Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology.

Abstract

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.

Epidemiology of eating disorders: Creating opportunities to move the current classification paradigm forward

“…The former association has been found in White populations 7 and may simply represent a cohort factor related to recall or lack of recognition of eating disorders in older generations. The latter finding was consistent with a previous suggestion 8 that eating disorders involving binge eating are ''culture-bound'' syndromes, at least in terms of socioeconomic status, age, and exposure to ''thin beauty ideal'' culture.…”

An association of early puberty with disordered eating and anxiety in a population of undergraduate women and men

“…Thus, psychosocial explanations based on societal ideals for body type do not fully account for the relationship between pubertal timing and disordered eating in women and men. It is most likely that disordered eating results from a complex interaction of both psychosocial and biological factors, an idea which is further supported by examining the incidence of disordered eating across cultures and history (Keel & Klump, 2003). Although the results of this study are consistent with an organizational effect of hormones on disordered eating and anxiety, the use of a retrospective, self-report of pubertal timing and cross-sectional study design limits our ability to draw firm conclusions about the exact mechanisms relating pubertal timing and young adult psychological characteristics.…”

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM‐V

“…Moreover, emergence of specific symptoms, such as dietary restraint or purging, may be constrained by personal autonomy or privacy. 36 Therefore, social context is relevant not only to clinician interpretation of signs and symptoms of disordered eating, but to therapeutic interventions which must address both their rationale and local salience for impairment and distress. While not uniquely relevant to the diagnosis of eating disorders, variation in social and cultural context renders the assessment of their subjective and dimensional cognitive attributes particularly challenging given the heterogeneity of social norms for body ideals.…”