The copious amount of research available on eating disorders is overwhelming to sift through, yet one factor seems unchanged throughout it all. Early research mainly focused on upper to middle class female Caucasians living in western cultures. Thus, forming a correlation between eating disorders and western culture, theorizing the notion that eating disorders are a culture-bound syndrome. However, eating disorders transcend this notion, they are non-discriminatory, complex medical conditions with underlying psychiatric afflictions that can have a significant impact on anyone, anywhere. It is also important to understand and consider the negative impact social media has on body image and the cultivation of an eating disorder. While the prevalence of eating disorders has been known to be primarily located in western cultures, continued research indicates this is not a culture-bound syndrome, but a medical illness that knows no race, color, or gender; a medical illness that has vast influence from social media and peer pressure.
The most common eating disorders include anorexia nervosa, bulimia nervosa and binge eating. Anorexia was “introduced as a new illness in the late 19th century… characterized by self-starvation and excessive weight loss” (Striegel-Moore & Bulik, 2007). Those suffering from anorexia limit their food intake drastically or self-imposed starvation, to initiate and maintain weight loss as they have an intense fear of weight gain. .9% of American women suffer from anorexia and about half have comorbid anxiety or mood disorders (Yoshie, Kato, Sadamatsu, & Watanabe, 2017). Eastern culture has no reported cases of anorexia, but this does not mean there are no sufferers, in their culture this would bring shame to the family so it is not brought to light. Bulimia nervosa has been described as “an ominous variant of anorexia nervosa” (Striegel-Moore & Bulik, 2007) where a perpetual cycle of binge eating followed by self-induced vomiting is implemented. Again, with an extreme concern for body image. About 1.5% of American women suffer from bulimia (Striegel-Moore & Bulik, 2007). Bulimia is the most common eating disorder to cross cultural borders, with .5% to 3.2% suffering compared to western culture (Jackson & Chen, 2011). Binge eating is similar to bulimia where as you eat uncontrollably, however, you do not self-induce vomiting or exercise. About 3.5% of women and 2% or men suffer from binge eating (Strand, 2018).
Eating disorders kill. This disease actually has the highest mortality rate of any mental illness (Jacobs, et al., 2009). If a patient is so lucky to get treatment in time, there are still long term effects of their eating disorder. The brain actually shrinks due to lack of nutrition with a proportionate lowering of IQ. The skeletal system is damaged, especially if the anorexia occurs in adolescents before the bones are fully developed. Nearly 90% of women with anorexia experience osteopenia and 40% have osteoporosis. This bone loss is usually permanent. Infertility is generally an irreversible side effect as well (Cummins, Simmions, & Zane, 2005).
As with most mental illnesses, eating disorders are not caused by one factor alone, rather a multitude of psychological, sociocultural and biological factors. Biologically, patients generally have “a deficiency or excess of certain neurotransmitters and have a genetic predisposition to eating disorders through depression and anxiety” (Striegel-Moore & Bulik, 2007). Also, genetically, if parents has a lower metabolism their children will more than likely inherit said trait. This makes it so, through conventional dieting weight loss is unachievable leading to an eating disorder. It is important to note, “once a person begins to starve or purge, those behaviors in and of themselves have the power to alter brain chemistry and prolong the disorder” (Strand, 2018).
On the sociocultural and psychological side, patients exhibit low self-esteem, over controlling parents which instills a drive for perfectionism, or are influenced by cultural norms displayed through media. Focusing on the perfectionistic factor, those with eating disorders tend to have unrealistic and unattainable expectations of themselves. Often people set these goals to combat their feelings of low self-esteem or sense of worthlessness. This thought process of, if I can achieve this unattainable goal gives a momentary sensation of control. This attribute has been linked more often than not to Asian parents in eastern cultures. The Frost Multidimensional Scale, was used to assess levels of perfectionism in those suffering with an eating disorder and compare results between east and west. The scale addressed concern over mistakes, personal standards, parental expectations, parental criticism, doubts about actions and organization (Chang , Yu, & Lin, 2013). Where Asian subjects scored higher on the scale of parental pressures, European subjects scored higher on the direct peer influence. “Research on Americans has established that social comparison often sustains or exacerbates negative self-appraisals” (Teo & Collinson, 2018). Self-appraisals or body-checking behavior and depression a few comportments of eating disorders that have been found in both western and eastern cultures. According to research done on Japanese University students, “eating disorder tendencies are positively correlated with greater risk or body-checking behavior, depression and obsessive behavior” (Yoshie, Kato, Sadamatsu, & Watanabe, 2017).
