Anorexia Nervosa

CULTURAL FACTORS IN PSYCHIATRIC DISORDERS [excerpt]


Wolfgang G. JILEK, M.D.,M.Sc.,M.A.,Dipl.Psych.,FRCP(C)
Clinical Professor Emeritus of Psychiatry, University of British Columbia, Vancouver, Canada
Past Chairman, Transcultural Psychiatry Section, World Psychiatric Association
Paper presented at the 26th Congress of the World Federation for Mental Health, July 2001.

The characteristic clinical picture of anorexia nervosa first appeared among daughters of the Western bourgeoisie in the 19th century, and the typical fatness phobia was not described until 1930 [BRUMBERG 1988; PFEIFFER 1994]. For some time anorexia nervosa remained a condition predominantly afflicting female teenagers in relatively affluent families of Western Europe and North America. However, in the decades following the postwar recovery a veritable psychosocial epidemic of anorexia nervosa developed and spread over Western, then also over Southern Europe, finally involving young women of all socioeconomic classes, emulating the fashionable body shape of movie stars and beauty queens who became ever thinner [SELV'INI-PALAZZOLI 1985; CABALLERO 1995; TORO, SALAMERO & MARTINEZ 1994]. In North America the incidence of anorexia nervosa increased dramatically since the 1960s, coinciding with a drastic change in the feminine body ideal towards thinness, as propagated by the fashion lords and publicized by the media [GARNER & GARFINKEL 1980; JONES et al. 1980; LUCAS et al. 1991]. It is of interest that the weight tables used by American physicians, supposedly objective scientific measures of "normal" standards of health, followed the fashionable downward trend in female body weight [RITENBAUGH 1982]. The increasing frequency of anorexia nervosa is associated with socio-cultural factors such as disturbance of intrafamily relations due to the nuclearization and limitation of Western families, and the penetrant influence of the mass media popularizing Hollywood-type life styles and beauty ideals. Since the 1980s, cases of anorexia nervosa have also become increasingly known in non-Western countries among young women in social strata exposed to heavy Westernizing influence, notably in Japan and Hong Kong [Di NICOLA 1990; LEE et al. 1993]. The epidemic spreading of anorexia nervosa among young females of all Western countries, and among certain Asian populations and immigrants under Westernizing influence, links this syndrome to socio-cultural emphases and developments in modern Western societies [Di NICOLA 1985; 1990; SELVINI-PALAZZOLI 1985; BRUMBERG 1988; GORDON 1990; WEISS 1995].

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