In “The BASH Magazine », Volume 7, Number 9, September, 1988 p. 210-215
By Vincenzo F. DiNicola, M.Phil, M.D., Dip.Psych., F.R.C.P.(C), Assistant Professor of Psychiatry, University of Ottawa ; Director, Family Psychiatry Service Royal Ottawa Hospital, 1145 Carling Avenue, Ottawa, Ontario, Canada KIZ 7K4
(The following paper was presented by Dr. DiNicola at the August 20, 1988, BASH meeting at Deaconess Hospital in Si. Louis. Missouri.)
SUMMARY
The hypothesis that anorexia nervosa (AN) is a culturebound syndrome (CBS) of developed, industrialized nations is examined. CBS are defined (Prince, 1985a). Five hypotheses of causation of AN (listed in order of level of complexity) am proposed :
(1) biomedical,
(2) psychodynamic (individual),
(3) family,
(4) feminist (social), and
(5) CBS (socio-cultural) hypotheses.
A comprehensive model must be able to integrate or refute each hypothesis and put forward the requirements to build its case in an empirical and refutable way.
Six kinds of observations comprise the requirements for a comprehensive model and support a socio-cultural approach (CBS) to AN :
(1) unequai sex ratio (female predominance).
(2) class bias (higher-class predominance),
(3) development gradient across cultures (predominance in developed countries).
(4) historical shift with increasing incidence,
(5) biological disturbances are secondary, and
(6) puberty as the psychobiolog » stress/trigger event (flawed by well-documented onset of cases before and after puberty).
Other studies that support the CBS approach am teviewed, including studies with dancing and modeling students. European transcultural studies, cross-cultural work on hwy image vocabulary, preferences and aversions in children, body image in puberty and pregnancy, and body image distoriions in eating disorders (AN, obesity).
Implications for classification generally, for DSM-111R and ICD-9 specifically, and for theory and treatment are discussed.
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