Cross-cultural research on anorexia nervosa: Assumptions regarding the role of body weight

Abstract

Objective To critically examine two assumptions guiding cross‐cultural research on the weight concerns of anorexia nervosa: (1) that weight concerns are specific to contemporary, Western manifestations of the disorder and (2) that the dissemination of Western values regarding thinness is primarily responsible for the development of anorexia nervosa in non‐Western contexts. Method A review of theoretical and empirical literature on cross‐cultural aspects of anorexia nervosa and the medical records of 14 Asian patients treated for eating disorders in Sydney, Australia. Results and Discussion Regarding the first assumption: It is argued that weight concerns when defined as weight loss that is positively valued (rather than a fat phobia) is a defininig characteristic of anorexia nervosa and is not limited to contemporary, Western cases of the disorder. Regarding the second assumption: It is argued that the occurrence of anorexia nervosa in non‐Western contexts cannot be solely attributed to the acceptance of Western thinness ideals because values and practices intrinsic to non‐Western cultures are also likely to be etiologically relevant. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 29: 205‐215, 2001.

Implicit out-group preference is associated with eating disorders symptoms amongst Emirati females

“…N. Robinson et al, 1996) and those living through rapid sociocultural transition (Abou-Saleh et al, 1996;Al-Adawi et al, 2002;Al-Subaie, 2000;Gordon, 2001). The fact that Western acculturation and explicit in-group evaluations were not associated with eating disorders symptoms both echoes (Haudek et al, 1999;Hill & Bhatti, 1995;Mumford et al, 1991), and contradicts previous findings in the field (Al-Subaie, 2000; Eapen et al, 2006) further adding to the equivocation surrounding the relationship between explicit measures of Western acculturation and eating disorders symptomatology (Rieger et al, 2001). …”

“…This assumption however requires a critical re-examination, especially in light of conflicting findings (Rieger, Touyz, Swain, & Beumont, 2001). Not only have several studies failed to find the anticipated positive relationship between Western acculturation and eating disorders symptoms (Haudek, Rorty, & Henker, 1999;Hill & Bhatti, 1995), at least one study has even reported the opposite link.…”

Should non‐fat‐phobic anorexia nervosa be included in DSM‐V?

“…5,16,20,[23][24][25][26]38 Notably, the majority are authored or co-authored by Professor Sing Lee, a psychiatrist and medical anthropologist credited with characterizing this phenomenologic variant. However, NFP-AN has also been reported in other nonWestern populations, including in Singapore, 14,21 West Malaysia, 19 Ghana, 27 and India 39 as well as in Asian patients residing in Australia 4 and in South Asian patients residing in the United Kingdom. 22,36 Moreover, two studies reporting the relative frequency of NFP-AN in South Asian versus 'White' AN patients in the United Kingdom found that NFP-AN was relatively more common in South Asians 36 ; however, one of these studies reported that ''sensitivity to 'fatness''' was ''invariably revealed'' during treatment.…”

Body image drawings dissociate ethnic differences and anorexia in adolescent girls

“…In multi-ethnic communities it is often helpful to distinguish between cultural norms and potential diagnostic features, particularly because cultural factors influence body weight norms, weight control, obesity, and body image (BI), body image dissatisfaction, and consequently may both obscure or increase vulnerability for ED [6–18]. At the same time in anorexia nervosa (AN), BI dissatisfaction is an essential diagnostic and together with the drive for thinness is extreme and underlies and perpetuates the psychopathology [8, 15, 19, 20].…”

“…Women, especially adolescent, are more likely to experience BI concerns [2, 7, 9, 18, 21, 22]. Social norms of feminine beauty, particularly western norms of shape and body weight are consistently correlated with increased weight consciousness and risk of ED [14–16, 21, 23, 24].…”