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Túry F, Szabó P, Dukay-Szabó S, Szumska I, Simon D, Rathner G. Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011. J Behav Addict 2020; 9:1079-1087. [PMID: 33245292 PMCID: PMC8969710 DOI: 10.1556/2006.2020.00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years. METHODS A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added. RESULTS Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%). DISCUSSION AND CONCLUSIONS The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.
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Affiliation(s)
- Ferenc Túry
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary,Corresponding author.
| | - Pál Szabó
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
| | | | - Irena Szumska
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
| | - Dávid Simon
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
| | - Günther Rathner
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
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Vu-Augier de Montgrémier M, Moro MR, Chen J, Blanchet C, Lachal J. Eating disorders and representations of the role of women in China: A qualitative study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:211-222. [PMID: 31981289 DOI: 10.1002/erv.2717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This qualitative study examines the representations of young Chinese girls and women with eating disorders (EDs) about the role of women in China, because conflicting societal values for women may foster the development of EDs there. METHOD Semistructured interviews were conducted with 11 adolescent girls or young women hospitalized for an ED and with eight of their parents. Interpretative phenomenological analysis was used to explore the data. RESULT Three superordinate themes emerged from the participants' narratives: the thin ideal in Chinese society; the experience of gender-related pressure; and independence and autonomization in a changing society. The ideal of thinness prevails, both in interpersonal relationships and in social roles. Highly codified representations persist, limiting women's opportunities. The participants and their parents show substantial ambivalence about independence; the young women have real difficulty in making decisions, thus failing to adopt roles that accord with their aspirations. DISCUSSION Young girls' and women's representations of their gender could have implications in the development of EDs, mediated by their focus on thinness and their difficulties in constructing their identity, in developing autonomy and self-esteem, as well as family conflict. These findings indicate that construction of femininity in China is unsettled by rapid societal changes.
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Affiliation(s)
- Marion Vu-Augier de Montgrémier
- AP-HP, Hopital Cochin, Maison de Solenn, Paris, France.,CESP, Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,PCPP, Université Paris Descartes, Boulogne-Billancourt, France
| | - Marie-Rose Moro
- AP-HP, Hopital Cochin, Maison de Solenn, Paris, France.,CESP, Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,PCPP, Université Paris Descartes, Boulogne-Billancourt, France
| | - Jue Chen
- Clinical Psychology Department, Shanghai Mental Health Center, Shanghai, People's Republic of China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Corinne Blanchet
- AP-HP, Hopital Cochin, Maison de Solenn, Paris, France.,CESP, Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,PCPP, Université Paris Descartes, Boulogne-Billancourt, France
| | - Jonathan Lachal
- AP-HP, Hopital Cochin, Maison de Solenn, Paris, France.,CESP, Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,PCPP, Université Paris Descartes, Boulogne-Billancourt, France
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Moreno-Domínguez S, Rutsztein G, Geist TA, Pomichter EE, Cepeda-Benito A. Body Mass Index and Nationality (Argentine vs. Spanish) Moderate the Relationship Between Internalization of the Thin Ideal and Body Dissatisfaction: A Conditional Mediation Model. Front Psychol 2019; 10:582. [PMID: 30949101 PMCID: PMC6437113 DOI: 10.3389/fpsyg.2019.00582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
It is believed that Women’s exposure to Western sociocultural pressures to attain a “thin-ideal” results in the internalization of a desire to be thin that consequently leads to body dissatisfaction (BD). It is also well documented that body mass index (BMI; kg/m2) correlates with BD. We tested for the first time a conditional mediation model where thin-ideal Awareness predicted BD through Internalization of the thin ideal and the path from Internalization to BD was hypothesized to be moderated by BMI and Nationality (Argentine vs. Spanish). The model was tested with a sample of 499 young women (age = 18 to 29) from Argentina (n = 290) and Spain (n = 209). Awareness and internalization were measured with the SATAQ-4 (Schaefer et al., 2015) and BD was measured with the BSQ (Cooper et al., 1987). The model was analyzed using PROCESSv3.1 (Hayes, 2018). As hypothesized, thin-ideal awareness predicted BD through internalization and the path from internalization to BD was moderated by BMI and nationality. Specifically, internalization predicted BD at all level of BMI and in both samples, but the relationship between internalization and BD increased with BMI and was also stronger among Spaniards than Argentines. We argue that the findings are congruent with theories that predict that economic development and modernization contribute to normative female BD through internalization of the thin ideal and that upward social comparisons or cognitive discrepancy between self-perceived body image and the sociocultural thin ideal interacts synergistically with thin-ideal internalization to increase BD.
