The Dr. Drew Response

Lately, I’ve been reading Dr. Drew’s latest book, “The Mirror Effect.”   It addresses celebrity narcissism and the extreme behavior that goes along with it. Dr. Drew does a great job at highlighting what has become typical tabloid material – multiple stints in rehab, sex tapes, drug use, eating disorders, etc. – and explaining the self-destructive pathology behind it.

Dr. Drew references troubling celebrity behavior over and over throughout the book. As I read, I found that most responses to this self-destructiveness fit in one of three categories (depending on one’s own background):

3 responses to troubling celebrity behavior:

1. Dr. Drew (empathetic / sympathetic)
2. “Regular” society (intrigued)
3. Relaters (Individuals with their own psychopathology)

The Dr. Drew Response

“As a group, however, [celebrities] often behaved in ways that unnerved and puzzled me.”

“…their behavior makes my heart ache for them.”

I’m coining this the Dr. Drew Response since I can’t think of any other word to better describes the reaction. His heart aches! He sees someone being self-destructive and he cares and feels their pain. It’s sympathy + knowledge + understanding + insight.

“Regular” society

“…this kind of behavior is portrayed as tragically glamorous, dramatically alluring, and, most alarmingly, normal and expected.”

A lot of people are interested in the self-destructive behavior of celebrities. It is a little bit of an obsession: Is Nicole Richie losing weight? Is Lindsay using? Is Amy Winehouse still alive? People want to know. The troubling behavior is intriguing and the press does a great job at, in essence, kicking celebrities when they’re down.

Relaters

“Witnessing such behavior also tends to provoke our own narcissistic impulses, causing us to feel envy, and tempting us to act like the celebrities we admire.”

“But for anyone who has experienced childhood trauma – the fundamental source of pathological narcissism – surrendering to such impulses can lead even mildly narcissistic people to spiral out of control with devastating results.”

Individuals with their own psychopathology or traumatic histories can be tempted (or even feel envious) by the self-destructive behavior of celebrities. There’s something triggering about it that makes these people want to engage in the same self-destructive behavior.

So there we go: In this world we have Dr. Drews, Regulars, and Relaters. I think that your response can change depending on the situation, and that it applies to anyone struggling – not just celebrities.

For example, I think about this girl who went to my college and was very obviously struggling with an eating disorder. “Regular” people would gossip about how sick she was. You’d hear the “I see her at the gym every single morning” and “I heard she eats a plate of broccoli for dinner” comments. Yes, it’s wrong and mean, but unfortunately that’s reality (at least on college campuses). Now, I was a Relater (struggling with an ED myself), so this girl kind of triggered me. I didn’t want to be that sick, but seeing her around campus would almost encourage my eating disorder; tempt me to cut corners, lose just 5 lb., eat a plate of broccoli for dinner, etc. That drove me CRAZY. I didn’t want to be a Relater – I wanted to be a Dr. Drew. I wanted to just empathize with her, wish she would get help, recognize how miserable she probably felt, and know how tough things were for her right now.

This is still a goal of mine: That Dr. Drew Response.

Parents, personality, and eating disorder symptoms

There have been many studies on family dynamics and the development of eating disorders, but I think that this is the first that I’ve seen that takes the next step and makes connections with specific symptomology: The dynamic relationship of parental personality traits with the personality and psychopathology traits of anorectic and bulimic daughters

Before I go further, I want to make two disclaimers.  First, from the article:

…we cannot infer a casual relationship between the parents’ personality traits and the daughter’s personality or psychopathology.  Moreover, correlational analysis does not define a direction for these relationships.  Nevertheless, some of the parental personality traits were specific to eating-disordered daughters, suggesting that they may be relevant.

Second, I in no way believe that parents cause eating disorders (just want to make that clear before I get any attacking comments).  I do think that parental personalities are significant, though.  Not only do they affect your core beliefs but they also influence the relationships that you have with your parents… which affect all of your other relationships in life.

So, with that said, on to my commentary of the article!

The study used several scales (the Clinical Global Impression Scale, Beck Depression Inventory, Temperament and Character Inventory, and the Eating Disorders Inventory-2) to assess personality and ED symptomology in daughters and their parents.  Among these variables were BMI, overall functioning, disease duration, eating attitudes and severity of ED behaviors, depression, and temperament.  The Temperament and Character Inventory (TCI) was a large part of the study, and previous to this article I was largely unfamiliar with it, so I’ll briefly explain it at the end of the post.

