Anorexia nervosa in Asian children

Eating disorders in women

Eating disorders, especially anorexia nervosa and bulimia nervosa have been classically described in young females in Western population. Recent research shows that they are also seen in developing countries including India. The classification of eating disorders has been expanded to include recently described conditions like binge eating disorder. Eating disorders have a multifactorial etiology. Genetic factor appear to play a major role. Recent advances in neurobiology have improved our understanding of these conditions and may possibly help us develop more effective treatments in future. Premorbid personality appears to play an important role, with differential predisposition for individual disorders. The role of cultural factors in the etiology of these conditions is debated. Culture may have a pathoplastic effect leading to non-conforming presentations like the non fat-phobic form of anorexia nervosa, which are commonly reported in developing countries. With rapid cultural transformation, the classical forms of these conditions are being described throughout the world. Diagnostic criteria have been modified to accommodate for these myriad presentations. Treatment of eating disorders can be quite challenging, given the dearth of established treatments and poor motivation/insight in these conditions. Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations.

Adolescent development and eating disorder related quality of life in Indian females

OBJECTIVE

To study the relationship of adolescent development and eating disorder related quality of life in Indian females.

METHOD

461 female school students (aged 12-17 yrs) were recruited from middle to high socio-economic status (SES), English speaking schools in Delhi, India. Adolescent development was measured by Tanner stage and months since menarche. Subjects completed the Quality of Life for Eating Disorders questionnaire (QOL ED), which included six subscores. Correlation and partial correlation coefficient analysis to control for Body Mass Index (BMI) were performed.

RESULTS

After controlling for BMI, all adolescent development measures were correlated with the psychological feelings (PSY) subscore. This subscore contained items relating to confusion, social unease, sadness, difficulty coping, desiring perfection and loss of control. Tanner breast stage was correlated with the eating behaviour (EB) subscore.

DISCUSSION

During adolescent development, Indian girls became more aware of their psychological feelings and emotions. Only those reporting breast development were using behaviours to control their body, weight and shape. These behaviours are not associated with the presence of disordered eating thoughts, such as preoccupation with food, eating, body weight or shape.

Translation of the Quality of Life for Eating Disorders questionnaire into Hindi

OBJECTIVE

The Quality of Life for Eating Disorders questionnaire was translated into Hindi (QOL ED-H) using the forward-backward translation procedure for use with Indian females.

METHOD

A total of ninety-five females were recruited from two secondary schools and one tertiary college from Delhi, India. They were aged between 14 and 37 years, ranging from low to high socioeconomic status communities. A psychologist and teacher produced a preliminary Hindi version, which was back-translated by the psychologist and a journalist and any disparity was checked. The Hindi and English versions were administered one week apart to the same participants, the order being randomised.

RESULTS

Repeated measures analysis revealed no significant differences in QOL ED scores (global and subscores) between the Hindi and English versions, when controlled for age.

CONCLUSION

The QOL ED-H can be used to assess eating and exercise disordered thinking, feeling, behaviours, psychological feelings and daily living in Indian females of all SES groups.

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

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.

Anorexia nervosa in early adolescence in Sri Lanka

We report four cases of anorexia nervosa (AN) seen over a period of 5 months in the psychiatry unit of a general hospital. The report is unusual because two of the patients were male, all were between 13 and 15 years of age and AN is thought to be rare in Sri Lanka. All four patients had features typical of AN. There are implications for clinical practice in Sri Lanka if the prevalence of AN is rising because all these patients presented to psychiatrists late in their illness, some in an advanced state of weight loss.

Eating disorders in Japan: finding the right context

Eating disorders have traditionally been described as a typically 'Western' illness. Cases that occur outside Western countries are often regarded as atypical. Peculiarities are thus emphasized. However, eating disorders are now prevalent in Japan, among non-Western immigrants in Europe, and in other societies. The author focuses on the universality of the background of eating disorders and looks at them as 'culture change syndromes'. Change in the family and in women's roles are the central themes. The majority of the subjects experienced very little emotional relationship with their parents when they were children. It is misleading to say that eating disorder patients lack femininity and that they should be encouraged to be more feminine, more passive. Gender issues concerning treatment settings such as the doctor-patient relationship, the doctor-nurse relationship influence the treatment process. Typical anorexics described in a 1788 Japanese document are briefly presented in order to challenge further the idea of eating disorders as a Western illness.