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Affiliation(s)
| | | | - Thomas A Geist
- Department of Psychological Science, The University of Vermont, Burlington, VT, United States
| | - Emily E Pomichter
- Department of Psychological Science, The University of Vermont, Burlington, VT, United States
| | - Antonio Cepeda-Benito
- Department of Psychological Science, The University of Vermont, Burlington, VT, United States
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Abstract
In the last three decades, anthropological analyses of eating disorders have peeled away layers of 'common sense' to reveal tacit and often contradictory forces that inhere in people's bodies, practices, and lives. From investigations of institutional practices to analyses of embodied experiences, anthropologists have developed insightful accounts of how local, shared worlds shape disordered eating, and of the grounding of disorder in social structures and relationships that tend to be obscured in clinical and popular interpretations. In this introductory essay, we offer a brief review of anthropological work on eating disorders, with particular emphasis on studies published in the last decade. Attending to person, structure, and bodily being-in-the-world, these anthropological studies reveal multiple cultural logics within which disordered eating practices are embedded. The deciphering of cultural logics forms the basis for this special issue, whose constituent papers interrogate recurring and ongoing eating disorders, with analyses that focus on relapse, ambivalence toward treatment, and the persistence of disordered eating practices. In their shared focus on long-term eating disorders, the papers offer anthropological responses to clinical questions about the low rates of treatment success. As such, the special issue conveys the potential for new productive collaborations between anthropology, policy, and clinical research and practice for the prevention of and effective intervention in eating disorders.
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Dell'Osso L, Carpita B, Muti D, Cremone IM, Massimetti G, Diadema E, Gesi C, Carmassi C. Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord 2018; 23:55-65. [PMID: 29134507 DOI: 10.1007/s40519-017-0460-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy. METHODS Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents' educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student's unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score. RESULTS more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender. CONCLUSIONS Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.
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Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy.
| | - D Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - G Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - E Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy
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Saghir S, Hyland L. The Effects of Immigration and Media Influence on Body Image Among Pakistani Men. Am J Mens Health 2017; 11:930-940. [PMID: 28625116 PMCID: PMC5675336 DOI: 10.1177/1557988317698627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023] Open
Abstract
This study examined the role of media influence and immigration on body image among Pakistani men. Attitudes toward the body were compared between those living in Pakistan ( n = 56) and those who had immigrated to the United Arab Emirates ( n = 58). Results of a factorial analysis of variance demonstrated a significant main effect of immigrant status. Pakistani men living in the United Arab Emirates displayed poorer body image than those in the Pakistan sample. Results also indicated a second main effect of media influence.Those highly influenced by the media displayed poorer body image. No interaction effect was observed between immigrant status and media influence on body image. These findings suggest that media influence and immigration are among important risk factors for the development of negative body image among non-Western men. Interventions designed to address the negative effects of the media and immigration may be effective at reducing body image disorders and other related health problems in this population.
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Affiliation(s)
- Sheeba Saghir
- Middlesex University Dubai, Knowledge Park, Dubai, UAE
| | - Lynda Hyland
- Middlesex University Dubai, Knowledge Park, Dubai, UAE
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7
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Vu-Augier de Montgrémier M, Chen J, Guo K, Moro MR. Aspects culturels et transculturels des troubles du comportement alimentaire chez des adolescentes et jeunes adultes chinoises. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.neurenf.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Vu-Augier de Montgrémier M, Chen J, Zhang F, Moro MR. Anorexie masculine en Chine : psychopathologie, facteurs culturels et transculturels. EVOLUTION PSYCHIATRIQUE 2017. [DOI: 10.1016/j.evopsy.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vu-Augier de Montgrémier M, Blanchet-Collet C, Guzmán G, Moro MR. [Towards a transcultural approach to eating disorders]. Soins Psychiatr 2016; 37:22-24. [PMID: 27890271 DOI: 10.1016/j.spsy.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anorexia must not be considered as a syndrome specific to a culture but as being linked to fast-moving sociocultural changes. Its occurrence can be favoured by certain transcultural phenomena, such as globalisation and the process of acculturation. The analysis of a clinical case of a young migrant with anorexia illustrates the complexity and need for complementary transcultural psychotherapy, to improve understanding and the future.
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Affiliation(s)
- Marion Vu-Augier de Montgrémier
- Maison de Solenn-Maison des Adolescents, Hôpital Cochin, APHP, CESP, Inserm 1178, université Paris-Descartes, USPC, 97, boulevard de Port-Royal, 75014, Paris, France.
| | - Corinne Blanchet-Collet
- Maison de Solenn-Maison des Adolescents, Hôpital Cochin, APHP, CESP, Inserm 1178, université Paris-Descartes, USPC, 97, boulevard de Port-Royal, 75014, Paris, France
| | - Gabriela Guzmán
- Maison de Solenn-Maison des Adolescents, Hôpital Cochin, APHP, CESP, Inserm 1178, université Paris-Descartes, USPC, 97, boulevard de Port-Royal, 75014, Paris, France; Unidad de Salud del Adolescente, Complejo Asistencial Dr Sótero del Río, Av . Concha y Toro 3459, Puente Alto, Santiago, Chile
| | - Marie Rose Moro
- Maison de Solenn-Maison des Adolescents, Hôpital Cochin, APHP, CESP, Inserm 1178, université Paris-Descartes, USPC, 97, boulevard de Port-Royal, 75014, Paris, France
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Abstract
ABSIRACT: The authors examine the growth and role of child psychiatry in the developing world over the last 25 years. They review national epidemiologi cal studies of the prevalence of child psychiatric disorders, culture-specific symptoms of maladjustment and the evidence for culture-specific parenting patterns. They consider the impact of social change on psychiatric disorders in the Third World, identify ing specific protective factors (e.g. gender, intelli gence, special schooling, social skills) and vulner ability factors (e.g. poor diet). The authors then examine the role of culturally sensitive intervention strategies. Training programs for child psychiatrists in the developing world must encompass both medical and public health models. The review closes with a brief discussion of urgent research questions and a summary of the most pressing clinical requirements for child psychiatry in the developing world.
