Bulimia nervosa in Hong Kong Chinese patients

Readiness to accept Western standard of beauty and body satisfaction among Muslim girls with and without hijab

The purpose of this paper was to determine whether there is a difference in the readiness to accept Western standards of beauty in which thinness is an ideal of beauty and attractiveness, as well in body and appearance satisfaction between Muslim adolescent girls attending madrassa and dressing in accordance with tradition, that is to say wearing hijab, and Muslim adolescent girls who do not wear hijab and who follow contemporary Western-influenced fashion trends. Both of these groups were also compared to a non-Muslim group of adolescent girls. The sample consisted of 75 Muslim adolescent girls with hijab, 75 Muslim adolescent girls without hijab and 75 Orthodox adolescent girls. The following instruments were used: the Eating Attitudes Test (EAT-26), the Sociocultural Attitudes towards Appearance Questionnaire (SATAQ-3) and the Contour Drawing Rating Scale (CDRS). The highest level of body satisfaction (despite this group having the highest body weight in the sample) was evident among Muslim adolescent girls attending madrassa and wearing hijab. They also showed significantly less pressure to attain the Western thin-ideal standards of beauty than adolescent girls who accept Western way of dressing. Research results indicate a significant role of socio-cultural factors in one's attitude towards the body image, but also opens the question of the role of religion as a protective factor when it comes to the body and appearance attitude among Muslim women who wear hijab.

The myth of Chinese Barbies: eating disorders in China including Hong Kong

Much of the literature on eating disorders deals with Western subjects. Although the majority of those seen in clinical settings are Caucasians, reports from Asia suggest that anorexia nervosa and bulimia nervosa do occur in the Chinese, sparking debate as to whether or not it is the result of Westernization. This project begins with a review of the current literature on eating disorders in Chinese populations and the role of culture as a mediating factor. A psychodynamic conceptualization and the potential role of traumatic experiences are explored in the emergence of pathological eating habits. Research suggests that applying Western models for Chinese subjects with eating disorders may not always be appropriate.

The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987-2007)

OBJECTIVE

To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007.

METHOD

Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987-1997 (n = 67) and 1998-2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared.

RESULTS

Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients.

DISCUSSION

The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries.

Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan

BACKGROUND

Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.

METHODS

The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

RESULTS

The prevalence of individual EDs was much higher in the dance [0.7% for anorexia nervosa (AN), 2.5% for bulimia nervosa (BN) and 4.8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0.1, 1.0 and 0.7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.

CONCLUSION

EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.

A comparative study of body image of Australian and Pakistani young females

This research compares Australian and Pakistani females on body image attitudes. The sample consisted of Caucasian-Australian and Pakistani first year university students, ranging in age from 17 to 22. The Pakistani sample was subdivided into two groups: Urdu-medium and English-medium, representing the middle and upper social classes, respectively. The results revealed that, although all the groups identified a similar body shape as the 'ideal', the Australian females expressed significantly higher levels of body dissatisfaction on all measures of body image than did the Pakistani females. Within the Pakistani sample, females from the English-medium institutions expressed greater weight concern than did the Urdu-medium females. The findings are discussed in terms of the possible role of cultural values in shaping the body image attitudes of young females.

Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students

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.

Eating disorders in Asian populations: a critique of current approaches to the study of culture, ethnicity, and eating disorders

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.

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.

Caring for the hospitalized patient with an eating disorder

Effective nursing care for hospitalized patients with anorexia nervosa or bulimia nervosa is based on a comprehensive assessment, including medical and treatment history, mental status, and core eating disorder symptoms. Although most patients with an eating disorder are treated in an outpatient setting, hospitalization is appropriate for patients experiencing severe malnutrition or comorbidity or who are at increased risk for medical instability. Inpatient nursing care is directed at optimizing health status, including focused interventions directed at improving nutrition, cognition, coping, and medical stability.

Eating disorders in the Far East

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.

