Cultural Variations in the Prevalence of Bulimia Nervosa
There are significant cultural variations in the prevalence of Bulimia
Nervosa, and it is vital to consider these when examining the etiology of this
mental disorder. National Institute of Mental Health (2009) prevalence rate is
between 2 and 3% of women and 0.02-0.03% of men in the US have been
diagnosed with bulimia. Frude (1998) female: male ratio of bulimia suffers is
approximately 10:1. Binge eating is the most common disorder and it affects
around 2% of all adults. Similar prevalence rates have been found in Japan and
some European countries. Keel et al. (2006) More than 5 million individuals are
believed to experience an eating disorder (bulimia or anorexia nervosa) in the
USA alone. Symptoms of bulimia, such as isolated episodes of bing eating and
purging, have been reported in up to 40 per cent of college women. Kender et al.
(1991) twin study. The prevalence of bulimia nervosa was 2.8% of those
interviewed. Crane et al (2009) prevalence rate is 3.2% in Tehran, 5.79% in Japan
for women ages 15-29 years of age. The countries represented here are all from
the USA, except for Crane et al, as the countries it represents are Iran and Japan.
The American Psychiatric Association (1994) states that immigrants from
cultures where these disorders are rare have been found to develop eating
disorders just as frequently as those born in industrialized societies, once these
ideals of attractiveness are assimilated. A study by Nasser (1986) compared 50
Egyptian women in Cairo universities. Twelve per cent of those in London
developed an eating disorder. None of those in Cairo did so. This shows that
culture does play an important role on the etiology of mental disorders. However,
another study conducted by Mumford (1991) found that Asian schoolgirls living in
Bradford, found that concerns about weight and body shape were more
commonly found among those girls who used Asian languages and wore Asians
dress. It has been suggested that the more traditional Asian girls might be
experiencing greater internal conflict about their identity as they grew up within
two sets of cultural values.
Jaeger et al. (2002) aimed to investigate body dissatisfaction, because it
had been identified in past research as a risk factor for bulimia and as dependent
on cultural factors. It was suggested that eating disorders are in fact western
culture-bound syndromes. However, few past studies have compared cultures
using rigorous methodology. This research aimed to gather reliable information
about body dissatisfaction and interrelated factors (self-esteem and dieting
behaviour), and consequent cultural differences in vulnerability to bulimia.
In total, 1751 medical and nursing students were sampled across 12 nations,
including western and non-western countries. This was a natural experiment, as
the independent variable (culture) could not be controlled by the experimenter. A
self-report method was used to obtain data on body dissatisfaction, self-esteem,
and dieting behavior. A series of 10 body silhouettes, designed to be as culturefree as possible, were shown to the participants in order to assess body
dissatisfaction. Body mass index (BMI), which takes account of height and weight,
was also measured.
Significant differences between cultures were obtained. The most extreme
body dissatisfaction was found in Mediterranean countries, followed by northern
European countries. Countries in the process of westernization showed an
intermediate amount of body dissatisfaction, while non-western countries
showed the lowest levels. Body dissatisfaction was the most important influence
on dieting behavior in most countries, and it was found to be independent of selfesteem and BMI.
The significant differences between cultures support the explanation that
bulimia is due to the ‘idealized’ body images portrayed in the media, which
encourage distorted views and, consequently, body dissatisfaction and dieting
behavior. Western countries are more exposed to these images, and they show
higher body dissatisfaction than non-western cultures. Perhaps even more
significant is the increase in body dissatisfaction in cultures undergoing
westernization, where exposure to idealized images is increasing. The implications
are that explanations of the disorder must be considered at a macro-level
(society), rather than as originating solely within the individual (micro-level).
However, the study raises some concerns. First it ignores the role of genetic
factors in causing bulimia, even though heredity certainly plays a part in the
development of the disorder. It is not easy to separate the influence of nature
and nurture, but it is oversimplified and reductionist to consider only one
explanation as a basis for eating disorders when where are many other possible
explanations. Second, this is a natural rather than a true experiment, because the
independent variable (culture) was not under the control of the experimenter.
Causation cannot be inferred if the independent variable was not directly
manipulated. As a result, it cannot be said that culture causes differences in body
dissatisfaction and the subsequent risk for bulimia. Third, the participants in the
study were all medical or nursing students. Such relatively well-educated groups
do not form representative samples, and it is not at all clear that other groups in
each country would have similar levels of body dissatisfaction.
In conclusion, this research above shows that there are significant cultural
variations in the prevalence of Bulimia Nervosa (Eating Disorders), and that
culture does have an important role on the etiology of mental disorders.