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1 Assignment 21: Developmental Theory Paper Perla H. Reaidy Department of Educational Psychology, The University of Texas at Austin EDP 383C: Developmental Psychopathology Dr. J. Mark Eddy November 17, 2023

2 Anorexia Nervosa and Psychosocial Theory The development of eating disorders, particularly anorexia nervosa (AN), has long been a subject of interest and concern within the field of psychology. Prevailing theories have often focused on the biopsychosocial impact of pubertal changes, asserting that the physical transformations during adolescence contribute significantly to the risk of developing these disorders. Additionally, research has seen the influence of sociocultural factors, such as social media and societal body “standards” impact eating habits among adolescents. These young individuals may exhibit a range of pathological behaviors surrounding food intake and body image due to these influences. Understanding the etiological factors that contribute to the development of AN is crucial for effective prevention and intervention strategies. The comprehension of the multifaceted etiology of AN, as demonstrated by the biopsychosocial model, may provide insight into how pubertal status, body dissatisfaction, and dieting behaviors may lead to the eventual onset of anorexia. This paper delves into the biopsychosocial theory of puberty and its role in the development of AN, exploring how the interplay between biological, psychological, and sociocultural influences during adolescence contributes to the manifestation of this eating disorder. By examining the existing literature and gaps in research, this exploration seeks to provide a nuanced understanding of how biological and psychosocial factors may converge to shape the trajectory toward anorexia nervosa. Biopsychosocial Theory The Effect of Puberty The conceptual foundation of the biopsychosocial theory suggests that the significant alterations in pubertal development, particularly in girls, play a pivotal role in shaping body satisfaction, self-esteem, and mood. Puberty is a critical period in human development

3 characterized by the activation of ovarian hormones, particularly estrogen, which plays a substantial role in sex-differentiated behaviors. The hormonal changes during puberty have been identified as significant factors contributing to the emergence of various psychopathologies, including eating disorders (Lewis & Rudolph, 2014). Anorexia nervosa development, in particular, has been closely examined in the context of puberty, as research suggests that AN typically manifests during adolescence, with a median age at onset ranging from 12.2 to 12.6 years among teenage participants (Youngstrom et al., 2020). Additionally, early maturation is proposed as a heightened risk factor, as these individuals undergo physical changes ahead of their peers, potentially leading to increased body dissatisfaction. The theory also highlights the gender-specific nature of this risk and claims that pubertal changes in girls, such as increased adiposity, may move them further from “ideal” beauty standards, thereby heightening vulnerability (Youngstrom et al., 2020). In contrast, boys, experiencing increased muscle mass during puberty, are suggested to move closer to societal beauty standards. This could be deemed harmful to males who may experience anorexia, possibly leading to the thought that anorexia and other eating disorders may only, or most likely, impact girls, rather than boys, completely excluding individuals who do not identify with either gender. Biological Aspect of the Theory The psychosocial model hypothesizes a chain of interconnected processes, in which the temporal sequence of events is crucial. According to this theory, the sequence unfolds as follows: the onset of puberty brings about increased body fat or muscle mass, triggering body dissatisfaction due to deviations from societal beauty norms (Prinstein et al., 2021). This dissatisfaction, in turn, propels individuals, particularly girls, towards engaging in dieting

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4 behaviors as a coping mechanism. While studies have supported associations between pubertal status, body dissatisfaction, and dieting, a critical gap exists in understanding the definitive link between these processes and the manifestation of full-blown eating disorders. The biopsychosocial theory of puberty and the development of anorexia nervosa proposes that the interplay of biological, psychological, and social factors during this critical developmental period contributes to the increased genetic risk for the disorder in girls. The activation of ovarian hormones, particularly estrogen, is central to this theory. Estrogen, a hormone that primarily regulates gene transcription and protein synthesis within the central nervous system, is believed to influence the production of neurotransmitters and neurotrophins associated with eating behaviors (Lewis & Rudolph, 2014). During puberty, hormonal changes in girls lead to a significant increase in genetic influences on disordered eating symptoms, as evidenced by twin studies. The heritability of disordered eating symptoms was virtually nonexistent in preadolescent females but rose to around 50% during mid-puberty and beyond (Lewis & Rudolph, 2014). Notably, these genetic effects were specific to girls, as evidenced by comparisons with boys, who experience increases in testosterone rather than estrogen during puberty. The hormonal changes, particularly the rise in estrogen levels, are theorized to contribute to genetic risk by influencing the production of neurotransmitters such as serotonin and brain-derived neurotrophic factor (Lewis & Rudolph, 2014). Additionally, the oxytocinergic system is highlighted as potentially significant, suggesting a neural basis for altered emotional regulation, while an excessive stress response and an overactive sympathetic nervous system are identified, contributing to heightened feelings of vulnerability and threat (Munro et al, 2017). When these factors coincide, this could lead to a heightened risk of developing anorexia, specifically during puberty.