Mass media provides an ominously persuasive platform for individuals to “learn” about body ideals and the value placed on attractiveness. Anyone connected to their phones is bombarded by thousands of images but those predisposed to eating disorders, use these images as a benchmark. Cultural pressure to be unrealistically thin portrayed by models in the media are a huge factor contributing to the rise of eating disorders. “On average, the average American child watches more than 21 hours of television a week” (Jacobs, et al., 2009), this is not counting social media time. In commercials, happy people are portrayed by fit models, stylishly dressed seemingly well put together. This influence can contribute to a poor self-value. Not to mention the rise of cyber-bullying, making it that much easier for a bully to infiltrate someone’s life constantly. Social media is not the cause of an eating disorder but a factor in the development of the issue. Unfortunately, social media is not reality but depicts a perfect life. Young people perceive this as reality and this manifests into unattainable goals to keep up.
One subdivision of eating disorders is Orthorexia, defined as “an unhealthy obsession with eating healthy foods… cases of orthorexia have been found in populations who take an active interest in their health and body and frequently comorbid with anorexia” (Turner & Lefevre, 2017). Disregarding the addition of anorexia, orthorexia can seem pretty harmless to some. The introduction of this subdivision is relevant to show the impact social media has over society. A direct correlation has been found between Instagram use and orthorexia symptoms. “Higher Instagram use was associated with a greater tendency towards orthorexia, higher use linked to increased symptoms” (Turner & Lefevre, 2017). This direct relationship highlights the implications social media can have on the psychological well-being and influence social media ‘celebrities’ can have over the thousands of followers they have. This correlation is present, not only in westerners with eating disorders but easterners as well. “In the United States, the portrayal of thinness as an ideal of feminine beauty in popular media has contributed to an unhealthy body ideal a causal risk factor for developing eating disorders… Similarly, Asian cultures have displayed comparable thin idealization” (Teo & Collinson, 2018). Asian’s experienced similar social comparisons as their western counterparts.
When comparing the eastern and western cultures, it is clear to see differences between the two, whether it be causes or sheer number of cases. Many of these differences can be attributed to cultural differences in translation or the relevance of the questions to the audience. “This pattern where symptom rates are similar or higher yet the prevalence of diagnosable eating disorders is still relatively low, suggest that the current diagnostic algorithm for assessing eating disorders may be less relevant for Asian populations. In other words, the western-based diagnostic criteria currently in use may not be appropriate for capturing the symptom patterns present among individuals living in Asian countries” (Cummins, Simmions, & Zane, 2005). Cultural bias in testing is extremely difficult to avoid when developing a test.
Differences can be recognized through the self-contractual variables, independent or individualism and interdependent or collectivism. Independent self-construal is characterized by the “uniqueness and separateness of an individual and is commonly found in individualistic cultures such as the United States” (Teo & Collinson, 2018). Independent self-construal persons value self-sufficiency and personal success. Where interdependent self-construal is characterized by “connectedness and relationships in collectivistic Asian cultures” (Teo & Collinson, 2018). Interdependent self-construal persons prioritize values like group cohesion, shame and harmonious relationships.
Too often the discussion of the etiology of eating disorders becomes separated into cultural versus biological reasoning’s, completely ignoring the fact that these variables are intricately associated. “Whether eating disorders are universal has been shown to depend on two factors, the methodology of historical research and the diagnostic criteria chosen” (Keel & Klump, 2003). As technology advances, hopefully the drive to create a standard test that is not culturally bias will prevail and be successful. This way accurate data can be available to precisely compare cultures on all issues, including eating disorders. Eating disorders are developed from an intense desire to achieve an impossible standard. However, beating them is possible if treatment is pursued in good time.