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12
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Carr SC, Maclachlan M. Psychology in Developing Countries: Reassessing its Impact. PSYCHOLOGY AND DEVELOPING SOCIETIES 2016. [DOI: 10.1177/097133369801000101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The last global review of the role of psychology in developing countries was edited by Sinha and Holtzman in 1984. This paper evaluates journal publications appearing in the Psychlit database in the decadefollowing Sinha and Holtzman's review, focusing on studies which contain scientific evidence of practical out come. There are three categories of such research, namely, social/organisational, health/welfare, and educational/developmental, with clear evidence of reliability, validity, and utility in each category, but largely in health and welfare. Despite this relative imbalance however; there are signs of what Sinha has defined as true indigenisation, namely, progressing beyond assimilation of, and anti-conformity against, the so-called "mainstream ", towards a more pluralistic search for a psy chology that works.
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Swami V. Change in risk factors for eating disorder symptomatology in Malay students sojourning in the United Kingdom. Int J Eat Disord 2016; 49:695-700. [PMID: 26876737 DOI: 10.1002/eat.22509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/16/2015] [Accepted: 12/28/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this investigation was to examine change in risk for eating disorders in higher education students sojourning in the United Kingdom (UK), as well as associations between such risk and experiences in the host culture. METHOD Participants were 98 female students from Malaysia, who completed a measure of risk factors for eating disorder symptomatology (the Eating Disorder Inventory-3 subscales of drive for thinness, body dissatisfaction, and bulimia symptoms) at two time points: two months prior to beginning their sojourn in the UK (Time 1) and four months after the sojourn began (Time 2). At Time 2, participants also completed measures of sociocultural adjustment, cultural distance between home and host cultures, and perceived discrimination in the host culture. RESULTS Analyses indicated that, compared to scores at Time 1, participants had significantly higher drive for thinness (d = 0.64), body dissatisfaction (d = 0.54), and bulimia symptoms (d = 0.29) at Time 2. Poorer sociocultural adjustment and greater perceived discrimination significantly predicted greater risk of eating disorders at Time 2. DISCUSSION The stress associated with culture change may place sojourning students at risk for disordered eating. Further research is needed to determine the extent to which this risk is related to culture-change specifically, as opposed to a general set of factors associated with transition-related psychopathology more broadly. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:695-700).
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Affiliation(s)
- Viren Swami
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom.,Department of Psychology, HELP University College, Kuala Lumpur, Malaysia
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Pilecki MW, Sałapa K, Józefik B. Socio-cultural context of eating disorders in Poland. J Eat Disord 2016; 4:11. [PMID: 26998306 PMCID: PMC4797342 DOI: 10.1186/s40337-016-0093-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków. METHODS Relationships between two given qualitative features were investigated using the chi-square test or Fisher's exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups. RESULTS Objective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one's self, as well as a multifaceted negative evaluation of one's own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment. CONCLUSIONS The results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied.
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Affiliation(s)
- Maciej Wojciech Pilecki
- />Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Kraków, Poland
| | - Kinga Sałapa
- />Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, ul. Św. Łazarza 16, 31-530 Kraków, Poland
| | - Barbara Józefik
- />Department of Child and Adolescent Psychiatry, Laboratory of Psychology and Systemic Psychotherapy, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Kraków, Poland
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16
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Is cultural change associated with eating disorders? A systematic review of the literature. Eat Weight Disord 2015; 20:149-60. [PMID: 25894606 DOI: 10.1007/s40519-015-0189-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND There is debate as to whether the development of an eating disorder (ED) may be triggered by acculturation to Western culture. While there is evidence to suggest that acculturation to Western culture is associated with risk of having an ED, these findings are limited, vary significantly, and are sometimes conflicting. AIMS To review the literature and empirical data on the association between ED symptoms and acculturation in the context of Western culture. METHODS A systematic search of peer-reviewed publications using a combination of the keywords "Culture", "Acculturation" and "Eating disorders" was first performed in August 2014 and updated in February 2015 with the following databases: PubMed and SCOPUS. Reference lists were also hand searched. In total, the search provided more than 50 studies. Following screening (as stated in the PRISMA guidelines) of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 25 studies were identified to be appropriate for the review. Articles were examined in relation to the findings, as well as the ED and acculturation measures used. RESULTS Eleven studies suggested considerable association between ED and culture change/acculturation. Six studies suggested little or no association between ED and culture change/acculturation. Eight studies did not primarily examine association, yet generated valuable insight. While there was relative consistency across studies in terms of the ED measures selected, measures of acculturation varied significantly. CONCLUSIONS The majority of the evidence reviewed here suggests that there is a substantial association between culture change and ED psychopathology. However, both greater and lesser acculturation have been identified as risk factors for the development of an ED, and this varies depending on the group studied as well as how acculturation and culture change are conceptualized and measured. Further research is warranted to form cross-culturally acceptable definitions and measures of problematic eating, and healthy and high acculturation, to study the relationship between EDs and the process of acculturation to Western culture.
