Discuss cultural and gender variation in prevalence of disorders Terminology: 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 (1996). 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: Strengths Limitations Does not ignore sociocultural factors; fitting with the Ignores biological and cognitive factors causing social norm – ideal image bulimia 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: Strengths Limitations 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 control 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: Strengths Limitations 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
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