Self-starvation in context: Towards a culturally sensitive understanding of anorexia nervosa

doi:10.1016/0277-9536(94)00305-D

Social Science & Medicine

Volume 41, Issue 1, July 1995, Pages 25-36

https://doi.org/10.1016/0277-9536(94)00305-D Get rights and content

Abstract

Extreme forms of self-starvation can be traced across time and place, and may be construed using a variety of explanatory models. Curiously, the prevailing biomedical definition of anorexia nervosa has assigned primacy to the exclusive use of ‘fat phobia’ by the affected subjects to justify their diminished food intake. This paper assembles evidence to show that this culturally constructed version of fat phobic anorexia nervosa has neglected the full metaphorical significance of self-starvation and, when applied in a cross-cultural context, may constitute a category fallacy. By delegitimizing other rationales for non-eating and thereby barring subjective expressions, this regnant interpretive strategy may obscure clinicians' understanding of patients' lived experience, and even jeopardize their treatment. Nonetheless, it is a relatively simple task to attune the extant diagnostic criteria to a polythetic approach which will avert cultural parochialism in psychiatric theory and practice. As a corollary of the archival and ethnocultural study of extreme self-starvation, there is, contrary to epistemological assumptions embedded in the biomedical culture of contemporary psychiatry, no ‘core psychopathology’ of anorexia nervosa.

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Citation Excerpt :
Until then, it is possible that the behaviors associated with ON and their rationale constitutes the type of case that requires us to rethink the cultural influences on our understanding of eating disorders. We present an overview of the history of eating disorder classification (extending beyond prior historical accounts of “self-starvation,” such as Bemporad, 1996; Dinicola, 1990; Lee, 1995), discuss nosological criteria for diagnostic validity and utility, and review research on ON's classification to date in these contexts. Although AN was first introduced into the formal classification of the DSM in the mid-20th century (APA, 1952), early accounts reminiscent of modern-day eating disorders date back to the medieval times.
Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of “unhealthy foods.” Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed “unhealthy.” Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.
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L’anorexie mentale ne doit pas être considérée comme un syndrome spécifique d’une culture mais comme liée aux changements socioculturels rapides.
Son apparition peut être favorisée par certains phénomènes transculturels, comme la globalisation et le processus d’acculturation.
L’analyse d’un cas clinique d’une jeune personne anorexique en situation migratoire illustre la complexité et la nécessité d’une prise en charge psychothérapique transculturelle complémentaire, pour en améliorer la compréhension et le devenir.
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^∗: Present address: Department of Psychiatry, 11/F, Prince of Wales Hospital, Shatin, Hong Kong.

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Self-starvation in context: Towards a culturally sensitive understanding of anorexia nervosa

Abstract

Soc. Sci. Med.

Soc. Sci. Med.

Soc. Sci. Med.

Chin. Ment. Hlth J.

Soc. Sci. Med.

The Structure of Scientific Revolutions

Anorexia nervosa: levels of causation

Human Nature

Youth and psychosomatic illness

Anorexia nervosa: Its identity as an illness and its treatment

Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within

Anorexia Nervosa: Let Me Be

Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease

The ICD-10 Classification of Mental and Behavioral Disorders—Clinical descriptions and diagnostic guidelines

Fat phobic and non-fat phobic anorexia nervosa—a comparative study of 70 Chinese patients in Hong Kong

Psycho. Med.

From categories to contexts: a decade of the ‘New Cross-Cultural Psychiatry’

Br. J. Psychiat.

Anorexia nervosa in Hong Kong—a Chinese perspective

Psycho. Med.

A clinical study of Chinese patients with eating disorders

Chin. Psychiat.

A clinical report of nine cases of anorexia nervosa

Chin. Ment. Hlth J.

Eating disorders in Hong Kong

Br. J. Psychiat.

Socio-cultural factors in anorexia nervosa

Indian J. Psychiat.

Anorexia nervosa in people of Asian extraction

Br. J. Psychiat.

A clinical and psychosocial study of seven cases of anorexia nervosa in Singapore

Sing. Med. J.

Statistical studies on anorexia nervosa in Japan: detailed clinical data on 1,011 patients

Psychother. Psychosom.

Introduction

The application of the diagnostic criteria of the Chinese Classification of Mental Disorders

Chin. J. Nerv. Ment. Dis.

Anorexia nervosa (apepsia hysterica, anorexia hysterica)

Transact. Clin. Soc. (London)

The first great increase in anorexia nervosa

J. Soc. Hist.

Notes towards the history of anorexia nervosa

Janus

Holy anorexia in modern Portugal

Cult. Med. Psychiat.

The modern history of anorexia nervosa—an interpretation of why the illness has changed

Anorexia nervosa: fact and theory

Am. J. Digest. Dis.

Anorexia nervosa in Czechoslovakia

Int. J. Eat. Dis.

Clinical, psychiatric and endocrinological correlations in 42 cases of anorexia nervosa

Psychiatr. Pol.

Eating attitudes among adolescent anorexia nervosa patients and normal subjects in former West and East Berlin: a transcultural comparison

Int. J. Eat. Dis.