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Health psychology is a fairly recently born subfield of psychology compared to others, in fact it was only in 1977 that the American Psychological Association added a division devoted to health psychology. The reason for this being that it was the recent advances in research in both medicine and psychology which led to new perspectives on mental health, illness and how they are related (Matarazzo, 1980). ‘Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. It is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness.’ (American Psychological Association). 

Mainstream health psychology which is taught majorly in universities, sylabbuses and adopted by health psychologists in their work is traditionally dominated by positivist approaches, and mostly fails to employ critical perspectives in both education and practice. As a reaction to this, critical health psychology emerged which focused more on understanding health and illness by keeping in mind issues of power and reducing the marginilization of people in minority or vulerable groups (Lyons and Chamberlain, 2017). Keeping these differing premises in mind, this essay will now proceed to understand how anorexia nervosa can be seen differently, with reference to both mainstream health psychology and critical health psychology. 

Defining Anorexia Nervosa

According to the American Psychological Association, people with anorexia nervosa present with a  distorted body image which leads to seeing themselves as being overweight even though they are dangerously thin. This often results in the individuals’ developing unhealthy eating and exercising habits, such as refusing to eat and exercising compulsively in order to lose large amounts of weight which sometimes even includes starving themselves to death and leading to hospitalization  (American Psychological Association). Simply put, anorexia nervosa is ‘a syndrome in which the individual maintains a low weight as a result of a pre-occupation with body weight, construed either as a fear of fatness or pursuit of thinness.’ (BPS, eating disorders).

This essay will first start by understanding anorexia nervosa from a mainstream health psychology point a view by referring to articles, text books and general literature. Then, by applying a critical health psychology perspective, anorexia nervosa will be explored differently by adopting the main premises upon which critical health psychology is based on. Finally, differing treatment options and recommendations from both perspectives will be evaluated and discussed. 

Mainstream Health Psychology’s Perspective

Anorexia nervosa is classfied as an eating disorder in the list of pathologies contained in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The condition is associated with having a distorted body image and abnormal eating behaviours leading to dangerously low weight. Having an unknown etiology, several psychological studies about anorexia nervosa examine it from a very medical point of view. For example, a study by Burkert (2015) examined brain activity in patients with anorexia nervosa to find that participants exhibited specific personality traits which included low self-esteem, high emotionality and volume loss in certain areas of the brain such as the amygdala and the hippocampus which were related to succeptability to stress and coping deficiencies. Mainstream health psychology is known to adopt a more scientific and medical approach and this is clearly seem in the fact that most studies about anorexia nervosa and other eating disorders are quantitative in nature, and in fact mainstream health psychology has a tendency to isolate behaviour from its context in order to find patterns which can be generalised in order to  achieve better overall understanding and more successfull treatment outcomes (Meganck). 

Mainstream health psychology has also widely adopted the biopsychosocial model (Engel, 1977) as a general framework. This model proposes that health and illness arise from the interplay of biological, psychological and social factors (fox et al, direct quote better to find another source). By using this model, health psychologists attempt to create a better picture of the development of an eating disorder such as anorexia nervosa by weighing in factors such as society, genetic predispositions and co-morbidities. The development of eating disorders can be highly attributed to one’s cultural environment. In fact, in Western countries in which the incidence of anorexia nervosa has been on the increase in recent years, a relationhsip was found between the percieved pressure to be slim and body dissatisfaction (Watkins, 2011). However, as is common in mainstream health psychology, although the significance of societal factors is taken into consideration, the focus is shifted back to individualistic factors to understand the pathology. Burkert (2015) stated that although most women nowadays are continuously exposed to influences about body image, not all women develop anorexia nervosa, so therefore biological determinants must be in play in order to trigger the development of anorexia nervosa.

In an article by Frank (2016), the author states that there is no existing great biopsychosocial model for eating disorders, and in the attempt to create one, he presents a bio-psycho-social risk model for developing and maintaining eating disorders which centers around dopamine as a major factor (check further). Another aspect to consider is that of the onset of anorexia nervosa usually occurs during puberty in one’s teenage years. This could mean that gonadal hormones and stress related to family, school and peers is also a contributing factor (check Kaye et al., 2005).

