Paradigm clash in the field of eating disorders: a critical examination of the biopsychiatric model from a sociocultural perspective

This article explores the clash between the biopsychiatric paradigm and the sociocultural paradigm. After considering their essential assumptions, it is argued that the biopsychiatric paradigm has a number of significant problems, including a misunderstanding and misrepresentation of the sociocultural perspective it purports to have minimised or circumscribed. An important aspect of this critique involves careful consideration of what is meant by ‘scientific’ and ‘evidence-based’ in relation to theory, methodology, and conclusions about etiology. We conclude by offering suggestions for a new paradigm that incorporates principles of developmental psychopathology and redefines the relationship between the sociocultural, the biological, and the psychological. This new paradigm recognises the need to abandon the notion of a ‘biologically-based’ illness in favour of a focus on the reciprocal, mutually constituent influence of biological and sociocultural factors, varying across time and development. This article is not another plea for integration based on the equal validity and utility for each approach. It is a renewed call for more careful attention to (1) what exactly is being proposed in the biopsychiatric model? (2) what is the status of the evidence? and (3) what does a biopsychosocial integration need to take into account?