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Demarque M, Guzman G, Morrison E, Ahovi J, Moro MR, Blanchet-Collet C. Anorexia nervosa in a girl of Chinese origin: psychological, somatic and transcultural factors. Clin Child Psychol Psychiatry 2015; 20:276-88. [PMID: 24363225 DOI: 10.1177/1359104513514067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increased prevalence of anorexia nervosa reported in non-Western societies inevitably raises the issue of the influence of cultural factors in the genesis and the patterns of this disorder. Anorexia nervosa is not a straightforward Western culture-bound syndrome, although an influence of Western ideals of thinness does exist. The illness seems more related to rapid cultural shifts, either societal or individual, such as those occurring in the migratory process. Migrants and their children have to face the acculturation process and may experience a culture-clash. The pathology can also fulfil a positive acculturative function. This is a case study concerning a second-generation Chinese girl born in France presenting with anorexia nervosa. This case leads us to raise the issue of the choice of diagnostic criteria in relation to cultural background. We will also discuss the impact of the family's migratory history on the construction of identity in adolescence. Finally we will explore the specific features of care provision for anorexia nervosa in a transcultural setting.
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Affiliation(s)
- Mélissa Demarque
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gabriela Guzman
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Elodie Morrison
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Jonathan Ahovi
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France Unité de Psychopathologie de l'Adolescent, Hôpital Louis Pasteur, Dole, France
| | - Marie Rose Moro
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Corinne Blanchet-Collet
- Maison de Solenn - Maison des Adolescents de Cochin, AP-HP, Unité INSERM 669, Université Paris Descartes, Sorbonne Paris Cité, France
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Gelo OCG, Vilei A, Maddux JE, Gennaro A. Psychopathology as Social Construction: The Case of Anorexia Nervosa. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2014. [DOI: 10.1080/10720537.2013.858087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Revelas A. Eating disorders are real treatable medical illnesses. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- A Revelas
- Department of Pathology, St Nicolas General Hospital, Crete
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Schulte SJ, Thomas J. Relationship between eating pathology, body dissatisfaction and depressive symptoms among male and female adolescents in the United Arab Emirates. Eat Behav 2013; 14:157-60. [PMID: 23557812 DOI: 10.1016/j.eatbeh.2013.01.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 01/03/2013] [Accepted: 01/30/2013] [Indexed: 11/28/2022]
Abstract
Research in the field of eating disorders remains limited in the Arab world. The cross-sectional study addressed this gap by examining eating disturbances and related problem behaviors among 361 (284 females, 77 males) undergraduates in the United Arab Emirates (UAE). Standardized measures were used to assess the relationship between symptoms of eating pathology, body dissatisfaction and depression. Three quarters (73%) of the sample indicated body dissatisfaction (78% of females, 58% of males) and 20% scored above the clinical cutoff on the eating pathology scale (20% of females, 22% of males). Depressive symptomatology predicted significantly higher levels of eating pathology in both genders. The findings highlight that eating disturbances and body dissatisfaction are of concern among adolescents in the UAE. Local eating disorders prevention strategies should address the needs of both females and males and consider potential depressive co-morbidity.
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Affiliation(s)
- Sabrina Janine Schulte
- Department of International Studies, College of Arts & Sciences, American University of Sharjah, P.O. Box: 26666, Sharjah, United Arab Emirates.
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Risk of disordered eating attitudes among adolescents in seven Arab countries by gender and obesity: a cross-cultural study. Appetite 2012; 60:162-167. [PMID: 23092757 DOI: 10.1016/j.appet.2012.10.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/10/2012] [Accepted: 10/12/2012] [Indexed: 11/22/2022]
Abstract
The objectives were to discover the prevalence of disordered eating attitudes (EAs) among adolescent males and females, and the association of obesity with EA in seven Arab countries. A multistage stratified sampling technique was used to select secondary students aged 15-18 years from cities in Algeria, Jordan, Kuwait, Libya, Palestine, Syria and Sharijah Emirate (United Arab Emirates). The total sample was 4698 (2240 males and 2458 females). The Eating Attitudes Test (EAT-26) was used to measure those at risk of disordered EA. Obesity was calculated according to the International Obesity Taskforce criteria. Participants were grouped into two categories, non-obese and obese (overweight and obese). The risk of disordered EA was twice as high among females as in males in Jordan, Libya, Palestine and Syria. Kuwaiti adolescents (males and females) showed higher prevalence of disordered EA than their counterparts in other countries. The risk of disordered EA among obese adolescents was two to three times higher than that of non-obese adolescents, in both genders. Excepting Kuwaiti females and Palestinian males. The association of obesity with disordered EA was statistically significant. This study highlighted the magnitude of the risk of disordered eating attitudes among both male and female adolescents in Arab countries and identified the need for programmes to prevent and control these disorders in the Arab region.
