Culture and Eating Disorders
by: Benjamin J. Calebs, B.A.
Eating disorders have traditionally been viewed as impacting the lives of non-Hispanic White women in Western countries. Relatedly, there have been debates about the degree to which eating disorders may be culture-bound syndromes (Keel & Klump, 2003). The DSM-5 defines a cultural syndrome as “a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context” (American Psychiatric Association, 2013, p. 14). As you can imagine cultural and ethnic differences in eating disorders are a very complex topic!
Some researchers have argued that eating disorder diagnoses such as anorexia nervosa and bulimia nervosa are culture-bound syndromes motivated by Western ideals of thinness, while others have emphasized the substantial biological and genetic components to eating disorders. After a review of the evidence on eating disorders across cultures and time periods, Keel and Klump (2003) concluded that bulimia nervosa is heavily influenced by culture, while anorexia nervosa is experienced similarly across cultures. The authors suggest that bulimia nervosa may be so influenced by culture because binge eating is reliant upon an individual having access to enough available food to have a binge episode. Relatedly, purging seems to predominately occur in cultures where thinness is highly valued (Keel & Klump, 2003).
In spite of the traditional view of eating disorders outlined before (i.e., that eating disorders are predominately seen in non-Hispanic White, Western women), it is now clear that disordered eating behaviors occur across different ethnicities and cultures. Lifetime prevalence rates of eating disorders vary among ethnic groups in the United States, yet disordered eating has been found among European Americans, African Americans, Hispanic Americans, and Asian Americans (for a recent review see: Levinson & Brosof, 2016).
Our lab recently completed a review on disordered eating across ethnic groups. I will discuss a bit about what this review found. African American women tend to show lower levels of disordered eating behaviors than European American women, which may be related to the lower levels of both body dissatisfaction and thin-ideal internalization reported by African American women as compared with European American women. Hispanic American women may have higher levels of binge eating than either European American women or African American women. Asian American women show lower levels of many disordered eating behaviors than European American women. Ethnic minority groups in the United States are less likely than European Americans to seek treatment for eating disorders, suggesting a further need to examine how cultural and ethnic differences relate to differences in eating disorder symptomatology and treatment.
Both similarities and differences in disordered eating symptoms have been found across cultures as well. Researchers have found that Japanese women may have levels of body dissatisfaction that are similar to women in the United States; yet there may be different motivations behind body dissatisfaction among Japanese women. For example, body dissatisfaction is largely motivated by the thin-ideal in American culture, while body dissatisfaction may be driven more by a desire for delayed maturation in Japanese culture. In Chinese culture, fear of fatness may play a role in body dissatisfaction similar to American culture.
However, such generalizations may be limited by common definitions of cultural and ethnic groups. For example, China is inhabited by 56 different ethnic groups. As was seen when looking at the differences in disordered eating between ethnic groups in the United States, it’s likely that variability exists in levels of disordered eating across ethnic groups in China (and everywhere!). Imprecise definitions of culture or ethnicity can contribute to difficulties in examining similarities and differences across cultures.
Eating disorders are the outcome of a complex interaction between a variety of factors, including culture, environmental risk factors, individual differences in personality, and genetic factors. In order to understand how to reduce the distress and impairment that eating disorders cause, it’s important to examine the unique contribution of each of these factors. In so doing, researchers and clinicians can create interventions that best meet the needs of diverse populations.