Eating disorders among Indian and Australian university students

In a study of eating disorders, 297 Australian and 249 Indian university students completed the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) and the Goldfarb Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1985). Contrary to predictions, the Indian participants scored significantly higher than the Australian participants on both measures. The Indian women scored significantly higher than the Australian women on the EAT-26 but not on the GFFS. The Australian men showed significantly fewer symptoms than all other groups. The Indian men did not differ from the Australian or Indian women on either the EAT-26 or GFFS. The urban Indians did not differ from their rural counterparts on the GFFS, but the rural Indians had significantly higher EAT-26 scores than the urban Indians.

Reconsidering the status of anorexia nervosa as a western culture-bound syndrome

Based on Ritenbaugh's 1982 definition, this essay reconsiders the status of anorexia nervosa as a Western culture-bound syndrome (CBS). It argues that anorexia nervosa, in its culturally reconstructed fat phobic form, is no longer bound to specific Western localities. Instead, it may be conceived as being grounded in the transnational culture of 'modernity', characterized by an internationalised socio-economic stratum now found in many rapidly urbanising parts of the world, and composed of increased affluence, as well as the globalization of fat phobia and diffusion of biomedical technology. Although the treatment implication of Ritenbaugh's CBS concept may appear to be misplaced from the clinician's pragmatic perspective, its salience for clarifying the interaction of individual and cultural concerns in self-starvation, as well as for fostering a needed self-scrutiny in psychiatry, is affirmed. A critique of the dialectical relationship between culture and psychopathology is then put forward. This addresses the apparently conflicting role of anorexia nervosa in enacting as well as combating the cultural pursuit of thinness, and ends by highlighting the inadvertent influence of the biomedical establishment in propagating the condition with measures intended, ironically, for preventing it.

Case study: early-onset anorexia nervosa in a Chinese boy

In this case study of early-onset anorexia nervosa in a male patient from Hong Kong, clinical features are outlined and compared with those of their Western counterparts. Implications of being the only son in a traditional Chinese family and the process of acculturation and cultural conflicts of growing up in a Western-oriented society are put forward as significant psychodynamic factors in the etiology of his illness.

Family pathology and anorexia in the Indian context

Frequent associations have been found between family interaction and anorectic behaviour. Family theorists have viewed anorexia as a manifestation of a dysfunctional family system. We report three families of cases of anorexia (one male and two female) where the symptom was a reflection of family pathology and was being maintained by it. The cases emphasize the need to assess families of anorectics in detail and view them in the cultural context of eating.

Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong

A mixed retrospective-prospective study of 70 Chinese anorexic patients in Hong Kong shows that although they were similar to Western anorexics in most other ways, 41 (58.6%) of them did not exhibit any fear of fatness throughout their course of illness. Instead, these non-fat phobic patients used epigastric bloating (31.4%), no appetite/hunger (15.7%) or simply eating less (12.9%) as legitimating rationales for food refusal and emaciation. Compared to fat phobic anorexics, they were significantly slimmer pre-morbidly (P < 0.0001) and were less likely to exhibit bulimia (P = 0.001). The possible explanations for the absence of fat phobia and the interpretive dilemma this provokes are discussed from historical, pathoplastic and cultural anthropological perspectives. It is argued that anorexia nervosa may display phenomenological plurality in a Westernizing society, and its identity may be conceptualized without invoking the explanatory construct of fat phobia exclusively. As non-fat phobic anorexia nervosa displays no culturally peculiar features, it is not strictly speaking a Western culture-bound syndrome, but may evolve into its contemporary fat phobic vogue under the permeative impact of Westernization. Its careful evaluation may help clarify the aetiology and historical transformation of eating disorder, foster the development of a cross-culturally valid taxonomy of morbid states of self-starvation, and exemplify some of the crucial issues that need to be tackled in the cross-cultural study of mental disorders.