Stress, coping, and crisis support in eating disorders.

OBJECTIVE: Recent research has supported the role of stress in the development and maintenance of eating disorders. However, coping and crisis support, important aspects of this stress process, have received little systematic attention. The cognitive-transactional approach to coping emphasizes the importance of the relationship between the individual and the particular problematic situation and yet most studies investigating coping in eating disorders have failed to measure situation-specific coping. METHOD: The present study used semistructured interviews to measure coping and crisis support in response to severe events and/or marked difficulties in 12 women with anorexia nervosa (AN), 21 women with bulimia nervosa (BN), and 21 women without an eating disorder (non-ED). RESULTS: Women with eating disorders were more likely to use cognitive avoidance or cognitive rumination and were less likely to downplay their problems. In addition, BN subjects were more likely to blame themselves and were less likely to receive crisis support from a core-tie. Overall, women with eating disorders were less likely to be masterful in response to crises than women without eating disorders. DISCUSSION: It is concluded that women with eating disorders are less effective in their coping than women without eating disorders.

Ways of coping in women with eating disorders.

The aim of this study was to investigate the strategies used for coping with stress in eating disorder patients. Twenty-four anorexia nervosa (AN) patients, 66 bulimia nervosa (BN) patients, and 30 female control subjects completed a revised Ways of Coping Checklist, indicating how they dealt with a self-nominated stressor. The AN and BN patients used proportionately more avoidance than control subjects. The BN patients used proportionately more wishful thinking and sought less social support than control subjects but patients with AN did not differ significantly from either BN or control groups. Patient groups did not differ significantly from control subjects on their use of problem-focused coping or self-blame, although the use of problem-focused coping was significantly lower, and self-blame significantly higher, with psychological problems than with relationship and general problems in all groups. Coping failed to predict severity of eating pathology but, in the patient groups, Beck Depression scores were related positively to avoidant coping (avoidance in BN patients and wishful thinking in AN patients) and inversely to problem-focused coping and seeking social support (although the latter just failed to reach significance in the AN group). It is concluded that a treatment approach that teaches coping strategies, as well as removing the obstacles (cognitive, emotional, or practical) that preclude the use of more effective coping, may be a useful component of treatment.