Anorexia Nervosa in Russia
By: Irina Vanzhula
I grew up in the city of Saint-Petersburg, Russia and moved to the United States 10 years ago. I have noticed many differences, including how women’s sizes are perceived in each country. A woman wearing dress size 8-10 in the US would be considered by most to be of normal weight, but in Russia, she would be called overweight. Most clothing stores do not even carry sizes higher than 10, and Plus size starts with 12. The “normal” clothing size in Russia is 0-4, and women go to considerable lengths to obtain this size at all costs. The thin-ideal is pervasive in Russian culture with its famous ballerinas and supermodels.
My 14-year old brother Vasya is a student at the world famous Vaganova Academy of Russian Ballet. He spends about 6 out of his 12-hour day dancing and only eats once a day. He is underweight, but is repeatedly told that if he gains weight he will be kicked out of the Academy. Vasya is not the only one. Although media’s focus on thin bodies is ubiquitous across countries, Russian women experience additional pressures to look “perfect.” Russia has approximately 85 men for 100 women, and considering very high rates of substance abuse in men, the number of ‘quality bachelors’ is even lower. To be competitive, Russian women pay extreme attention to their looks, including body weight and shape. It is considered necessary to dress up and do hair and make-up just to go to a grocery store, and wearing sweatpants in public is unthinkable. Much of woman’s value is based on looks, and being thin is a sign of having strong willpower and being successful.
Based on these observations, I suspect that prevalence of eating disorders and especially anorexia nervosa (AN) in Russia would be higher than in the US. Thus, I decided to do some research. My search revealed that no epidemiological studies have been done and no official statistic of eating disorders exists in Russia. Prevalence rates reported range from 0.5% (Bobrov, 2015) to 20% (Anorexia in Russia, n.d.). Since Russians don’t believe in mental illness and most people don’t seek treatment, the rates are likely underreported. A large population with subclinical AN symptoms may account for the large discrepancy in prevalence rates.
I continued my search to uncover how AN is portrayed in both internet and the scientific community. Most internet articles accurately described the disorder and emphasized fear of fat, perfectionism, and disturbed body image. Health complications were usually mentioned, but I did not find anything about high levels of suicide, which is likely due to the topic of suicide being a social taboo in Russia. One disturbing discovery was that the webpages that described the dangers of AN were full of advertisements of various diets. For example, next to the article “Anorexia – severe disease statistics” you can find “how to lose weight and keep it off forever” and advertisements of various diets (www.http://www.on-diet.ru).
Most internet articles recommended the help of a professional, but after reviewing treatment options, I lost most of my optimism. I did not find any specialized eating disorder clinics in the entire country, and help with AN was offered at general medical or psychiatric hospitals. One gastrointestinal clinic advertised AN treatment, but the treatment team consisted most of the dietitians and only one psychologist. Even the clinics that offer any kind of treatment for eating disorders are few and spread thin. Most clinics are located in Moscow and Saint-Petersburg. Considering size and population of the country, the majority of Russians don’t have access to any eating disorder treatment or even a therapist. Thousands of small Russian towns are lucky to have one general practitioner, and the closest psychologist is usually hundreds of miles away.
Next, I turned to scientific journals. Most of the information was consistent with that in US journals. I came across one surprising trend strongly linking AN with psychotic disorders. Bobrov (2015) describes AN as having inaccurate cognitive perceptions of reality and empathizes its high comorbidity with schizophrenia. Further, Artemyev & Vasiliev (2012) explain that some researchers see AN as a schizophrenia syndrome, citing an article from 1932, and report that schizophrenia precedes AN in 25% cases. In another study, out of 101 women with AN on inpatient psychiatric unit, 81 were diagnosed with schizophrenia (Artemyeva & Arsenyev, 2010).
Patients with AN often report that their family and friends find their eating disorder related beliefs strange and unusual, and refusing to eat despite life-threatening complications may be perceived as particularly strange. This interpretation may have led to over-diagnosis of schizophrenia in those with AN. However, recent studies report that prevalence of psychotic in those with AN is no higher than in general population (Seeman, 2014). Russian psychologists, however, may still over-diagnose schizophrenia, or these statistics are a result of a biased sample. They mostly studied patients in psychiatric hospitals, where comorbidity of severe mental disorders is high. On the other hand, new research revealed a genetic link between AN and psychosis (Duncan et al., 2017), so there may be some connection there after all.
One major implication of connecting AN with schizophrenia in the literature is increased stigma. If seeking treatment for AN means the high probability of being diagnosed with a psychotic disorder and likely prescribed anti-psychotic medication, it is not surprising that people would avoid it at all costs.
In conclusion, the amount of social pressure on all Russian women to be thin is incredible, and the standards are impossible to achieve. People who have symptoms of AN are admired and praised for their strong wills and dedication. The scientific community is lagging behind in proper diagnosis and further contributes to already high stigma of mental illness. Although rates of AN may be high in Russia, treatment options are almost non-existent. Epidemiological studies that bring attention to prevalence of AN in Russia and lack of treatment options are needed. While the research field is catching up, all of us can help increase awareness by making translated US articles available on the Russian web.