Discuss cultural and gender variation in prevalence of disorders

Discuss cultural and gender variation in prevalence of disorders
 Prevalence: A statistical concept in psychiatry refers to the percentage of individuals within a population who are
affected by a specific disorder at a given time.
 Cultural beliefs and attitudes have been identified as factors leading to the development of prevalence of eating
disorders (etiology). There are some disorders known as culture-bound syndromes, that is, disorders which exist
in one culture but not in others.
 Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic
efforts to avoid gaining weight such as induced vomiting, excess exercising and use of laxatives.
o Eating disorders affect 35% of the men and 65% women; most prevalent between11 – 13 years of age.
 Depression is a disorder characterised by prolonged feelings of sadness, hopelessness and guilt.
o Weisman et al (1996) found cross cultural variation in data from 10 countries; prevalence of depression
ranged from 19.0% (Lebanon) to 1.5% (Taiwan). The researchers argued that different risk factors, social
stigma, cultural reluctance to endorse mental symptoms may account for some of the differences.
o Marsella et al (2002) argue that depression is the foremost psychiatric problem due to natural disasters,
racism, poverty, war etc.
o Kleinman (1982) interviewed 100 patients diagnosed with neurasthenia using structured interviews based
on DSM-III to investigate if neurasthenia in china could be similar to depression in DSM-III; 87% could
be classified has being depressed, 90% complained of headaches, 78% insomnia, 73% dizziness and 48%
various pains; however depressed mood was only 9%. Neurasthenia could be a Chinese way of expressing
depression in somatic ways. Somatization is perhaps the cultural mode of distress in china but in the west
reference to mood (psychologization) is the common mode of distress.
LAQ thesis:
 This essay will discuss cultural and gender variation affecting the prevalence of bulimia nervosa with reference
to the studies conducted by Jaeger et al (2002), Becker et al (2002) and Makino et al (2004) and Weisman et al
Study One: Jaeger et al (2002)
Aim: To investigate the role of cultural differences on body dissatisfaction and other interrelated factors (selfesteem and dieting behaviour) and vulnerability to bulimia.
 Procedure:
o 1751 medical and nursing students were sampled across 12 nations; both western and non-western countries.
o A series of 10 body silhouettes were shown to participants; designed to be as culture free as possible to assess
body dissatisfaction. Body mass index which accounts for height and weight were measured.
o Self-report method was used to obtain information on body dissatisfaction, self-esteem and dieting behaviour
 Findings:
o Significant differences between cultures were obtained
o Most extreme body dissatisfaction were found in Mediterranean and northern European countries,
intermediate discontent in westernized countries and the lowest levels in non-western countries.
o Body discontent is the most important influence on dieting behaviour; independent of self-esteem and BMI
 Conclusions and Applications:
o Significant differences between cultures supports explanation that bulimia is due to the "idealized" body
images portrayed in media; distorted views leading to body dissatisfaction and dieting behaviour
o Western countries are more exposed to the media; higher body dissatisfaction than non-western countries
o Explanations of the disorder must be considered at a macro-level (society), rather than as originating solely
within the individual (micro level)
 Evaluation:
Does not ignore sociocultural factors; fitting with the
Ignores biological and cognitive factors causing
social norm – ideal image
Ethical as there was not physical or psychological harm Oversimplified and reductionist
Insight on factors that can cause eating disorders
Not a true experiment – IV not controlled for
Large sample size
All medical or nursing student - less variability
Study Two: Becker et al (2002)
Aim: To investigate the role of Western television on disordered eating patterns among Fijian adolescent girls.
Procedure: Field Study
o Teenage girls from 2 secondary schools were recruited.
o Participants were observed once television was introduced to a remote island in Fiji in 1995. They were reobserved in 1998.
o Traditional Fiji body ideal at the time = robust, therefore, the pressure to be thin found in many Western
countries was absent; wasn’t a very influential issue
o Qualitative study (survey) and qualitative methods (semi-structured interviews) on issues like television
viewing, dieting, body satisfaction, and purging were conducted.
 Findings:
o Increase in dieting and self-induced vomiting to control weight from 0% in 1995, to 11.3% in 1998
 Conclusions and Applications:
o Increasing globalization exposure to Western media could explain the increase in symptoms related to eating
disorders in non-Western countries
o After introduction of TV= specific combination of binge eating and purging to control weight
o Supports the idea that bulimia is a culture- bound syndrome
o Can be used for further research on Western cultural influences on young girls
o Can be used in self-esteem meetings for young girls; demonstrates how easy it is to get influenced from the
people in TV
 Evaluation:
The questionnaires revealed clinical signs (vomiting
Didn’t use clinical diagnoses, mainly observations;
and body discontent) associated with eating disorders limits the reliability of the results of this study
Insight on factors that cause a person to be bulimic or
exhibit symptoms of bulimia; cultural impact, body
dissatisfaction, peer pressure etc.
There may be a tendency to report symptoms (e.g.
purging) in anonymous self-reports but a clear
diagnosis cannot be made
Provides cause and effect relationship; strong IV
Data collected is rich and detailed
Gender bias as sample consisted of only girls
Low cross-cultural validity
Study Three: Makino et al (2002)
Aim: To investigate the role of gender variation in prevalence of bulimia.
Procedure: Meta-analysis
o Reviewed studies on eating disorders in 11 western countries
 Findings and Conclusions:
o Men generally less likely to develop eating disorders, perhaps due to less pressure to obtain ideal body
shape and weight (Ross et all 1991). Men who do develop eating disorders tend to resemble women in
terms of dissatisfaction (Olivardia et al 1995).
o Men with specific job descriptions (jockeys and wrestlers) have an increased risk of having an eating
disorder. Homosexual men are also more likely to have an eating disorder (Silberstein et al 1989).
o Steady increase in bulimia nervosa from 1988-2000. 94 of 100 cases were women. Also found that women
between ages of 10-19, especially ballerina and models have higher risk (Currin et al 2005).
 Applications:
o Used to treat people in rehab who are suffering from bulimia
o Used to explain the difference in symptoms and etiology in men and women
 Evaluation:
Takes into account socio-cultural factors
Does not consider biological or cognitive factors
Insight on factors that cause a person to be bulimic
Low cross-cultural validity as only western countries
Minimal gender bias – takes into account both genders
Interpretation open to researcher bias