Eating Disorders Are Culturally Bound Syndromes Essay Example
Abstract
Eating Disorders such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN) typically afflict women from adolescence to their mid twenties (Griffin, 2003). The multifactorial nature of eating disorders include the biological, familial and environmental contributions that differ in each individual (Griffin, 2003). This combination of factors makes it difficult for researchers to pinpoint the exact contributions of each factor.
The societal and cultural factors that may, in part, contribute to anorexia nervosa and bulimia nervosa may resemble a culture-bound syndrome. This begs the question could Western culture be a significant factor that influences the development of eating disorders? The contemporary view of the causes of eating orders has failed to acknowledge the “inherent pathogenic qualities in our culture that play a significant role in the development of eating disorders” (Griffin, 2003).
The disproportionately high pressure that W
...estern society puts on women to be thin and beautiful demonstrates this. Literary analysis has shed light on the importance of this correlation by comparing the incidence of such disorders in Western and non Western societies. The conclusion that was drawn from these studies indicated that Anorexia nervosa is not a culture bound syndrome, in contrast, bulimia nervosa is a culture bound syndrome.
Introduction
Eating disorders are characterized by a disturbance in eating behaviors; this maladaptive behaviors is detrimental to the the individual's health and ability to their function adequately (Hooley, 2017). These are disorders that are characterized by extremes (Judd pg. 24), examples include caloric restriction, binge eating and compensatory behaviors.
Commonly, these behaviors are accompanied by other disorders, most notably, and discussed later in this paper are anxiety disorder and attachment disorder (Judd pg. 25). Individuals with AN or BN share
common preoccupation with their shape and their weight (Hooley, 2017). Specifically, Anorexia Nervosa is characterized by a relentless mission to lose weight and is accompanied by severe body dysmorphia.
A defining sign of individuals that suffer from anorexia is that they are severely underweight (Hooley, 2017). Individuals with BN markedly different from those suffering from AN. Individuals that suffer from BN are difficult to diagnose due to the fact that their weight is typically normal or slightly overweight (Hooley, 2017).
Statement of the Problem
Eating disorders are generally more prevalent in Western industrialized countries including the United States, Canada and Japan (Paniagua). This has caused researchers to question if eating disorders became more common in this generation or has it been a disease that has been masked until now? The answer to this questions is that both are true.
The trends of eating disorders demonstrate that the rate of people with eating disorders have increased continuously since their recognition (Costin, 2007). As Carolyn Costin states, this sheds light on society’s increasing consumption and obsession with the idea of being thin, losing weight and the overall fear of being fat. The problem examined is the impact of Western values that trigger a number of stresses within populations of Western and Western influenced societies.
Understanding that, not only can these values affect the mental health of societies that are raised with Western value but it can also affect the mental health of females that are not, due to globalization and exposure to media that is predominantly Western. With that being said, this raises the possibility of a pandemic of eating disorder diagnoses in all kinds of societies and cultures.
Research Question
This paper pursues
the answer to the question: Is there evidence to support the theory that eating disorders are culture-bound syndromes? In order to determine the extent to which this is possible, qualitative cross-sectional studies are reviewed. The intention of this paper is to expose factors of the development of eating disorders that are contributing to the increase the incidence rates of those that suffer from eating disorders.
This in turn, is due to the increased international exposure to Western values and ideals. By examining the affected populations in Western and non-Western societies, one reveals the presence of eating disorders historically, shedding light on the societal factors that could contribute to its development.
Theoretical Background
Eating disorders are ironically considered to be modern disorders, yet pathological patterns of eating are evident dating back to the medieval era (Silverman, 1997). Descriptions of extreme fasting that resemble early signs of anorexia nervosa are also present as far back as the 12th century with religion being the cornerstone used as motivation (Vandereycken, 2002).
Historical cases of anorexia nervosa reveal that in the Victorian era, Anglo American girls were exposed to the religious fasting of Victorian Saints (Keel et al., 2003). Therefore, girls embraced the idea of fasting and adopted it into their own behaviors (Keel, et al., 2003). Specifically in the case of a young Welsh girl in 1847 who engaged in religious fasting became not only a source of inspiration for religious pilgrims but was also a tourist attraction (Keel et al., 2003).
