Sociocultural origins of anorexia

Many people automatically assume that anorexia is a social disorder - that is, the result of social and cultural factors.  But how strong is the evidence that anorexia may be the result of media and modern pressure to "look beautiful?"

The sociocultural approach proposes two main theories of the etiology of anorexia. Social Cognitive Learning theory argues that we learn behaviour from our society by observing the behaviour of others. The second theory is Kirmayer's theory of explanatory models - that is, that cultures create socially acceptable sets of symptoms for mental distress.  In this case, the argument would be that anorexia is a response to a cultural norm. 

Social Cognitive Learning theory

Social cognitive learning theory links a person's desire to be a certain size or weight with the western expectations of the ideal body image.  It is commonly argued that images in the media model the "ideal weight" and that the rise in anorexia reflects the desire of many women to reach the ideal weight.

This argument is based on evidence that women in the Western media have become taller and thinner over the past 50 years. But how do we go from seeing images on television to developing anorexia?

Groesz, Levine and Murnen (2002) did a meta-analysis of 25 studies in which women were exposed to either images of thin models, average size models, plus size models or inanimate objects.  The results were that body dissatisfaction significantly increased after exposure to media images of thin women, but not when exposed to the other images. In addition, they found that the increase in dissatisfaction was greatest in those with most dissatisfaction before exposure.

Becker et al (2002) Carried out a case study of eating habits and television viewing on the islands of Fiji. The Nadroga province was chosen because it did not have access to television until 1995. The study was prospective with the first surveys given in 1995 and the second set of surveys given in 1998. In addition, semi-structured interviews were carried out to confirm self-reported symptoms. Findings showed that at the beginning of the study 3% of girls said that they vomited in order to control their weight. By the end of the study, this had increased to 15%. This shows that there is a strong link between western media and eating habits.

Research in psychology: Becker et al (2002)

You can see an interview with Anne Becker discussing her research here. What could you add to the description above of her research based on this video?

Another way that Social Learning Theory has been studied is to look at behaviours within families. For example,  Brown & Ogden (2004) found a clear relationship between parents' and children's internal motivations with regard to food and body dissatisfaction. It appears that parental modelling of eating behaviours and attitudes toward body weight and shape has a clear effect on the behaviour of their children.

Explanatory models and cultural norms

Kirmayer & Bhugra (2009) argue that cultures have "explanatory models" for disorders. Their theory is that cultures create socially acceptable sets of symptoms for mental distress. Since cultures are continually evolving, especially in the era of globalization, these explanatory models may change in prevalence rates over time.  This change in explanatory models may account for a seeming "rise" in the disorder within a culture.  In his book Crazy Like Us, Watters argues that in the case of anorexia in Hong Kong, the women were attracted to the "cultural template of behaviour" which shows dysfunction or distress. In other words, when an individual feels psychological distress, the symptoms that one adopts come out of the "symptom pool" that is appropriate for one's culture, age and gender. The society dictates what the appropriate "illness" is.

Lee & Lee (2000) investigated the role of "Westernization" on the development of behaviours associated with eating disorders among female high school students in three Chinese communities - a rural community in Hunan, the city of Shenzhen and Hong Kong. The three communities differed both in the level of Westernization and the socioeconomic development. 796 Chinese students completed several questionnaires, including the Eating Attitudes Test (EAT-26) and a Body Dissatisfaction Scale (BDS).

Compared to students in Hunan and Shenzhen, students from Hong Kong were slimmer, but desired a lower body mass index and reported more body dissatisfaction.  They also showed greater concern about becoming or being overweight.  Hunan students had significantly higher BDI scores but lower fat concern than Shenzhen and Hong Kong students. This shows that modernization and Westernization may be having an effect on Chinese women's perceptions of healthy weight.

ATL: Thinking critically

One of the recent trends is the "A4 waist" which began in China.  Here is a short video of the trend:

It could be argued that this trend has spread thanks to the Internet. Do you think that the Internet should remove such promotions with the goal of preventing further development of eating disorders?  What do you think would be the problems with this approach to solving the problem?

Research on the role of culture in eating behaviour is not limited to "national cultures," but also subcultures.  For example, Brooks-Gunn, Burrow & Warren (1988) looked at eating habits among female adolescent athletes. They compared three different athletic "cultures" - swimmers, gymnasts and dancers - and one control group made up of non-athletes. All girls were age 14 - 18. There were 25 figure skaters, 64 ballet dancers, and 72 swimmers. The total number of girls surveyed was 424.

The study found that dancers and figure skaters also had more negative eating attitude scores than swimmers or non-athletes. Dancers and skaters also had higher perfectionism scores that the other two groups.

Later research showed that among professional athletes there is a high prevalence of behaviours related to eating disorders. Female gymnasts, for example, reported rates as high as 60% (Petrie 1993) and between 38% and 54% of figure skaters (Monsma & Malina, 2004). You may want to read more about anorexia and ballet in this BBC article.

Evaluation of sociocultural arguments

  • Cultural factors do not account for variations in vulnerability to eating disorder. The great majority of young women are exposed to cultural pressures towards slimness yet do not develop eating disorders.  Sociocultural theories do not explain why some people are more influenced by these factors than others.
  • The behavioural explanations can be criticized as environmentally deterministic.  The theories ignore the free will of the individual to reject the influence of the environment.
  • Sociocultural explanations are also reductionist because they do not consider biological and cognitive factors. It is highly likely that the three levels of analysis interact, resulting in the disorder.  For example, sociocultural stressors may lead to gene expression which then makes one more vulnerable to eating disorders.
  • Much of the research above shows "disorder eating" or "behaviour related to eating disorders." The theory does not explain how one goes from eating habits to an eating disorder.  Not all who have negative eating habits go on to develop a diagnosable eating disorder.

Checking for understanding

1.  What are the limitations of using a meta-analysis as evidence to support a theory?

A meta-analysis is based on published research on a research question.  There is often a publication bias - that is, research that produces insignificant results is often not published.  In addition, the selection of which research to use in the meta-analysis is highly subjective and thus open to researcher bias.

2. To what extent can Becker et al's study be generalized?

Becker was able to study a unique situation.  However, it is not possible to establish a true cause and effect relationship because of the lack of controls in the study.  It also cannot be replicated. The population - rural Fijians without television - has a lot of factors that may make this study difficult to generalize, including genetic traits, cultural norms and diet. This being said, the study presents strong evidence of a clear change in behaviour with the introduction of television to the community.

3. What are some potential limitations of Brown & Ogden's (2004) study?

The study was based on self-reported data. This type of data cannot be verified and is open to demand characteristics, memory distortion and optimism bias.

4. What does it mean to say that a theory is based on "environmental determinism?"

Environmental determinism is the idea that we are passive responders to our environment and therefore the environment shapes our behaviour.  This concept does not account for free will and our ability to make decisions to consciously change our behaviour.

5. Why do you think that figure skaters and dancers may have a higher rate of disordered eating behaviours than other athletes?

A significant part of the theory is that there are cultural expectations for how ballet dancers and figure skaters must look.

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