frequent occurrence of the program participation effect both indicate the need for more powerful prevention programs. One important aspect of state-of-the-art prevention work in the area of substance abuse is missing from all but a few eating disorders prevention studies (e.g., Neumark-Sztainer et al., 2000 and Piran, 1999a—namely, a focus on changing multidimensional aspects of environment, such as school policies, teacher behavior, and mass media in the community (e.g., Pentz et al., 1989). A more systemic approach is also needed in order to design prevention programs that integrate universal, selective, and targeted approaches. To date, research on universal-selective and targeted prevention has two other glaring shortcomings. First, there is a dearth of controlled studies that measure the impact of the program on eating pathology over a long follow-up period. Second, the outcome evaluation research currently available provides little information about the “active ingredients” of prevention. We know precious little about the essential program components that induce attitudinal and behavioral change, let alone the mediating variables in the process of change. This information is very important to enhancing the effectiveness of prevention. Successful programs to date have used varied approaches to prevention, including one systemic program for middle school students that attempted to prevent obesity and ended up inadvertently preventing purging and use of diet pills in girls who were initially not dieting (Austin, Field, & Gortmaker, 2002). In order to clarify the “active ingredients” of prevention, outcome studies should be designed with comparison groups that differ in their exposure to specific hypothesized active components of a program (see Cash & Hrabosky, in press and Stice et al., 2002, for a few examples in the area of targeted prevention). Barring that, and considering the preliminary stage of this research, even exploratory qualitative inquiries with program participants about what they found most helpful may prove useful. Similar to the field of psychotherapy, it is also possible that the different approaches to prevention described in this paper share “nonspecific” factors that contribute to prevention. Based on research concerning the prevention of substance abuse, and based on the critical social perspectives model for the understanding of body image, likely candidates are the voicing of a critical look at the culture and the development of healthy norms and values within the group (Botvin, 2000). Research on practice should aim beyond the examination of efficacy in order to clarify the active ingredients contributing to prevention. We believe that research informed by each of the divergent perspectives described in this paper can be used to enrich theory and practice in the field of eating disorders prevention.