Social Cosmos

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Social Cosmos – URN:NBN:NL:UI:10-1-101272

Anorexia Nervosa in Adolescent Girls: A Culture-Bound Disorder of Western Society?
Elizabeth N. Hopton
Abstract
Drawing upon the present body of epidemiological and etiological research on anorexia nervosa (AN) this review paper investigates the role of modern Western society, and in particular the influence of the media, as a precursor to the underlying body image disturbances central to the current diagnostic definition of the disorder. Although cases of self-starvation have been documented throughout history, in contemporary psychiatry poor self-image (specifically body image disturbance) is conceptualized as a central feature of the pathology underlying the illness. In the lead up to the publication of the DSM-V an ongoing debate has emerged as to the true origins of anorexia nervosa, either as a uniquely modern culture-bound disease of Western society or as an historically continuous phenomenon spanning many centuries. From the former perspective, epidemiological studies indicate an ‘anorexia epidemic’ confined to young women in Western society, and the portrayal of the female body in the media presents as the popular culprit responsible for the alarming proportion of adolescent girls with body image concerns. From the latter viewpoint, however, epidemiological studies should be viewed with caution, and while the influence of the media in body image dissatisfaction has received some support, its role in the onset of AN remains tenuous, with many young women presenting with self-starvation in the absence of any obvious body image pathology. The current debate, although clearly unresolved, identifies areas for future research and challenges the present conceptualization of the illness, posing potential implications for its diagnosis and treatment. Keywords: anorexia nervosa, adolescent girls, body image, media, advertizing. Anorexia Nervosa in Adolescent Girls: A CultureBound Disorder of Western Society? Anorexia nervosa (AN) is a serious eating disorder

predominantly affecting adolescent girls (Hoek & van
Hoeken, 2003). The incidence among young women
aged 15-19 has been recorded as high as 135.7 per
100,000 per year, and the rate of incidence among
adolescent girls living in Western societies appears to
have been rising steadily throughout the latter half of
the previous century (Lucas, Crowson, O’Fallon, &
Melton, 1999). Furthermore, research undertaken at
the turn of this century suggests that the disorder is
sub-clinical in up to 10% of young women aged 1625 (Walsh, Wheat, & Freund, 2000). AN is associated with an array of lifethreatening health complications, such as heart arrhythmias, hypotension, and hypoglycemia (Attia,

2010; Robinson, 2000; Rome et al., 2003).
Adolescence is a time in which the body is
particularly vulnerable to the effects of malnutrition
and starvation, with even a short episode of AN
potentially resulting in a permanent stunting of
growth, infertility, and reduced bone calcification,
increasing the susceptibility for osteoporosis in later
life (Golden et al., 2003; Misra et al., 2004). Of those
who are diagnosed with the disorder less than half
fully recover within 10 years and in a quarter of cases
the disorder follows a chronic course (Walsh et al.,
2000). Moreover, with a mortality rate of 5% per year
AN is considered the most deadly of any psychiatric
illness (Harris & Barraclough, 1998; Sullivan, 1995).

While accounts of self-starvation date back
to the Hellenistic era, the first medical description of
AN was not published until the mid-19th century, and
it has been argued that the diagnostic classifications
in use today (DSM-IV and ICD-10) represent a
modern reconceptualization of the pathology
underlying the disorder (Habermas, 2005; Pearce,
2004,
2006).
Specifically,
contemporary
classifications of AN can be distinguished from
earlier medical definitions by their inclusion of poor
self-image (and...
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