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Cheney AM. Emotional distress and disordered eating practices among southern Italian women. QUALITATIVE HEALTH RESEARCH 2012; 22:1247-1259. [PMID: 22767701 DOI: 10.1177/1049732312449214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study is one of the first to examine the narrative links connecting social change, contested gender norms, body image, and eating disordered practices among southern Italian women. The research is based on 16 months of fieldwork, and I compare and contrast the stories of 23 educated women in southern Italy to highlight the contentious realities of entering adolescence in conservative social contexts where gender relations and value systems are undergoing rapid transformations. I examine how these young women dealt with conflicting cultural expectations of womanhood and whether it affected their emotional, psychological, and physical well-being. Their stories shed light on how parental control, community surveillance, and conflicts in developing gender identities and maturing womanly bodies contributed to their emotional distress. Distressed young women used rebellion and manipulation and control of food and the body to negotiate unjust social relations, specifically gender relations, that delegitimized their selves and, in some cases, their bodies.
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Affiliation(s)
- Ann M Cheney
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, Arkansas 72205, USA.
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Swami V, Mada R, Tovée MJ. Weight discrepancy and body appreciation of Zimbabwean women in Zimbabwe and Britain. Body Image 2012; 9:559-62. [PMID: 22717762 DOI: 10.1016/j.bodyim.2012.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/17/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Few studies have investigated a cultural group's corporeal experiences in both its country of origin and a host, Western country using the same methodology. To overcome this dearth in the literature, the present study examined body image among 140 women in Harare, Zimbabwe, and an age-matched sample of 138 Zimbabwean migrants in Britain. Participants completed measures of actual-ideal weight discrepancy, body appreciation, and lifetime exposure to Western and Zimbabwean media. Preliminary analyses showed that there were no significant differences in body mass index between the two groups. Further analyses showed that Zimbabwean women in Britain had significantly greater weight discrepancy and lower body appreciation than their counterparts in Zimbabwe. In addition, weight discrepancy and body appreciation among both samples were significantly associated with exposure to Western media, but not Zimbabwean media. These findings support the contention that transcultural migration may place individuals at risk for symptoms of negative body image.
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Affiliation(s)
- Viren Swami
- Department of Psychology, University of Westminster, London, UK.
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Latzer Y, Witztum E, Stein D. Eating disorders and disordered eating in Israel: An updated review. EUROPEAN EATING DISORDERS REVIEW 2008; 16:361-74. [DOI: 10.1002/erv.875] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cummins LH, Lehman J. Eating disorders and body image concerns in Asian American women: assessment and treatment from a multicultural and feminist perspective. Eat Disord 2007; 15:217-30. [PMID: 17520454 DOI: 10.1080/10640260701323474] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Eating disorders are one of the most lethal psychiatric illnesses and affect millions of individuals worldwide. While they have been more typically attributed to middle class, Caucasian, adolescent females, current research suggests that there is a similar prevalence of eating disorders and their symptoms, especially body dissatisfaction, among Asian American girls and women. Despite this, very little research has investigated how culture and gender may impact the assessment and treatment of eating disorders for Asian American women. This review examines the literature on the prevalence of eating disorders and negative body image in Asian American women and describes current research on the efficacy of a variety of theoretical approaches for treatment, including psychodynamic, cognitive-behavioral, and feminist perspectives. Recommendations for considering culture and gender when working clinically with Asian American women who experience eating concerns as well as suggestions for future research directions are provided.
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Affiliation(s)
- Lillian Huang Cummins
- California School of Professional Psychology, Alliant International University, One Beach Street, San Francisco, CA 94133, USA.
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Multidimensional Assessment of Body Dissatisfaction and Disordered Eating in Korean and US College Women: A Comparative Study. SEX ROLES 2006. [DOI: 10.1007/s11199-006-9058-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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le Grange D, Louw J, Russell B, Nel T, Silkstone C. Eating attitudes and behaviours in South african adolescents and young adults. Transcult Psychiatry 2006; 43:401-17. [PMID: 17090625 DOI: 10.1177/1363461506066984] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the presence and severity of disordered eating attitudes and behaviours in a group of 895 South Africans. The Eating Attitude Test-26 (EAT-26), the Bulimic Investigatory Test, Edinburgh (BITE) and the Rosenberg Self-esteem Scale (RSE), were administered to high-school and college students (515 White, 126 Black, and 254 'Coloured'). There were few differences between these three groups on measures of eating disorder pathology and self-esteem. A small number of participants (3.5%) were identified as at 'high risk' for an eating disorder as shown by scores in the clinical range for both the EAT-26 and BITE. Weight, self-esteem and age were predictors for this subgroup. This study suggests that ethnicity per se may not 'protect' against the development of disordered eating attitudes and behaviours in nonwestern black populations. These findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.
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Affiliation(s)
- Daniel le Grange
- Department of Psychiatry, Section for Child and Adolescent Psychiatry, University of Chicago, IL 60637, USA.
