Are adolescents and young females from Western cultures the only sufferers of Bulimia Nervosa?

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Bulimia Nervosa is an eating disorder characterised by the recurrent binge eating of junk food, combined with self-induced vomiting, misuse of laxatives or extreme exercise (Wilson and Pike, 2001). Bulimia is 9 times more common in women than in men (Barker, 1993), and more prevalent in Western industrialised cultures (Nasser, 1986). It has been claimed that Bulimia Nervosa is a culture-bound syndrome (Keel and Klump, 2003); however recent evidence has suggested this is not completely true.

 Eating disorders were previously thought to be isolated to achievement-oriented, upper and middle class individuals in Western countries. Pate, Pumariega and Hester (1991) suggested that these disorders may be increasing in other sectors of society and in a number of diverse cultural settings. Eating disorders are, in fact, more prevalent within various cultural groups than previously recognized, both within American ethnic minorities and those in other countries. According to Nasser (1997, as cited in Gleitman, Gross and Reisberg, 2011), as cultures become more westernized, rates of bulimia nervosa increase.

However, there is also conflicting evidence. Davis, Clance and Gailis (1999) studied women living Canada, America, Africa and the Caribbean and took into account socio-cultural factors such as oppression, sexism and racism. They concluded that perceptions of body image change between African-American women and Caucasian women, with African- Americans having more body confidence and higher self-esteem.

 Bulimia is believed to be confined to women only, however recently Psychologists have also been interested in the increase of bulimia in gay and bisexual men. Feldman and Meyer (2007) estimate that 15% of gay or bisexual men have at some time suffered from bulimia, compared with less than 10% of lesbians and 8% of heterosexual women. It is not clear why some gay men suffer from eating disorders; one reason may be that they have similar views to women towards body image and physical appearance, the ideal of which is promoted in the gay community.

Another belief is that bulimia is restricted to adolescent girls and young women, yet recent research suggests that is not entirely the case. Mangweth-Matzek et al (2006) suggest that body dissatisfaction continues into old age. 475 60-70 year old women were analysed, out of this sample 3.8% met the diagnostic criteria for bulimia. Although this is a small percentage, it shows that eating disorders are not just confined to young women.

In conclusion, evidence suggests that bulimia nervosa is more a characteristic of Western cultures, where women have a preoccupation with thinness (American Psychiatric Association, 2000). Research also suggests that within these Western cultures it is not just women who are suffering, but also gay and bisexual men. It would be wrong to assume that only adolescent and young females are bulimic, as studies have shown that the disorder carries on into later life.

 

References

American Psychiatric Association (2000). Practice guideline for the treatment of patients with eating disorders (2nd Edn). Washington, DC: American Psychiatric Association.

Barker, S.E. (1993) Journal of Abnormal Psychology, Volume 102(1), Pages 173-176, US: American Psychological Association, February 1993. DOI: 10.1037/0021-843X.102.1.173

Davis, N.L., Clance, P.R., Gailis, A.T. (1999) Psychotherapy: Theory, Research, Practice, Training, Volume 36(1), Pages 27-35, US: Division of Psychotherapy (29), American Psychological Association, 1999. DOI: 10.1037/h0087643

Feldman, M.B., Meyer, I.H. (January 2007) Eating Disorders in diverse lesbian, gay and bisexual populations, International Journal of Eating Disorders, Volume 40, Issue 3, Pages 218-226. DOI: 10.1002/eat.20360

Gleitman, H., Gross, J., Reisberg, D. (2011) Psychology Eighth Edition, Chapter 16, Pages 669-670. Norton & Company, Inc., 500 Fifth Avenue, New York, NY, 2011.

Keel, P.K., Klump, K.L. (2003) Psychology Bulletin, Volume 129(5), Pages 747-769, US: American Psychological Association, September, 2003. DOI: 10.1037/0033-2909.129.5.747

Mangweth-Matzek, B. (2006) Never too old for eating disorders or body dissatisfaction: A community study of elderly women, International Journal of Eating Disorders, Volume 39, Issue 7, Pages 583-586, November 2006. DOI: 10.1002/eat.20327

Nasser, M. (1986), Psychological Medicine, 16, Pages 621-625, Cambridge University Press, 1986. DOI: 10.1017/S0033291700010370

Pate, J.E., Pumariega, A.J., Hester, C. (1992) Journal of the American Academy of Child & Adolescent Psychiatry, Volume 31, Issue 5, Pages 802-809. DOI:10.1097/00004583-199209000-00005

Pike, K.M., Wilson, G.T. (1994) Assessment of diagnostic features of bulimia nervosa: Interview versus self-report format, International Journal of Eating Disorders, Volume 16, Issue 1, Pages 75-81, Wiley Periodicals, Inc., A Wiley Company, 1994. DOI: 10.1002/1098-108X(199407)16:13.0.CO;2-E

