A Cultural Perspective on Gender and Eating Disorders in Group Therapy By: Stephen L Salter, Psy.D

When I began running groups at the SBK Eating Disorders Program, I wasn’t surprised to find I’d be working primarily with women.  I was aware that the epidemic hit women three times harder than men, but I wasn’t sure why.  I knew larger social forces were at play.  After all, The United States fosters more eating disorders than any country in the world.  Many point to the flooding of media images—unrealistic, unhealthy, and grossly underweight ideals of what it mean to be beautiful.  Is it possible to avoid these external influences? Why not turn off the television?  Or turn on tunnel vision at the checkout stands?  If only life were that simple…. Seduction by the American dream of beauty is an intoxicating one…a promise of perfection—happiness and wholeness.  By the time reality shatters that promise, many patients find the integrity of their bodies compromised, fatally in the worst cases.

The gravity of the disorder noted, I continue to wonder…why women?  Why is the proportion of women seeking treatment so high? Perhaps it is that women are asked to take up less space, both physically and metaphorically.  In the ED group, when individuals begin to feel safe, they often express feelings of hatred, severe criticism, and blame toward themselves, beginning with their bodies.  In my view, the temptation to turn her anger inward eclipses the social nature of this disease.  Specifically, many women become marginalized—placing her hopes for happiness on an identity as an object—an object of male desire—but not a desiring individual in her own right.  Her true self is abandoned, feeling rejected by the world.  Turning her anger inward validates that rejecting world.

The group reverses the sense of isolation felt in the labyrinth of an eating disorder.  The seductive ruse—that being beautiful means getting thinner—crumbles when closeness begins.  A space opens for emotional exploration and self-reflection.  Group leaders invite for an exploration of the psychology of the group as a whole as well as its individual members.  From a macro perspective, the group may challenge the ordinary assumptions about femininity, masculinity, beauty, and lovability.   In my view, such attention to the role of gender is integral to treatment.  If an eating disorder develops within the social world, then the community of the group can be ideal for recovery.