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Vazquez R, Carrera O, Birmingham L, Gutierrez E. Exploring the association between anorexia nervosa and geographical latitude. Eat Weight Disord 2006; 11:e1-8. [PMID: 16801733 DOI: 10.1007/bf03327745] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This paper explores the relationship between anorexia nervosa (AN) and climate by mapping the distribution of references of AN in the literature at different latitudes. METHOD The distributions of the bibliographic references of two medical disorders -psoriasis and cataracts-, and four mental disorders -AN, anxiety disorders, seasonal affective disorders, and schizophrenia- were mapped according to the institutional affiliation of their first author. RESULTS The distribution of references to AN was quite similar to the mental and medical disorders associated to high latitudes, although references to AN were more frequent in the range of 40 masculine-55 masculine in the Northern Hemisphere. DISCUSSION The psychosocial and sociocultural features of 'cultures' do not exhaust the factors defining the environment in which we live. Our findings indicate that climatic parameters, such as latitude may be a relevant factor in the occurrence of AN.
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Affiliation(s)
- R Vazquez
- Departamento de Psicología Clinica y Psicobiología, Universidad de Santiago de Compostela, 15706 Santiago de Compostela, Spain
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Jennings PS, Forbes D, McDermott B, Hulse G, Juniper S. Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students. Aust N Z J Psychiatry 2006; 40:143-9. [PMID: 16476132 DOI: 10.1080/j.1440-1614.2006.01761.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand. METHOD Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI). RESULTS Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.
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Affiliation(s)
- Piangchai S Jennings
- School of Psychiatry and Clinical Neurosciences, Princess Margaret Hospital for Children, The University of Western Australia, Perth, Australia.
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Soh NL, Touyz SW, Surgenor LJ. Eating and body image disturbances across cultures: a review. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.678] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Fichter MM, Quadflieg N, Georgopoulou E, Xepapadakos F, Fthenakis EW. Time trends in eating disturbances in young Greek migrants. Int J Eat Disord 2005; 38:310-22. [PMID: 16254871 DOI: 10.1002/eat.20187] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established. METHOD Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX). RESULTS At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria. CONCLUSION Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.
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Cummins LH, Simmons AM, Zane NWS. Eating disorders in Asian populations: a critique of current approaches to the study of culture, ethnicity, and eating disorders. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2005; 75:553-74. [PMID: 16262514 DOI: 10.1037/0002-9432.75.4.553] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
There is increasing evidence that eating disorders are present among ethnically diverse populations, and researchers have suggested that investigations in this area may inform the field's understanding of how sociocultural factors are related to the development of eating disorders. Although it is generally accepted that sociocultural factors are key in eating disorder etiology, knowledge on how best to study these influences in diverse groups is still limited. In this article, the authors review how the research literature has explored relationships among culture, ethnicity, and eating disorders in Asian populations and critically examine strategies that have been used to investigate these issues across 1 ethnic/racial group. The methodological challenges encountered in these approaches are identified and considered in the provision of recommendations for future endeavors to improve the field's understanding of how culture is related to eating disorders.
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Affiliation(s)
- Lillian Huang Cummins
- California School of Professional Psychology, Alliant International University, CA 94133, USA.
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Le Grange D, Louw J, Breen A, Katzman MA. The meaning of 'self-starvation' in impoverished black adolescents in South Africa. Cult Med Psychiatry 2004; 28:439-61. [PMID: 15847050 DOI: 10.1007/s11013-004-1064-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent surveys in South Africa have demonstrated that disordered eating is equally common among black and white female students. Self-report measures have been used in these surveys to establish levels of disordered eating. One study in Tanzania, where a two-stage design was implemented, showed that upon interview the majority of participants did not present with disordered eating. The absence of two-stage studies in South Africa brings into question some of the findings from these surveys. In the present study, we surveyed a sample of black and white high school students in South Africa to establish the prevalence of disordered eating. In the second phase of this study, we attempted to interview those black students from one particular school who scored high on the eating disorder measures. This process proved both challenging and elucidating. While a significant number of young black females endorsed eating disorder symptoms on self-report, interviews with some participants showed that self-starvation and related symptoms had a different meaning from what we would typically expect from someone with an eating disorder. Consequently, this study highlights the need to revisit the methods typically employed in cross-cultural research in eating disorders. Careful consideration of a variety of cultural factors that may alter the meaning of standard measures is called for.
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Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry, The University of Chicago, IL 60637, USA.
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Stock C, Kücük N, Miseviciene I, Petkeviciene J, Krämer A. Misperceptions of body shape among university students from Germany and Lithuania. HEALTH EDUCATION 2004. [DOI: 10.1108/09654280410525559] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hawkins N, Richards PS, Granley HM, Stein DM. The impact of exposure to the thin-ideal media image on women. Eat Disord 2004; 12:35-50. [PMID: 16864303 DOI: 10.1080/10640260490267751] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to experimentally examine the effects of exposure to the thin-ideal body image on women's affect, self-esteem, body satisfaction, eating disorder symptoms, and level of internalization of the thin-ideal. College women (N=145) were randomly exposed to photographs from popular magazines containing either thin-ideal images or neutral images. Exposure to thin-ideal magazine images increased body dissatisfaction, negative mood states, and eating disorder symptoms and decreased self-esteem, although it did not cause more internalization of the thin-ideal. Exposure to thin-ideal media images may contribute to the development of eating disorders by causing body dissatisfaction, negative moods, low self-esteem, and eating disorders symptoms among women.
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Keel PK, Klump KL. Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychol Bull 2003; 129:747-69. [PMID: 12956542 DOI: 10.1037/0033-2909.129.5.747] [Citation(s) in RCA: 318] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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.