Her behavior led to her eventual death, although it remained clear that her parents revered her and were committed to the fact that this was a reflection of their daughter’s deep faith
in a God, by her food refusal (Keel et al., 2003). Of the 260 anointed saints, 170 of them are described and have evidence recorded that reveal a eating pathology (Keel, et al., 2003).
This idea has serious implications and sheds light on the mindset that may have led to why eating disorders could be found at a higher prevalence in Western societies. This raises the possibility that the reason Western culture places such a high value and glorifies “thinness” in modern society had a religious origin.
Despite the fact that bulimia nervosa was recognized in the early 19th century, as previously noted, there are accounts of fasting saints that engaged in binge eating and self induced vomiting between the twelfth and seventeenth century (Keel et al., 2003). As described with Anorexia Nervosa, the religious association with eating disorders before their official recognition is incredibly telling. What is unclear is whether or not the motivation behind this behavior was to achieve a desired weight or to achieve spiritual purification (Keel, et al., 2003).
There is also evidence that supports the idea that the elites of the Roman Empire engaged in binge eating and purging that allowed them to be gluttonous and eat as much as they wanted (Keel et al., 2003). This demonstrates that the patterns of bulimia nervosa were associated with social status in previous centuries and it was therefore desired to binge and purge one’s food for it symbolized superfluity.
Although the religious and elitist ties that eating disorders are associated with historically, it is not uncommon that eating disorders have a comorbidity with a number of other mental illnesses. Additionally, there is a substantial amount of
research that supports the comorbidity of eating disorders and anxiety disorders (Keel, 2013).
The association between anxiety and disordered eating as a moderator of self worth is investigated by Bardone-Cone et al. (2013). It was determined that there is a substantial influence of weight and shame on self evaluation and that individuals that conform to such ideals are more likely to demonstration anxiety and dietary restraint. In the case of developing an eating disorder it is clear that symptoms of anxiety will appear in patients before the development of eating disorders (Kaye et al., 2004).
The reason for the development of eating disorder as a secondary diagnosis could stem from the need to alleviate anxiety in the short term, for example the behavior of caloric restriction implements a false sense of control. This suggests that interventions assigned to address the problems related to anxiety disorders might also be effective treatments of eating disorders (Keel, 2013).
Current research is also investigating attachment insecurity that may contribute to the development of an eating disorder. The theory of attachment hypothesizes that it is crucial for an infant to have repeated interactions and be in close proximity with their primary caregiver (Tasca et al., 2014). These interactions become encoded in the implicit memory system and develop into a working model that translates to adulthood (Tasca et al, 2014).
This model therefore encompasses the adults interactions with the world (Tasca et al., 2014). Adults that were raised with sufficient attachment have the ability to accept love and intimacy and support of others without feelings of anxiety and stress (Tasca et al., 2014). Recent studies of attachment and social disorders observed with eating disorders revealed
that there is higher prevalence of attachment disorders and insecurities with individuals diagnosed with eating disorders with a prevalence between 70 and 100% (Tasca et al., 2014). Not only is this incredibly telling about early environmental factors that put adolescents and young adults at risk but it also reveals a deeper cognitive fear of rejection that manifests itself physically.
Methodology
The methodology used in order to determine the prevalence of Anorexia Nervosa and Bulimia Nervosa in Western and Non-western cultures used a mainly quantitative analytical approach by
was analyzed by Klpublished journal article “Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing their Etiology”.
They began their research by investigating if the rates of both eating disorders have increased significantly over recent decades. The relevance of looking at this data provides strong evidence of secular increases caused by the recent emphasis on thinness (Keel et al., 2003). They used a meta-analysis to conduct their evaluation by examining the secular trends in incidence rates (Keel et al., 2003).
They then examined the cross-historical and cross-cultural sections. This kind of examination is classified as a qualitative review for the reason that they relied on specific cases historical for the sufficient detail of the presence of eating disorders (Keel et al., 2003).
Their examination was limited to public works only in order to ensure the permanent availability of the works within the public domain for independent evaluation by others. This analysis also included studies with non significant results that would alter the meta analytic findings to prevent “file drawer phenomenon” (Keel et al., 2003).