Disordered eating in three communities of China: a comparative study of female high school students in hong kong, Shenzhen, and rural hunan

OBJECTIVE

To examine disordered eating and its psychological correlates among female high school students in three Chinese communities that lay on a gradient of socioeconomic development in China.

METHOD

796 Chinese students from Hong Kong, Shenzhen, and rural Hunan completed a demographic and weight data sheet, the Eating Attitudes Test (EAT-26), a Body Dissatisfaction Scale (BDS), the Beck Depression Inventory (BDI), and the Rosenberg Self-Esteem Scale (RSES).

RESULTS

Compared to students in Hunan and to a lesser extent students in Shenzhen, students from Hong Kong were slimmer, but desired a lower body mass index (BMI), reported more body dissatisfaction, exhibited a more typical EAT-26 factor structure, scored higher on the "fat concern and dieting" factor, and constituted more EAT-26 high scorers. Multiple regression analyses indicated that BDS was the most significant predictor of fat concern at each site, but this effect was strongest in Hong Kong. Hunan students had significantly higher BDI scores but lower fat concern than Shenzhen and Hong Kong students.

DISCUSSION

The consistent gradient of fat concern across the three communities gives credence to the view that societal modernization fosters disordered eating in women, possibly via the gendered social constraints that accompany it. It is also expressive of the marked socioeconomic heterogeneity within China nowadays. The predictable rising rate of eating disorders that follows global change will pose a growing public health challenge to Asian countries.

Epidemiology of the eating disorders

Recent studies on the epidemiology of anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders in special populations and in other cultures are reviewed. In addition, studies on the epidemiology of dieting behavior and longitudinal studies of the outcome of dieting behavior are reviewed. It is concluded that anorexia and bulimia nervosa are uncommon disorders but probably have increased in incidence in recent years. However, they are one of the most common psychiatric disorders to affect young women in the west. Dieting behavior is a major risk factor in the pathogenesis of the eating disorders. The prevalence of the eating disorders in a given community is, therefore, correlated with the prevalence of dieting behavior in the community.

An epidemiological study of eating disorders in a northern area of Japan

A total of 97 patients with eating disorders who visited the Department of Neuro-Psychiatry, Yamagata University Hospital, between 1978 and 1992 were studied. According to the diagnostic criteria of DSM-III-R, there were 48 cases of anorexia nervosa (AN). 38 cases of bulimia nervosa (BN) and 11 cases with both AN and BN. Both the number of patients and the ratio to all out-patients in each year increased four times during the period 1988-1992 compared to the previous period. With regard to their places of residence, the number of patients with AN and with BN from every district appeared to increase at almost the same rate, although the majority of the patients were from medium-sized cities. These findings may indicate that eating disorders are influenced by urbanization.

Bulimia nervosa in the Chinese

Typical DSM-III-R bulimia nervosa with self-induced vomiting was found in 2 women of Hong Kong Chinese origin and a Chinese man from Malaysia. All 3 cases had a family history of obesity. In 2 of the cases a period of weight gain and in the third case frank obesity preceded the onset of the eating disorder. Cultural transition seemed to play an important part in the onset and maintenance of the eating disorder.

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.

How abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong

Using the 40-item Eating Attitudes Test and other self-report questions, a two-stage screening survey of 1020 (F 646, M 374) Chinese bilingual university students in Hong Kong showed that although female students were 'underweight' by Western standard, the majority of them and nearly all female students above a body mass index of 20.5 kg/m2 were cognitively inclined to diet and weigh less, albeit without being driven to actual weight control behaviour. In contrast, most male students and a minority of constitutionally thin female students clearly wished to gain weight. While a number of items were culturally inappropriate, factor analysis supported the overall cross-cultural conceptual validity of the EAT. The principal factor, reflecting dieting concerns, correlated positively with the current body mass index. Among the high scorers, only three female students with partial syndrome bulimia nervosa were identified, yielding a low prevalence of 0.46% for the spectrum of eating disorders. It is argued that the desire for slimness is widespread but its intensity and pathogenic potentiality vary across cultures. In the relative absence of obesity, it may not lead to more eating disorder.