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Tsai G, Curbow B, Heinberg L. Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors of Asian women. J Nerv Ment Dis 2003; 191:309-18. [PMID: 12819550 DOI: 10.1097/01.nmd.0000066153.64331.10] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study is an examination of the influence of sociocultural and developmental factors on body dissatisfaction and disordered eating attitudes and behaviors in two Asian populations: 298 Taiwanese-American (TA) women undergoing acculturating changes and 347 Taiwanese (T) women undergoing modernizing changes. Contrary to the initial hypothesis, body dissatisfaction rates and disordered eating attitudes and behaviors were found to be significantly higher in the T group. Subjects in the T group had higher Taiwanese ethnic identity scores but also lower perceptions of maternal control. Body dissatisfaction was found to be a moderating variable between ethnic identity and disordered eating attitudes and behaviors for the TA group only. The "girl next door" hypothesis, based on the social comparison theory, was set forth to help explain why this result was found only in the TA group. In the T group, ethnic identity and body dissatisfaction were independently associated with disordered eating. Results failed to support a link between parental control and the development of an eating disorder, and implications from a cross-cultural perspective are addressed.
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Affiliation(s)
- Grace Tsai
- Johns Hopkins University, Department of Health Policy and Management, Baltimore, Maryland, USA
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Emanuelli F, Ostuzzi R, Cuzzolaro M, Watkins B, Lask B, Waller G. Family functioning in anorexia nervosa: British and Italian mothers' perceptions. Eat Behav 2003; 4:27-39. [PMID: 15000986 DOI: 10.1016/s1471-0153(02)00097-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did the Italian mothers. In contrast, the Italians perceived their families' behavior control methods as less healthy than did the British mothers. The findings might be explained by differences between British and Italian interpretations of the role of "family," particularly giving the British emphasis on independence and the Italian emphasis on family life. It is suggested that these culturally divergent attitudes towards family life might have different influences on anorexia nervosa. Finally, implications for family therapy are discussed, taking into account those characteristics that are more relevant for each cultural group.
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Affiliation(s)
- Francesca Emanuelli
- Department of Psychiatry, St. George's Hospital Medical School, Jenner Wing, Cranmer Terrace, London SW17 0RE, UK.
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Al-Adawi S, Dorvlo ASS, Burke DT, Moosa S, Al-Bahlani S. A survey of anorexia nervosa using the Arabic version of the EAT-26 and "gold standard" interviews among Omani adolescents. Eat Weight Disord 2002; 7:304-11. [PMID: 12588059 DOI: 10.1007/bf03324977] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria. METHODS Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT-26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score. RESULTS The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%). DISCUSSION Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.
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Affiliation(s)
- S Al-Adawi
- Department of Behavioural Medicine, College of Medicine, Sultan Qaboos University, Muscat, Sultanate of Oman.
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Abstract
BACKGROUND There is debate as to whether eating disorders may be culture-bound. However, accumulating evidence suggests that eating disorders may be found outside of the West, although the precise form of the eating disorder may differ. AIMS There were two aims of this study: (1) to translate and establish the psychometric properties of standard questionnaires to measure eating pathology in a Georgian sample; (2) to use these measures to determine whether cases of eating disorders exist in Georgia. METHODS We held focus groups of various health professionals to establish how eating disorders present in Georgia and to identify groups perceived to be at high risk of having an eating disorder. We obtained translated versions of a number of standardized questionnaires (measuring eating and general psychopathology) from 245 women from these identified high risk groups and a subsample were given a structured clinical interview. RESULTS We estimated from the responses to the questionnaires, that as many as 5% may have clinically significant bulimia nervosa, 7% fell in the weight range for anorexia nervosa with a further 7% in the weight range for obesity. We interviewed a sample of the high scoring group which confirmed the presence of clinically significant eating pathology in the majority of those identified as possible cases. CONCLUSIONS The results of this study suggest there may be women in Georgia with significant eating problems.
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Al-Adawi S, Dorvlo ASS, Burke DT, Al-Bahlani S, Martin RG, Al-Ismaily S. Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents. J Am Acad Child Adolesc Psychiatry 2002; 41:1124-30. [PMID: 12218434 DOI: 10.1097/00004583-200209000-00013] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.