In short, the personality of parents, personality of daughters, and ED symptoms were all analyzed.  Among the results, some of the more interesting were:

1. In AN-R, father’s persistence predicted the daughter’s age of ED onset.
2. Also in AN-R, novelty-seeking, body dissatisfaction, and interpersonal distrust were all affected by the father’s reward dependence.
3. Mother’s self-directedness affected novelty-seeking in AN-P and BN.  The same was not true for AN-R.
4. AN-P exhibited the most severe eating psychopathology.  These girls had the greatest body dissatisfaction, drive to thinness, and level of depression.
5. Women with AN-R were less concerned about body shape than both AN-P and BN.
6. The father plays a larger role in personality-based family dynamics of ED women (especially with AN-R).

There are a MANY more conclusions than just those in the study, but I could probably write a whole series on the findings.  I’m trying not to do that.  There are a couple more things that I want to mention, though.  First, the paper discusses the personality types of the ED-daughters.  If you are a family member and are feeling attacked by this point, you might want to read this section since it’s not very complimentary to those with EDs, either.  No one escapes the article feeling good:

Restricting Anorexics – stubborn, obsessive, self-determined
Purging Anorexics – impulsive, immature, disordered personalities
Bulimics – explorative, disorderly, conflicting
All EDs – frightened by potentially harmful stimuli, immature character, low self-acceptance, low resourcefulness, low self-esteem

Now, what’s the take-home message from all of this?  Well, I think that the article does a good job of explaining the role of family therapy in the treatment of eating disorders.  Specifically:

Counseling or family therapy may help modify specific aspects of the parent-daughter relationship to produce specific changes in eating symptoms.

I like the point about helping the parents in family therapy.  To change your relationship and your home environment, you have to help your parents.  The things that you learn from them are reflections of both their own core values and their personality traits.  When they are struggling with their own anxiety, negative body image, etc,., that translates.  I think that when you (the person with the eating disorder) is in therapy and are being told things like it’s important to take care of yourself, you have to cut yourself some slack, what you think and how you feel matters, you don’t have to listen to the messages of society, etc., that it’s hard to believe these things and take them as truth when the people around you don’t.  Will my dad ever work on his anger issues?  Probably not.  Do I think it would help both him and I?  Sure.  Is my mom ever going to let go of her own disordered eating tendencies?  Unlikely.  Would her being healthy being a good influence on me?  Yes.

There is clearly a link between parental personality, the daughter’s personality, and ED symptoms.  I think that family therapy that helps the parents with their own issues then allows them to form healthier relationships with their daughters, which helps with her ED recovery.

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The Temperament and Character Inventory (TCI)
Purpose: Instrument used for the dimensional assessment of personality, with four dimensions assessing temperament and three assessing character.

Temperament:

1. Novelty seeking – level of exploratory activity
2. Harm avoidance – efficacy of behavioral inhibition system
3. Reward dependence – maintenance of rewarded behavior
4. Persistence – ability to resist frustration

Character:

1. Self-directedness – view self as autonomous and integrated
2. Cooperativeness – view self as part of society
3. Self-transcendence – how self is integral part of the universe

Economists and bulimia

I can’t remember the last time I saw “economist” and “bulimia” in the same headline — I usually don’t put the two together.  However, this article (Eating-Disorders Experts Challenge Economists’ Conclusions About Bulimia) made some pretty interesting statements:

1. Bulimia Nervosa (BN) is an addiction rather than an eating disorder
2. Black females are 50% more likely to be bulimic than white females
3. “Bulimic behavior” is less likely among wealthier, better-educated families.

You should definitely read the article, but I have a couple of things to add to these points:

1. BN is an addiction
I always compare eating disorders and addictions — but I still wouldn’t put BN and alcoholism in the same category.  There are several key differences:

1. Lack of an addictive substance: Addictions require you to be, well, addicted to something — alcohol, opiates, cocaine, etc.  With bulimia, there’s no addictive substance.  I don’t think you can even argue “food” as the addictive substance.
2. No healthy use for symptoms: Occasional purging is not okay or normal.  I’d argue that anyone who purges has an eating disorder (at least on some level).  However, there are appropriate uses for alcohol, opiates, and even cocaine.
3. Goals of treatment: With addictions, the goal is to abstain from the addictive substance.  However, you can’t abstain from food (maybe from purging, but again, that’s only half of it).
4. Psychopathology: “Addict thinking” is not really the same as “eating disorder thinking.”  Similar — but not the same.

2. BN more common in black females
I don’t have much to say about this one, except that I’m skeptical.  I don’t think EDs are limited to certain races, but I think that if you looked at the cultural make-up of treatment centers, you’d find this claim to be false.  Yes, this is measuring those in treatment vs. BN prevalence — and there is likely a difference — but not a 30%+ difference!

3. Bulimia less common in upper-class families
Similarly, I don’t think that BN has socioeconomic limitations…

If for no other reason, the article at least challenges the many ED stereotypes.  It’s curious to me that a) there is no reference to males with eating disorders and b) the study is unique to bulimia.  I’d be interested to see if authors found similar results with anorexia.