This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Cultural Differences in Eating Disorders by Alexis Pendarvis
Many people believe that Eating Disorders are associated with white, middle-class females. However, individuals from different cultures and ethnicities are also developing disordered eating behavior. The etiology of Eating Disorders is strongly related to social norms, culture, and ethnicity. Geophagia, for example, is the ingesting of non-nutritive substances such as clay or chalk during pregnancy or religious ceremonies. A diagnosis of pica would not be necessary for someone engaging in geophagia. Also, many religions fast for periods of time, but these periods would not warrant a diagnosis of Anorexia Nervosa. Many cultures however, are beginning to experience an increase in the prevalence of Eating Disorders, specifically Anorexia Nervosa and Bulimia Nervosa. Some studies have found an increase in eating related psychopathology among women around the world. White American women, African American women and Asian women are the most commonly studied populations when it comes to understanding Eating Disorders.
In many Asian cultures, they consider heavier people to have wealth and fortune and assume skinny people are suffering from poverty or being sick. In contrast to this belief, many Asian nations have experienced a rise in the prevalence eating disordered behavior. The prevalence of Eating Disorders has been on the rise in Japan since the 1980’s. Although the number of Eating Disorders has increased significantly, it is still low compared to Western countries. There is evidence of higher rates of Eating Disorders among Asian women than African American women. Unhealthy dieting behaviors start in adolescence in Japan, which is similar to Western countries. Japan and Western countries also have more young females with Eating Disorders or eating disturbance than men or older females. Obesity is a major concern in many Western countries but it is also on the rise in some Asian countries as well, including Japan. This increase in obesity has the potential to precipitate or worsen body image concerns as well as develop eating disturbance. The normal weight among adolescents has actually been getting lower over the past two decades. Body image disturbance and body dissatisfaction are growing in both Western and non-Western countries. Body disturbance can lead to a decline in health among those who experience it. The decline in health comes from extreme eating disorder behaviors including, restrictive dieting, excessive exercise and use of laxatives or diuretics. Body estimation among Japanese females may be distorted and many women desire to be thinner, regardless of their actual size. It has been suggested that women living in Western countries aspire to the thin ideal regardless of their cultural background. Therefore, it could be that as other countries become more Westernized or are more infiltrated by Western ideas, including the beauty myth, the rate of Eating Disorders and eating disturbances increase.
Many socio-cultural factors also contribute to Eating Disorders in all cultures, but Japan may have some factors that are particular to that culture. The tripartite model of body image disturbance includes three factors that can be socio-culturally influential – peers, parents, and media. The tripartite model factors are where many individuals develop a sense of their body and self-esteem. There are not enough studies on peer relationships among Japanese adolescents to confirm if it influences Eating Disorders, but research suggests that parents who over-protect their child’s eating can contribute to the development of Eating Disorders. Similar to that of Western countries, the more media that adolescents are exposed to in Japan, the more they develop a negative body image and come to accept the “thin ideal”. Some mothers in non-Western cultures pressure their children into losing weight or maintaining a thin figure, similar to some parents in Western countries. Also, some children develop their eating disturbance by copying the behavior of their mothers. Ultimately the Japanese culture has a strong ideal of thinness created by a mix of their own personal cultural values and Western ideals. Low self-esteem can lead to body disturbance and eating problems. Many adolescents face low self-esteem anyway, but Japanese females are attempting to balance their gender roles as liberated women and also conservative, traditional mothers. Females must likewise praise men and confirm their higher status in the virtual hierarchy. This can place a strain on their self-esteem and lead to eating disturbance.
Prevalence rates of Eating Disorders in African American women living in Western countries are on the rise. Research suggests that African American women were once less susceptible to Eating Disorders. One theory is that African American women did not internalize the negative body image comments of others. Non-internalization is a common coping strategy used to confront racism in the larger society, but also has the benefit of combating Eating Disorders. The use of non-internalization may be on the decline however, because Eating Disorders in African American women is now on the rise. However, research still shows white samples with more eating disturbance and body dissatisfaction. It may be that the rise of eating disturbance in non-white women is being caused by the changing economic and professional status of many ethnic minorities. Some could argue that as women increase their socioeconomic status their risk of yielding to unrealistic beauty ideals increases.
There is still disagreement about the actual prevalence of Eating Disorders in non-Western countries. The Western measurements (Eating Attitudes Test) used such as the DSM for diagnosing Eating Disorders often do not take religious, cultural, or beauty practices into account from other non-Western cultures. Therefore, clinical Eating Disorders and subclinical Eating Disorders have different prevalence rates across non-Western cultures. Eating disturbance is present in non-Western cultures, but may be more difficult to identify without knowledge of the culture. The increase in eating disturbance can soon lead to an increase in Eating Disorders. Western cultural ideals may be leading to the increase in eating disturbance. The beauty myth and other thin messages that come from the media need to be addressed to lower the prevalence of Eating Disorders in all cultures. Some cultures may have more access to such messages and the more access they have the more likely women in that area will develop eating disturbance or body dissatisfaction.