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14 responses »

  1. The media also plays a huge part in the issue of eating disorders. As Western society produces the most of it, it can easily be assumed that Western cultures suffer the most from its negative consequences, however this is not always the case. It can also have a large impact on other cultures as well. Becker et al (1995) conducted a study in Fiji which looked at the outbreak of eating disorders after television was introduced. Some alarming statistics show that in 1998, 74% of the adolescents believed they were “too big or fat” and 15% reported using vomiting as a means of controlling their weight. Thus, looking at the findings, we can imply that the media is a great influential factor in eating disorders, and can effect most cultures – even those which actively promote a robust, muscular body type in both males and females.

    Becker, A. E., et al. (1995) Adaptation and Evaluation of the Clinical Impairment Assessment to Assess Disordered Eating Related Distress in an Adolescent Female Ethnic Fijian Population
    Doi: 10.1002/eat.20665

    • As you have shown, Becker et al have studied the effects of Western cultures upon people living in Fiji. Although investigators have suggested that the thin ideal for women represented in the media is related to the high rates of bulimia among females, little research has examined the relationship between media exposure and eating disorders.

      However, Stice et al (1994) assessed the relation of media exposure to eating disorder symptoms, and tested whether gender-role endorsement, ideal-body stereotype, and body satisfaction mediated this effect. In data from 238 female undergraduates, results revealed a direct effect of media exposure on eating disorder symptoms. Furthermore, links were found for gender-role endorsement, ideal body stereotype internalization, and body satisfaction. The results support the assertion that sociocultural pressures effect people’s vision of the thin ideal.

      • References

        Stice, E., Schupak-Neuberg, E., Shaw, H.E., Stein, R.I.(1994) Relation of media exposure to eating disorder symptomatology: An examination of mediating mechanisms, Journal of Abnormal Psychology, Vol 103(4), Nov 1994, 836-840. doi: 10.1037/0021-843X.103.4.836

  2. Eating disorders such as Bulimia Nervosa are often thought to be confined to societies in Western countries and is the ‘the price paid for Western civilization’ (Bemporad, 1996). However, research has found that disorders may be growing in other cultural settings. For example King and Bhugra (1989) used 580 schoolgirls living in a small North Indian town were screened using the EAT-26 (Eating Attitudes Test). 167 (29%) scored above the recommended cut-off point for the questionnaire, a high level of responses (68%) of those revealed that felt that food controls their lives, 61% attempted to display self control around food and 44% engaged in dieting behaviour-which demonstrate abnormal eating attitudes.

    References:

    Bemporad, J. R. (1996). Self-starvation through the ages: Reflections on the pre-history of anorexia nervosa. International Journal of Eating Disorders, 19, 217–237.

    King, M., & Bhugra, D. (1989). Eating disorders: Lessons from a cross-cultural study. Psychological Medicine, 19, 955–958

    • Sjostedt et al (1998) also used the Eating Attitudes test when comparing eating disorders in Australia with India. 297 Australian and 249 Indian university students completed the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982) and the Goldfarb Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1985). Contrary to predictions, the Indian participants scored significantly higher than the Australian participants on both measures. The Indian women scored significantly higher than the Australian women on the EAT-26 but not on the GFFS.

      This study further supports the idea presented by thailiafoo that not just western cultures are affected by eating disorders.

      References

      Sjostedta, J.P., Schumakera, J.F. & Nathawatb, S.S.(1998)Eating Disorders Among Indian and Australian University Students, The Journal of Social Psychology, Volume 138, Issue 3, pgs 351-357 (1998) DOI:10.1080/00224549809600387

  3. I agree with katierbradford about the media’s impact on eating disorders. The media promotes the idea of a perfect body through every form of media. Eating disorders are all about self image and in comparison to other countries such as those in the Middle East, there is a lot more of the body on show in western countries so those who develop eating disorders could do so because they worry that they are not attractive enough compared to others.

  4. Makino and Dennerstein (2004) looked at the prevalence of acting disorders in a comparison between severeal western and non western demographics using the eating attitudes test-26 (EAT-26). The EAT-26 itself has been criticised on its western foundation, and subsequently may not be applicable to other cultures. This piece of research has found a higher prevalence of bulimia in western cultures, however there has been a gradual increase in non western cultures.

    Keel and Klump (2003) suggest that changes in non western cultures may be due to socioeconomic changes such as economic growth. This relates to increases such as wealth. They suggest this by looking at sociohistorical factors. For example, western cultures were generally wealthier, so people would of had more food. This is important as one of the symptoms of bulimia nervosa is binge eating which requires a reasonable amount of food. The researchers suggest that developing countries would of had subsequently less food.