In mainstream health psychology, when it comes to anorexia nerova, there is a great emphasis on how detrimental the effects of the problem behaviour are on the body, since it can cause grave harm such as ammanorea (check spelling), hospitilization and in some cases even death (check if Kaplan, 2005). Therefore, when dealing with patients suffering from anorexia nervosa, health psychologists focus on getting the body back to a functional state, and addressing the cognitive distortions which lead the individual to abstain from eating and other problem behaviours. Anorexia nervosa if often seen as being closely related to an obsessive compulsive disorder, as eating and exercise habits are very ritualistic and the person is ‘obsessed’ with their body image and weight (Taylor, 2012 health psychology book). Health psychology looks at anorexia nervosa as being an illness brought about by cognitive distortions. It is the distorted image of oneself that leads and maintains anorexia nervosa, or the obsession with becoming extremely thin or not having an ounce of fat (find reference). There is a major theme in mainstream health psychology in how anorexia nervosa occurs and is maintained by the individual’s cognitions, being that they need to be thin in order to be accepted or that they are fat when in fact they are severely underweight. Apart from this, links to impaired emotional functioning are also evident in anorexia nervosa patients which may lead them to feel depressed, anxious and neurotic, enabling even furhter the negative thoughts which fuel the belief that they are not good enough (Adenzato, Todisco and Ardito, 2012). Finally, the aspect of control comes into play.A study by Fairburn, Shafran and Cooper (1999) found that in individuals suffering from anorexia nervosa, the great need to control what they consume is of great importance to them as they may feel that they have no control over other aspects in their life such as how society views them. This presents a cognitive bheavioural theory of anorexia nervosa which is another commonly adopted theory in health psychology (fox et al.)

mind body relationship? health promotion, changing health habits, cbt

Critical Health Psychology’s Perspective 

When looking at anorexia nervosa from a mainstream health psychology perspective such as the biopsychosocial model, it is true that societal factors are taken into consideration, however what critical health psychologists point out is that although they do list factors such as societal pressures and media portrayals of body image, they still focus on treating the person’s cognition and perceptions of oneself without addressing or trying to change the external forces acting upon and influencing the individual. ‘From a critical health psychology perspective, a central aim is the development of understanding, not necessarily the attempt to predict, manage and control.” (Crossley, 2000, pg. 12). Mainstream health psychology differs from critical health psychology in this aspect. With regards to anorexia nervosa, critical health psychologists would argue that we need to gain a deep understanding as to why individuals are suffering from anorexia nervosa, qualitatively, instead of using quantitative methods to generalise causes and treatment. 

In mainstream health psychology, anorexia nervosa is seen as a pathology, an illness to be diagnosed and treated effectively. Khoury et al. (2014) critized the use of the DSM in diagnosing pathologies for trying to set appropriate cutoff points between what is considered “normal” from what is “pathological,” in order to treat the individuals belonging to the latter category, when in fact the concept of pathology is strictly determined by societal standards and is arbitrary, not backed up by any statistical data. In mainstream health psychology, pathologising removes the individual’s experience from their context. As opposed to this, critical health psychology aims to give importance to wider social issues and believes that these are directly related to health and illness (fox et al.)

As Bordo (1997) stated in her article on anorexia nervosa, eating disorders have very much risen over the past decade so much so that it has become an epidemic. She argues in the culture we live in, ideas of beauty are homogenised, so the idea is implanted into adoloscents early on in life that you need to look a certain way in order to be considered as attractive and ‘normal’ in society. As stated in the previous section, in mainstream health psychology, anorexia nervosa is seen to closely resemble an obsessive complusive disorder which shifts the blame to the person’s cognitions and desire to control. Bordo (1997) also noticed that this obsession to excessively control our body is fed to us and supported by the media surrounding us, promoting weight loss programmes, exercise and nutrition products and cosmetic programs. In his research on commercial weight loss organizations, Heyes (2006) showed how the disciplinary practices found in the strict diet and exercise programmes require a very restrictive and absurd regulation of food intake and exercise habits that is oddly similar to obsessive behaviours commonly associated with eating disorders. This exposes how it could be the case that instead of this obsession with weight and body image stems from a problem in the individual which distorts their perception and cognitions of themselves, it is society which is teaching us to be obsessed with our body image. 

This can also tie in to how economy comes into play. Economical factors are also given importance in critical health psychology as they contribute to ill-health. In anorexia nervosa, the profit made by companies endoursing weight loss programmes and dieting treatments is enormous (find reference) The more it is fed to us by adverts on the media that we should buy these products to reach the standard of beauty, the more money these companies make, but there is a huge disregard as to how badly this effects the mental health of individuals and how this can lead them to anorexia nervosa. If  the world around us puts constant pressures about how we need to look, behaviours such as those in anorexia nervosa patients, constitute important strategies of “survival” and ways of adapting to life in contemporary society. (crossley)

Critical health psychology also encourages the investigation of power differentials that privilege the powerful and discriminate against the weak (Kawachi, Kennedy, & Wilkinson, 1999; Kim, Millen, Irwin, & Gersham, 2000; McCubbin, 2001; Petersen, 1994; Prilleltensky & Nelson, 2002). (as cited in crossley). It is a fact that thin and beutiful people do better socially and therefore in life (find statistic) whereas people who are not considered as such can be less successful because they are overlooked and even sometimes bullied and seen as inferior, especially in the case of adolescents. (find study).  