5 Psychosocial Aspect of the Theory The psychosocial theory of puberty hypothesizes that the onset of anorexia nervosa is intricately linked to the challenges and adjustments experienced during puberty. Puberty often brings about heightened self-awareness and social scrutiny. The desire for conformity to societal ideals of thinness, highlighted during this phase, may trigger body dissatisfaction and contribute to the development of maladaptive eating behaviors. This can be seen in individuals who undergo puberty at an earlier stage as compared to peers, engaging in disordered eating symptoms, including dieting, body dissatisfaction, and binge eating. Twin studies exploring pubertal timing revealed shared genetic risk factors contributing to early puberty and disordered eating symptoms, emphasizing the intricate interplay between biological and psychosocial elements (Lewis & Rudolph, 2014). Moreover, the theory suggests that the pubertal period is marked by an increased emphasis on appearance and social comparison, fostering an environment where individuals, particularly adolescents, may develop distorted body image perceptions and engage in extreme weight control strategies and factors such as self-esteem, perfectionism, and societal influences, including exposure to media promoting unrealistic body standards come into play (Prinstein et al., 2021). The transition from early to middle adolescence, as well as from middle to late adolescence, corresponds to critical periods where extreme weight control strategies surge in prevalence, signifying the impact of developmental and social changes on the manifestation of eating disorder pathology (Prinstein et al., 2021). The theory indicates that these individuals develop a profound fear of an unacceptable 'feared self,' marked by beliefs of inadequacy, greediness, and shame. This negative self-concept is maintained by misleading signals from the feelings processing systems, creating a cycle of

6 self-critical thoughts and beliefs. Anorexia has an ego-syntonic nature, wherein individuals find their disordered eating behaviors consistent with self-image, fostering denial and resistance to treatment (Youngstrom et al., 2020). To cope with the overwhelming vulnerability and perceived threat, individuals with anorexia adopt maladaptive physiological and psychological coping mechanisms. Starvation and over-activity are proposed as physiological regulation mechanisms that provide short-term relief by prioritizing the need to feel safe and acceptable in the immediate moment (Munro et al, 2017). Psychologically, maladaptive coping modes such as self-critical behavior, avoidance of social interactions, and rigid routines emerge to manage emotional distress (Munro et al, 2017). Maladaptive coping mechanisms lead to socially disruptive behaviors, fostering insecure interpersonal relationships and a lack of trust. The individual increasingly turns inward, forming a detrimental 'relationship' with their eating disorder. Social isolation ensues, and the adoption of anorexia as an identity further exacerbates the disconnection from healthy social interactions (Munro et al, 2017). The theory highlights the concept of unmet core needs, suggesting that maladaptive behaviors prioritize short-term safety over fulfilling fundamental psychological and physical needs. By integrating these factors, the theory provides a nuanced understanding of how AN develops. The excessive vulnerability, distorted self-beliefs, and maladaptive coping mechanisms create a self-reinforcing cycle that, in the short term, offers a sense of control and safety but, in the long term, leads to physical and psychological deterioration. The theory also highlights the importance of addressing the complex interplay of biological, psychological, and social factors in the treatment of anorexia, advocating for integrated therapeutic approaches that consider the multifaceted nature of this severe disorder.

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7 Conclusion The exploration of the biopsychosocial theory of puberty and its role in the development of anorexia nervosa in adolescence provides a comprehensive understanding of the multifaceted etiology of this severe eating disorder. This paper has delved into the intricate interplay between biological, psychological, and sociocultural factors during adolescence, shedding light on the processes that may lead to the eventual onset of AN. The psychosocial aspect of the theory emphasizes the challenges and adjustments individuals face during puberty, marked by hormonal fluctuations and physical transformations. The desire for conformity to societal ideals of thinness, societal beauty standards, and the emphasis on appearance and social comparison contribute to body dissatisfaction and maladaptive eating behaviors. This is highly emphasized among girls, yet the theory does not delve into the effects on boys and non-binary adolescents. The theory should move to a more encompassing population, as their main focus was on puberty affecting the onset of anorexia in girls, as they are more pressured to fit the societal beauty standard of being thin. The biological aspect of the theory adds a crucial dimension, highlighting the role of hormonal changes, especially estrogen, in influencing genetic predispositions and neural mechanisms associated with eating behaviors. The heritability estimates from twin studies underscore the significant genetic component, with hormonal changes during puberty amplifying genetic influences on disordered eating symptoms. The oxytocinergic system and stress response are identified as potential contributors, emphasizing the neural basis for altered emotional regulation during the development of AN. This comprehensive biopsychosocial theory provides valuable insights into the intricate web of variables contributing to the vulnerability of anorexia nervosa. The understanding of the

8 developmental factors during puberty, encompassing genetic, hormonal, and psychosocial aspects, is crucial for effective prevention and intervention strategies. As the paper navigates through the complexities of AN development, it highlights the importance of integrated therapeutic approaches that consider the holistic nature of this severe disorder. The interplay of biological, psychological, and social factors must be addressed to formulate more effective treatments and interventions, moving beyond reductionist approaches to embrace a more integrative understanding of anorexia nervosa.

9 Figure 1: Bio-psycho-social maintenance model of anorexia nervosa.

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10 References Lewis, M., & Rudolph, K. D. (Eds.) (2014). Handbook of developmental psychopathology (3rd ed.). Springer. Munro, C., Randell, L., & Lawrie, S. M. (2017). An Integrative Bio‐Psycho‐Social Theory of Anorexia Nervosa. Clinical Psychology and Psychotherapy , 24 (1), 1–21. https://doi.org/10.1002/cpp.2047 Prinstein, M. J., Youngstrom, E. A., Mash, E. J., & Barkley, R. A. (Ed.) (2021). Treatment of disorders in childhood and adolescence , 4th Edition. The Guilford Press. Youngstrom, E. A., Prinstein, M. J., Mash, E. J., & Barkley, R. A. (Eds.) (2020). Assessment of disorders in childhood and adolescence , 5th Edition. The Guilford Press.

assign 21 reaidy Nov 17

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