    One particular problem with both of these theories is that they follow the DSM -IV’s definition of Bulimia nervosa, which according to the Keel and Klumps research severely limits the scope of application in terms of relevance to the socioeconomic, sociohistorical, and other definitions of Bulimia.

    References:
    Keel, P.K. & Klump, K.L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, Vol 129(5), Sep 2003, 747-769.
    Doi: 10.1037/0033-2909.129.5.747

    Makino, M. & Dennerstein, L. (2004). Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries. MedGenMed. 2004; 6(3): 49. Retrieved from; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1435625/

  5. It was mentioned that bulimia is not only common in young women and evidence show that dissatisfaction with the body-image continues into later age. The study of Mitchell, Hatsukami, Pyle, Eckert & Soll (1987) was conducted to find out whether older people with bulimia were different in important ways and whether their symptoms were different. Two groups were compared, where one consisted 22 women, who indicated an onset of their eating disorder at age 25 or beyond and the other group with 22 women who had a more typical age of onset of bulimia, at age 20 or before. Results suggest that later onset of bulimia is more as a variant of an affective disorder, because it is often related to other psychopathology including depression and drug abuse. This research also highlights the need to investigate the hypothesis that suggest that the late onset group is probably less sensitive to cultural pressures concerning weight than early onset patients.

    Mitchell, J. E., Hatsukami, D., Pyle, R. L., Eckert, E. D. & Soll, E. (1987). Late onset bulimia. Comprehensive Psychiatry 28(4). doi: doi:10.1016/0010-440X(87)90068-X

    • Nossa, eu amo a coleção A–TDLE-OÁ no dia que lançou recebi a revistinha e pedi na hora, inclusive estou usando ele mas com um brilho chamado fashion tambem da avon.

  6. Eating disorders are more common amongst western women, but their is a misconception that it is only females who are suffering from eating disorders. Between 10-25% of people who suffer from eating disorders are men, and the numbers are rising. (mengetedstoo, 2011).

    Changing times and new pressures in the media are more of an influential factor for westerners, as society tells us we have to dress or look a certain way.
    Their was a dramatic increase in the frequency on how the media illustrated their articles, on the body images of models during the 1960’s – 1990’s. Whereas between the 1980’s – 1900’s body size decreased significantly, possibly to counteract the media coverage. (Sypeck, M,. James, J. 2004)

    Reference

    Mengetedstoo, 2011. Retrieved from http://mengetedstoo.co.uk/about-us/about-the-charity.

    Sypeck, M,. James, J. (2004) No longer just a pretty face: Fashion magazines’ depictions of ideal female beauty from 1959 to 1999. International Journal of Eating Disorders, Volume 36(3), pages 342-347, US: Oct 2004. Doi: 10.1002/eat.20039

  7. I would disagree with the assertion that bulimia is only suffered by women, homosexuals and bisexuals. It can also affect heterosexual men (Pope, Hudson & Jonas, 1986). There are cultural factors surrounding physical attractiveness that make women and homosexual men more vulnerable to developing bulimia, but there are also factors which make heterosexual men vulnerable, such as sporting fitness and bodybuilding (Gwirtsman, Roy-Byrne, Lerner & Yager, 1984; Goldfield, Blouin & Woodside, 2006) and social pressures that cause them not to seek help (Pope & Hudson, 1986). This biases the perceived number and ratio of heterosexual men that are affected by the disorder. It is believed with the continuing growing pressure of physical appearance and the obsession with weight both the number of men and women suffering from the condition will increase (Striegel-Moore, Silberstein & Rodin, 1986).

    References

    Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and bulimia nervosa in male bodybuilders. The Canadian Journal of Psychiatry/ La Revue canadienne de psychiatrie, 51, 160-168. Retrieved from http://psycnet.apa.org/psycinfo/2006-11306-005

    Gwirtsman, H. E., Roy-Byrne, P., Lerner, L., & Yager, J. (1984). Bulimia in men: Report of three cases with neuroendocrine findings. Journal of Clinical Psychiatry, 45, 78-81. Retrieved from http://psycnet.apa.org/psycinfo/1984-29116-001

    Pope, H. G., & Hudson, J. I. (1986). Bulimia in men. Medical Aspects of Human Sexuality, 20, 33-37. Retrieved from http://psycnet.apa.org/psycinfo/1987-22480-001

    Pope, H. G., Hudson, J. I., & Jonas, J. M. (1986). Bulimia in men: A series of fifteen cases. Journal of Nervous and Mental Disease, 174, 117-119. doi: 10.1097/00005053-198602000-00008

    Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia. American Psychologist, 41, 246-263. doi: 10.1037/0003-066X.41.3.246

