456 CHAPTER 10
P SNP SN Parents and siblings aren’t the only ones who can shape a person’s relationship
to eating, food, and body. Friends also play a role, especially if they tease or criticize
an individual concerning her weight, appearance, or food intake; such comments
can have a lasting infl uence on her (dis)satisfaction with her body, her willingness
to diet, and her self-esteem. Such infl uences can make a person more vulnerable
to developing an eating disorder (Cash, 1995; Crowther et al., 2002; Fabian &
Thompson, 1989; Keery et al., 2005; Muir, Wertheim, & Paxton, 1999; Tantleff-
Dunn, Gokee-LaRose, & Peterson, 2004).
Unfortunately, many girls and women feel that symptoms of eat-
ing disorders—particularly preoccupations with food and weight—are
“normal” and that talking about these topics is a way to bond with
others. Hornbacher was aware of this social facet of eating disorders
and its underlying drawback:
Women use their obsession with weight and food as a point of connec-
tion with one another, a commonality even between strangers. Instead
of talking about why we use food and weight control as a means of
handling emotional stress, we talk ad nauseum about the fact that we
don’t like our bodies.
(1998, p. 283)The Role of Culture
Many people believe that eating disorders have become more common
and pervasive in recent decades. Hornbacher associated the increased prevalence
with a cultural fad:
Starving is the feminine thing to do these days, the way swooning was in Victorian
times. In the 1920s, women smoked with long cigarette holders and fl ashed their tooth-
pick legs. In the 1950s, women blushed and said tee-hee. In the 1960s, women swayed,
eyes closed, with a silly smile on their faces. My generation and the last one feign disin-
terest in food. We are “too busy” to eat, “too stressed” to eat.
(1998, p. 118)
Is Hornbacher right—are eating disorders a cultural phenomenon of modern times,
as swooning was in the Victorian era? Yes and no. A meta-analysis of the inci-
dence of eating disorders across cultures over the 20th century found only a small
increase in the number of cases of anorexia. This fi nding indicates that Hornbacher
was wrong to think that self-induced starvation—anorexia—is a type of “fad” in
mental illness (Keel & Klump, 2003). Historically however, people who engaged
in self-starvation were not obsessed about their weight; this weight concern has only
been observed recently, suggesting that its inclusion in the DSM-IV-TR defi nition of
anorexia may be related to a transient cultural fad.
However, Hornbacher seems to have been on the right track about the “fad”
aspect of bulimia. In contrast to the stable incidence of anorexia over time, the
incidence of bulimia signifi cantly increased from 1970 to 1990 (Keel & Klump,
2003)—suggesting a cultural infl uence (Striegel-Moore & Cachelin, 2001)—and
bulimia only arises in the context of concerns about weight.
Three elements come together to create the engine driving the culturally induced
increase in eating disorders (Becker et al., 2002):- a cultural ideal of thinness,
- repeated media exposure to this thinness ideal, and
- an individual’s assimilation of the thinness ideal.
In order to examine the cultural ideal of thinness, David Garner and colleagues
(1980) undertook an innovative study: They tracked the measurements of Miss
America contestants and Playboy centerfold playmates over time and found that
their waists and hips gradually became smaller. Other studies have found similar
results (Andersen & DiDomenico, 1992; Field et al., 1999; Nemeroff et al., 1994).
In fact, while the size of playmates’ bodies has decreased over time (as assessedFor a teenage girl, her friends’ comments can
have a lasting infl uence on how she feels about
her body, her willingness to diet, and her
self-esteem.M Nader/Getty Images