Until recently, anorexia nervosa was believed to be a disorder largely confined to the United States, Canada, and Western Europe. Researchers also thought that the disease was virtually nonexistent in people of color and/or those from disadvantaged socioeconomic backgrounds. As early as 1880, S. Fenwick observed that anorexia nervosa “is much more common in the wealthier class of society than amongst those who have to procure their bread by daily labor” (Fenwick 1880:11).This image of anorexia nervosa as a disease of abundance has persisted into the present day. Many researchers suggest that individuals from non-Western societies, minority groups, and impoverished backgrounds are “protected” from eating disorders because thinness is not highly valued in these communities, and fatness is often viewed as a sign of health and prosperity (Andersen and Hay 1985; Gray, Ford, and Kelly 1987; Gowers and McMahon 1989). The apparent absence of the disorder in developing nations and its high incidence among affluent social groups in Westernized countries led many clinicians to classify anorexia nervosa as a “culture bound” syndrome, meaning a disorder that is restricted to certain cultures primarily because of their distinctive psychosocial features (Prince 1985).
As a result of these views, none of the early literature on anorexia nervosa mentioned individuals from minority groups, non-Western countries, or lower socioeconomic classes (Bruch 1966; Kendall et al. 1973; Garfinkel and Garner 1980). The first cases of nonwhite anorectics appeared in a paper by M. P. Warren and R. L. Vande Wiele (1973), which noted 1 Chinese and 1 black person out of 42 patients seen at their New York clinic between 1960 and 1971. Other articles from the late 1970s and early 1980s mentioned one or two cases of nonwhite anorectics but did not offer any explanations of this phenomenon (Jones et al. 1980; Hedblom, Hubbard, and Andersen 1981; Garfinkel and Garner 1982; Roy-Byrne, Lee-Benner, and Yager 1984).
More recently, research on nonwhite and nonWestern anorectics has grown significantly: Investigators have identified cases of the disorder in Malaysia (Buhrich 1981), Greece (Fichter, Elton, and Sourdi 1988), Nigeria (Nwaefuna 1981), Zimbabwe (Buchan and Gregory 1984), and Ethiopia (Fahy et al. 1988). The non-Western country to receive the most attention from researchers has been Japan, probably because it is one of the most Westernized East Asian countries. In Japan, anorexia nervosa and a bingeeating syndrome called Kirbarashi-gui have been well documented by researchers for a number of years (Nogami and Yabana 1977; Azuma and Henmi 1982; Nogami et al. 1984; Suematsu et al. 1985).
Within the United States and Great Britain, there has been a growing body of research on the incidence of anorexia nervosa in blacks (Pumariega, Edwards, and Mitchell 1984; Andersen and Hay 1985; Nevo 1985; Robinson and Andersen 1985;White, Hudson, and Campbell 1985; Silber 1986; Gray et al. 1987; Hsu 1987;Thomas and James 1988), Hispanics (Silber 1986; Hiebert et al. 1988; Smith and Krejci 1991), Asian-Americans and British-Asians (Nevo 1985; Root 1990), and Native Americans (Rosen et al. 1988;White-house and Mumford 1988; Smith and Krejci 1991), as well as recent immigrants from Eastern Europe (Bulik
1987), the Middle East (Garfinkel and Garner 1982), and the Caribbean (Thomas and Szmukler 1985; Holden and Robinson 1988). Researchers have also challenged the notion that lesbians are “protected” from eating disorders because lesbian ideology challenges culturally prescribed beauty ideals (Striegel-Moore et al. 1990;Thompson 1994).
Although all of this recent research indicates that the number of reported cases of anorexia nervosa and other eating disorders is substantially lower in nonwhites, lesbians, and individuals from non-Western countries, there is a difference of opinion on what this implies about the actual incidence of eating disorders in these groups. Some researchers who have investigated anorexia nervosa in racial minorities have suggested that the disorder is linked more to socioeconomic class than to race and argue that the growing incidence of nonwhite anorectics reflects the growing economic prosperity of certain minority group members. These researchers argue that as nonwhites become more prosperous, their exposure to white, middle-class beauty standards increases, thereby making nonwhites more vulnerable to anorexia and other eating disorders. Because fewer nonwhites than whites belong to the middle and upper economic classes, fewer nonwhites become anorexic (Pumariega et al. 1984; Andersen and Hay 1985; Robinson and Andersen 1985;White et al. 1985; Gray et al. 1987; Hsu 1987;Thomas and James 1988).
Other investigators, however, have exposed methodological and philosophical flaws behind this kind of argument. Some have suggested that the reason there are so relatively few nonwhite anorectics is because people of color do not have the same access to health-care facilities as whites. Because most of the studies of anorexia nervosa record only those sufferers who come to the attention of medical and psychiatric facilities, nonwhites who lack access to these facilities will not be acknowledged by health-care researchers. Moreover, even those minorities who do have access to medical care may feel threatened by a white-dominated medical profession and/or may be embarrassed to seek help for a mental health problem. Thus, the actual number of nonwhites with anorexia nervosa in the general population may be greater than indicated by case reports (Rosen et al. 1988; Root 1990; Dolan 1991; Smith and Krejci 1991;Thompson 1994).
In addition, some have argued that racial stereotypes about who is most vulnerable to anorexia nervosa can explain the apparent rarity of the disorder in minority groups. Anorexia nervosa is frequently referred to in medical and popular literature as a “Golden Girl’s Disease” that afflicts only young girls from white, Western European, privileged backgrounds (Root 1990). Consequently, this ethnocentric bias may lead medical personnel to misdiagnose or underdiagnose eating disorders in persons of color (Silber 1986; Hiebert et al. 1988; Rosen et al. 1988; Dolan 1991;Thompson 1994).
Even those who agree that minority group status may “protect” nonwhites from eating disorders also argue that this status does not necessarily protect specific individuals within these groups. As Maria Root (1990: 534) notes in a recent article on eating disorders in women of color: “Individuals within each racial/ethnic group are subject to the standards of the dominant culture, particularly when the culture-of-origin is devalued by the dominant culture.” Because thinness in Western and Westernized societies is associated with higher social class, and the attendant social power, resources, and opportunities, some individuals of color may see the pursuit of a slim body-type as a ticket to upward social mobility and acceptance by the dominant culture (Root 1990; see also Silber 1986 and Thompson 1994).
Whatever the explanation, the standard image of anorexia nervosa as a privileged white girl’s disease is increasingly being called into question. The disorder has been detected in a variety of racial, ethnic, and socioeconomic groups and in both Western and nonWestern societies, although at the moment the number of cases among these groups appears to be relatively rare. Clearly, more research is needed before any definitive statements on the incidence and form of eating disorders in nonwhite and non-Western groups can be made.
Heather Munro Prescott
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World History