  8. I would disagree with the assertion that bulimia is only suffered by women, homosexuals and bisexuals. It can also affect heterosexual men (Pope, Hudson & Jonas, 1986). There are cultural factors surrounding physical attractiveness that make women and homosexual men more vulnerable to developing bulimia, but there are also factors which make heterosexual men vulnerable, such as sporting fitness and bodybuilding (Gwirtsman, Roy-Byrne, Lerner & Yager, 1984; Goldfield, Blouin & Woodside, 2006) and social pressures that cause them not to seek help (Pope & Hudson, 1986). This biases the perceived number and ratio of heterosexual men that are affected by the disorder. It is believed with the continuing growing pressure of physical appearance and the obsession with weight both the number of men and women suffering from the condition will increase (Striegel-Moore, Silberstein & Rodin, 1986).

    References

    Goldfield, G. S., Blouin, A. G., & Woodside, D. B. (2006). Body image, binge eating, and bulimia nervosa in male bodybuilders. The Canadian Journal of Psychiatry/ La Revue canadienne de psychiatrie, 51, 160-168. Retrieved from ://psycnet.apa.org/psycinfo/2006-11306-005

    Gwirtsman, H. E., Roy-Byrne, P., Lerner, L., & Yager, J. (1984). Bulimia in men: Report of three cases with neuroendocrine findings. Journal of Clinical Psychiatry, 45, 78-81. Retrieved from ://psycnet.apa.org/psycinfo/1984-29116-001

    Pope, H. G., & Hudson, J. I. (1986). Bulimia in men. Medical Aspects of Human Sexuality, 20, 33-37. Retrieved from ://psycnet.apa.org/psycinfo/1987-22480-001

    Pope, H. G., Hudson, J. I., & Jonas, J. M. (1986). Bulimia in men: A series of fifteen cases. Journal of Nervous and Mental Disease, 174, 117-119. doi: 10.1097/00005053-198602000-00008

    Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia. American Psychologist, 41, 246-263. doi: 10.1037/0003-066X.41.3.246

  9. It is generally believed that western societies’ views of attractiveness are influential in the development of eating disorders. In western society the media are believed to be an influential source on adolescents with regards to body image. The role of very thin models on TV and in popular magazines is thought to affect adolescent girls in particular, with regards to their attitude to food consumption and body image. Becker (2002) reports on Fijian girls after TV was introduced in 1995. The girls stated a desire to lose weight to become more like Western TV characters. However Yamamiya (2005) found that if individuals are open to instructional intervention before their media exposure than any adverse effects are reduced.

    It is suggested that eating disorders are much more common among white, western women compared to non-western cultures and black populations in western cultures. Grabe and Hyde (2006) conducted a meta-analysis of 98 studies and found that African-American women had less body dissatisfaction than Caucasian and Hispanic females. Pollack (1995) also reported more positive attitudes towards larger body sizes for people from the Caribbean and Fiji. However, Cachelin and Regan (2006) found no significant difference between African-American women and white Caucasian participants and AN. They believed that the differences only exist in older adolescents.

    Similar to bulimia, Hoek (1998) tested the hypothesis that anorexia is rare in non-western cultures. Records of 44,192 people who were admitted to hospital between 1987 and 1989 in Curacao (a non-westernised society in which being overweight is acceptable) were examined and only 6 cases of anorexia were found. This supports the idea that eating disorders are primarily found in western societies.

  10. References:

    Becker, A. E. (2002). Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. The British Journal of Psychiatry, 180, 509-514. doi: 10.1192/bjp.180.6.509

    Cachelin, F. M., & Regan, P. C. (2006). Binge eating and purging in a multi-ethnic community sample. International Journal of Eating Disorders, 39(6), 523-526. doi: 10.1002/eat.20268

    Grabe, S., & Hyde, J. S. (2006). Ethnicity and body dissatisfaction among women in the United States: A meta-analysis. Psychological Bulletin, 132(4), 622-640. doi: 10.1037/0033-2909.132.4.622

    Hoek, H. W., van Harten, P. N., van Hoeken, D., & Susser, E. (1998). Lack of Relation between Culture and Anorexia Nervosa — Results of an Incidence Study on Curaçao. The New England Journal of Medicine, 338, 1231-1232.

    Pollock, N. (1995). Cultural elaboration of obesity – fattening practices in pacific societies. Asian Pacific Journal of Clinical Nutrition, 14, 357-360.

    Yamamiya, Y., Cash, T. F., Melnyk, S. E., Posavacc, H. D., Posavac, S. S. (2005). Women’s exposure to thin-and-beautiful media images: body image effects of media-ideal internalization and impact-reduction interventions. Body Image, 2(1), 74-80. doi: 10.1016/j.bodyim.2004.11.001

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