Eating Disorders in Different Cultures

Abstract

The epidemiology of eating disorders in non-western cultures and among ethnic minorities in the west is reviewed. The evidence from case reports and the few epidemiology studies suggests that eating disorders are rare in these populations. However, high rates have been found in Japan and among South Asian schoolgirls in Britain. The use of western questionnaires and western diagnostic criteria in non-western cultures raises major methodological issues. Questionnaires designed for western populations when used cross culturally, must be evaluated for linguistic, conceptual and scale equivalence. This will clarify whether the questionnaire is satisfactory, whether modifications are required, or whether a new instrument needs to be developed. The validity of western diagnostic criteria also needs critical evaluation, since eating disorders may have different characteristics in non-western cultures. The question has been raised whether eating disorders are culture bound syndromes, specific to modern western culture. High rates of eating disorders have been reported in groups undergoing rapid westernization. Whether eating disorders occur in cultures untouched by western influence is still unknown. However, there is considerable historical evidence for self-inflicted fasting syndromes occurring in Europe in previous centuries. The importance of current western attitudes towards dieting and body shape in the aetiology of eating disorders may have been over-stated.