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Bhugra D, Bhui K. Eating disorders in teenagers in east London: a survey. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.486] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Caradas AA, Lambert EV, Charlton KE. An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls. J Hum Nutr Diet 2001; 14:111-20. [PMID: 11330260 DOI: 10.1046/j.1365-277x.2001.00280.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether differences exist in eating attitudes and body shape concerns amongst adolescent schoolgirls representing South Africa's ethnically and culturally diverse population currently undergoing epidemiological transition. METHOD A questionnaire survey, including the Eating Attitudes Test, Body Shape Questionnaire and a Body Silhouette Chart, was administered to 228 South African schoolgirls (60 black, 83 mixed race and 85 white) aged 15-18 years from five secondary schools in the greater Cape Town area. RESULTS Black girls had significantly higher mean BMI values (24.1 (3.3)) than either white (21.9 (3.0)) or mixed race girls (22.1 (3.7)) (P < 0.05). Controlling for differences in BMI, white subjects scored significantly higher on the Body Shape Questionnaire than did mixed race or black subjects, whereas no ethnic differences were found for Eating Attitude Test scores. A comparable percentage (mean = 18.8%) of black, mixed race and white girls had scores indicative of eating disorder pathology on the Eating Attitudes Test, while a higher percentage of white, compared to mixed race and black, girls had abnormal scores on the Body Shape Questionnaire (33%, 26% and 20%, respectively; P < 0.05). The ideal body size desired by white girls was significantly smaller than that of the mixed race or black samples. Dissatisfaction with present body size was significantly higher in white, compared to black or mixed race girls (P < 0.001). CONCLUSION These findings suggest that the prevalence of abnormal eating attitudes is equally common in South African schoolgirls from different ethnic backgrounds. White girls exhibit greater body image concerns and body image dissatisfaction than mixed race or black individuals. These findings reinforce the notion that eating disorders are culture-reactive rather than culture-bound phenomena and provide insight into the extent of eating-related problems and body image issues in developing societies.
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Affiliation(s)
- A A Caradas
- Department of Nutrition, Institute of South Africa, University of Cape Town
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Abstract
Cultural beliefs and attitudes have been identified as significant contributing factors in the development of eating disorders. Rates of these disorders appear to vary among different racial/ethnic and national groups, and they also change across time as cultures evolve. Eating disorders are, in fact, more prevalent within various cultural groups than previously recognized, both within American ethnic minorities and those in other countries. This review examines evidence for the role of culture as an etiological factor for the development of eating disorders. Historical and cross-cultural experiences suggest that cultural change itself may be associated with increased vulnerability to eating disorders, especially when values about physical aesthetics are involved. Such change may occur across time within a given society, or on an individual level, as when an immigrant moves into a new culture. Further research into the cultural factors that promote the development of eating disorders is much needed. Understanding how cultural forces contribute to the development of disorders is needed so that preventive interventions can be created.
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Affiliation(s)
- M N Miller
- Department of Psychiatry at the James H. Quillen College of Medicine, East Tennessee State University, Johnson City 37614, USA.
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Abstract
OBJECTIVE To investigate eating disorders (EDs) prevalence rates among Asian populations and identify characteristics that distinguish them from their Western counterparts. METHOD Potential references were identified through an English-language literature search using Medline, Psychinfo, Dissertation Abstracts (1966 to 1999) and through extensive manual searching of textbooks, reviews and reference lists. RESULTS The majority of studies related to EDs were conducted in Japan and China and a few were conducted in Singapore, Malaysia, Taiwan, and Korea whereas there was none in the Philippines, Laos, Vietnam, Cambodia, Myanmar, Indonesia and Thailand. Prevalence rates in Japan range from 0.025 to 0.030% for anorexia nervosa (AN) and from 1.9 to 2.9% for bulimia nervosa (BN). Community studies in China have found the AN prevalence to be 0.01% and BN rates ranging from 0.5% to 1.3%. These rates are lower than ED rates in the West (particularly the U.S. and Britain). Body dissatisfaction (BD) and dieting rates, however, were similar to those in the West. BD rates ranged from 68% (Taiwan) to 81% (Korea) and dieting rates ranged from 34% (Taiwan) to 68% (Japan). Sociocultural and developmental risk factors were relevant to this population. CONCLUSIONS EDs in Asian populations have received little attention because they have been predominantly viewed as associated with Western culture. Classified by many as a "culture-bound syndrome" of the West, they may really be a culture-change syndrome.
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Affiliation(s)
- G Tsai
- Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Baltimore, MD 21205-1099, USA
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Haudek C, Rorty M, Henker B. The role of ethnicity and parental bonding in the eating and weight concerns of Asian-American and Caucasian college women. Int J Eat Disord 1999; 25:425-33. [PMID: 10202653 DOI: 10.1002/(sici)1098-108x(199905)25:4<425::aid-eat7>3.0.co;2-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this research was to explore the associations among ethnicity, parental bonding, acculturation, and eating disturbance in Asian-American and Caucasian weight-concerned college women. METHODS Twenty-five Asian-American and 26 Caucasian weight-concerned women were administered the Eating Disorder Examination interview, the Parental Bonding Instrument, and three subscales of the Eating Disorder Inventory. Asian-American subjects also filled out the Suinn-Lew Asian Self-Identity Acculturation Scale questionnaire. RESULTS Contrary to hypotheses, weight-concerned Asian-American women reported more dissatisfaction with body shape than did Caucasian women. Moreover, in the Asian-American group, acculturation was not associated with level of eating disturbance. In both groups, perceptions of low maternal caring were associated with higher levels of eating problems. In regression analyses, maternal care emerged as a better predictor of eating disturbance than did ethnicity. DISCUSSION Results suggest that quality of parent-child relations, particularly the mother-daughter relationship, may be important in the etiology of eating problems, irrespective of ethnicity. Longitudinal investigations will be required to test causal relations.
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Affiliation(s)
- C Haudek
- Department of Psychology, University of Southern California, Los Angeles, USA
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Abstract
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.
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Affiliation(s)
- A Nishizono-Maher
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
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