Written by Susana Cruz Garcia.
Our cultural context can influence the way we think and how we behave. Medical experts advise us to eat healthy. Self-appointed “lifestyle gurus” share their routines on social media. Popular media highlights increasingly unrealistic bodies and social media pressure encourages ‘selfie’ sharing and other visual chronicles of our daily existence. The messages we are getting and the digital age we are living in can naturally lead to assumptions that these cultural influences directly influence rates of eating disorders. This, however, is a bold and over-simplified misconception. It’s one of the many myths about eating disorders in popular culture and as always, we at the Columbia Center for Eating Disorders, would like to tease out fact from fiction.
Myth: Anorexia nervosa is a relatively new disorder.
Anorexia nervosa is a serious mental illness with amongst the highest mortality rates in comparison to other psychiatric conditions. It is characterized by:
- low weight or, in youth, failure to make expected gains in growth
- fear of fat or weight gain
- excessive concern with food, eating, calories, body shape or weight
- restrictive eating, and
- binge-purge behavior in a subset of individuals.
Anorexia nervosa is not only a complex and serious illness – it’s an old disease. The earliest description of symptoms characteristic of the disorder – extreme dietary restriction in the form of fasting – date back to the Middle Ages in some Italian, female saints.
St. Catherine of Siena, who was born in 1347 in that Tuscan hill town, about 30 miles south of Florence, is one such saint, described by scholars to have symptoms of what we would now recognize as anorexia nervosa. Her symptoms were initially understood within her cultural context. Starvation started off as a religious practice; to the vulnerable individual, then just as now, it ultimately took on a life of its own, at times resulting in death.
In 1689, the earliest medical description of anorexia nervosa was provided by an English physician, Richard Morton. In 1873, Sir William Gull, one of the Queen Victoria’s personal physicians, published a paper which established the term anorexia nervosa and described three cases. By the late 19th century, the disorder was widely accepted by the medical profession.
Myth: Rates of anorexia nervosa are on the rise.
The best information from the US and Europe actually suggests that the frequency of anorexia nervosa is stable (and, that the frequency of bulimia nervosa is declining!). Recent stats from American cohorts, which mirror those in the UK and Europe, indicate an average prevalence rate of 1%.
Myth: Western culture is the main factor explaining why people get eating disorders.
There is some truth behind the notion that the environment (culture, media exposure, etc.) impacts rates disordered eating behavior and body dissatisfaction. For example, among female university students, amount of social media use is positively correlated with unhealthy eating behaviors. Moreover, time spent viewing slim body representations on social media platforms was specifically related to greater body image concern. And in a study in Fiji examining the impact of the introduction of Western TV shows on young girls’ attitudes about appearance, researchers found that Fijian girls had internalized the beauty standards of the Western culture after having watched these TV shows for just one month.
However, the statistics alone remind us that exposure to content glorifying thinness or advising about healthy eating does not equal development of an eating disorder. In Western culture, nearly all people are exposed to these images and messages and yet, relatively few will develop full-blown eating disorders. It is likely the combination of culturally unhelpful messages in the biologically vulnerable individual that contribute to the onset of an eating problem.
Myth: Eating disorders, like anorexia nervosa, bulimia nervosa, and binge eating disorder only occur in Western culture.
Eating disorders do not discriminate and are known to occur across cultures.
As described above, for some eating disorders, the transmission of Western ideals (such as equating thinness with beauty) and economic factors (such as newly abundant food resources available for binge eating) may play a role in their development. Though eating disorders have been described across cultures, their frequencies and manifestations have not yet been well-examined. That is, misclassification may result from differences in the symptoms of eating disorders in different parts of the world and a lack of awareness of how to complete a culturally competent eating disorders assessment. For us to really understand the extent of the problem with eating disorders across the globe, we must remember what we do know – for example, that people with anorexia nervosa in Asia are more likely to complain of vague physical discomfort rather than describe a fear of fat, that in some places, traditional herbs may be misused for weight management, or that obsessionality about food may be a symptom of food deprivation due to poverty or food resources – and acknowledge what we don’t.
Eating disorders are complex and rare illnesses. There are several misconceptions about eating disorders that need to be debunked in order to better understand individuals who suffer from them. Studying Western cultural perspective’s impact on eating behavior and attitudes about appearance offers insights into the high prevalence of disordered eating and body dissatisfaction. Nonetheless, our culture does not unilaterally explain the presence of an eating disorder.