Literature Review
(1) Review of the literature of eating disorders reveals there is a substantial amount of multifaceted research that provides massive insight
to its development. The study conducted by Keel and Klump (2003) was by far the most in depth study that meticulously examined three aspects of eating disorders, the epidemiology of the syndrome, the historical evidence of the syndrome prior the formal recognition and lastly the cross-cultural evidence of the syndromes.
It provided insight into the history and origin of eating disorders. The sociohistorical aspect clearly demonstrates a pathogenic quality in our culture that as per, their research, has ties to religion, and in terms of bulimia nervosa, Western culture. Unlike previous conclusions, their study found that it is not black or white whether or not eating disorders are culturally bound or not, this was demonstrated by the fact that their research shows that anorexia nervosa is not a culture bound disorder, while bulimia nervosa is a culture bound disorder.
This sheds light on the importance of distinguishing the two syndromes. The fact that one kind of eating disorder is culturally bound and the other is not provides significant evidence to the fact that each of these syndromes should be researched independently and ultimately treated differently.
(2) In a study conducted to determine the relationship between anxiety, self worth and disordered eating by Bardone-Cone et al (2013) light was shed on the relationship of eating disorders and anxiety in Western societies. Their research demonstrated the strong correlation between anxiety and eating disorders. They also determined that a condition that strengthened the relation is the appearance contingent on self worth.
The significance of this study reveals, anxiety, which Western countries such as the United States are in the top five highest in the world is linked to self worth and the
development of eating disorders. In light of the connection that this study made and the high rates of anxiety in Western countries, it should be of no surprise that Western countries such as the United States are thought to have some of the rates eating disorder in the world. (SITE).
Results
Investigation of the leading studies of eating disorders reveal that the influences of Western societies do in fact contribute to the development of eating disorders, specifically that of bulimia nervosa. Conflicting evidence suggests that there is a clear implication of cultural values on the development of Anorexia Nervosa those specifically which ones that are involved are not known (Banks, 1992).
Discussion
Examination of the cross-historical and cross-cultural evidence used to determine if eating disorders are culturally bound or not demonstrated something that had not been previously investigated; the possibility that one eating disorder may not be culturally bound while the other in fact is. As was discussed previously, this was exactly the case. This provides insight into the importance of distinguishing types of eating disorders and of viewing them as independent syndromes. Therefore this study highlights this necessity.
As the cross-sectional studies revealed, self starvation can occur under any context (Keel et al., 2003), therefore what are the factors surrounding the BN patterns of behavior of binging and purging? The parallels in the appearance of BN in the elite of the Roman Empire and in Western urban society suggest that a factor that comes into play could possibly explain the culturally bound nature of this syndrome.
Cases of BN may be limited to places and periods where there is abundant food available (which is needed in order to binge). This
would be limited to members of elite groups and affluent families and therefore eliminates individuals part of a lower social strata due to the fact that they simply do not have access to large quantities of food.
The second factor that is necessary is the ability to purge and prevent weight gain without detection (Keel et al, 2003). Significantly, purging may be limited in the context of prevention of weight gain is “culturally meaningful”. The cultural meaning behind preventing weight gain is significant because of the Western ideals that idolize thinness.
Implications
The most important implications of these study demonstrate the need to explore the values that certain societies hold to a high regard.
The limitations of this research reviewed on the culture bound aspect of eating disorders are concerning the definition of what is considered a Western vs. non-Western culture. Unfortunately this does not clearly create two populations of people for the reason that globalization is inherently a Western phenomenon and therefore it is near impossible to not only with certainty and accuracy know degree of exposure certain regions have.
References
- Bardone-Cone, A. M., Brownstone, L. M., Higgins, M. K., Fitzsimmons-Craft, E. E., & Harney, M. B. (2013). Anxiety, appearance contingent self-worth, and appearance conversations with friends in relation to disordered eating: Examining moderator models. Cognitive Therapy and Research.
- Hooley, J. M., Butcher, J.N, Noc, M., & Mineka, S. (2017). Abnormal Psychology. Boston: Pearson.
- Paniagua, F. Culture- Bound Syndromes, Cultural Variations and Psychology
- Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & the Price Foundation Collaborative Group. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. The American Journal of Psychiatry, 161, 2215–2221. doi:
10.1176/appi.ajp.161.12.2215.