It is a very well documented fact that anorexia nervosa is seen much more in women than it is is men (find statistic). The reason for this can very well be that the media places much more emphasis on women’s body image then it does on mens’. Also, the sexualization of women has been part of our culture for a very long time and dates back centuries as can be seen in paintings and other forms of art. A critical health psychologist could argue that women are a vulnerable group in society. Not only are they subject of various forms of abuse, but are also oppressed and pressured even to this day about their place in society, as well as how they are expected to behave and look. This is a major contributing factor to anorexia nervosa, one which mainstream health psychology fails to address or tries to change. 

Thin means ‘healthy’
?Norm of thinness
?Especially with reference to women 

Treatment suggestions and recommendations

Anorexia nervosa if often seen as being closely related to an obsessive compulsive disorder, as eating and exercise habits are very ritualistic and the person is ‘obsessed’ with their body image and weight. Health psychology looks at anorexia nervosa sometimes as being an illness brought about by cognitive distortions. It is the distorted image of oneself that leads and maintains anorexia nervosa, or the obsession with becoming extremely thin or not having an ounce of fat (find reference). This would lead the health psychologist to proceed with treating by the popular CBT, in order to change the patient’s perceptions of themselves and the cognitions which lead them to participating in the problem behaviours. Sometimes treatment centres also participate in negative or positive reinforcement to encourage or discourage problem behaviours, even monitoring closely the patients during mealtime and in their rooms in order to make sure that eat all their food and do not exercise accessively. This is a very medical based model of treatment, so much so that often when patients are released from specialised facilities, after a few months they relapse and need to be admitted again (find statistic). 

Results derived from a thematic analysis revealed the women’s high degree of dissatisfaction with treatment and their perception that the treatment system is overly focused on, and driven by, food and weight. In contrast, what the women really wanted was to be seen and treated as a ‘whole person’ and to have a ‘real’ relationship with their therapist. (Rance et al., 2015). As opposed to the medical model adopted by mainstream health psychology towards treating and dealing with anoreixa nervosa, critical health psychology takes a social construction of disease. It is’not content with describing reality, but rather seeks to transform reality’ (Murray & Poland, 2006: 383). This would mean trying to transform the society at large in which people in today’s world are constantly being surrounded by pictures and adverts on all types of media portraying stick thin models and shaming being anything but a size 2. Critical health psychologists would argue, where are the efforts of health psychologists in reducing these unhealthy pressures created by our society? It is not the perception of the person suffering from anorexia nervosa which is distorted, but rather the unattainable pressures that the world puts on them is what is distorted and needs to be fixed (somewhere in bordo). Society is the real disease and culprit and not the person’s condition. 

An important part of health psychology is that of health promotion. Health promotion campaigns to promote healthy habits and reduce unhealthy ones such as smoking or drinking can often be seen in schools, hospitals and in the media. With regards to anorexia nervosa, in past years, there has been a lot of awarness raised about how life threatning the condition can be, and how important it is to seek professional help as soon as possible in order to prevent long term damage to the body. Health psychology has recognised how grave the condition is, and has tried to improve the situation by promoting the awareness of it in the hopes that effected people will reach out. Mainstream health psychology often tried to reach out to individuals and convince them to improve or treat their unhealthy behaviours. In anorexia nervosa, emphasis is very much placed on how much the condition is harmful for the body. This again show how much of a medical stance mainstream health psychology places on eating disorders and other pathologies. As opposed to reaching out to individuals, critical health psychologists may instead take a different approach to trying to reduce the prevalance of anorexia nervosa, by instead reaching out to society. Maybe raising awarness and creating new laws about how the media and societal pressures influence the development of anorexia nervosa would be more effective, and more successfully preventative than the approach taken by mainstream health psychology. 


Both mainstream and critical health psychology provide us with important insight and information that can help us combat anorexia nervosa. Throughout this essay it was seen that although anorexia nervosa can be differently understood, it is a fact that the very serious condition is on the rise. I feel that it is imperative that we try to elicit change by addressing better and exposing how factors such as culture, the media, society and gender can greatly effect the development of anorexia nervosa and not just cognitions, genetics and bio-psycho-social factors. The wider context needs to be held accountable for the detrimental pressures is poses on individuals in today’s society in order to try and create change towards a healthier mind and body.