Eating Disorders 213symptoms,” and therefore argued that a too-rigid classification of anorexia
nervosa ignored the potential variation in anorexia nervosa and risked locat-
ing it within one particular time frame. This need for flexibility is also
reflected in cultural differences in the expression of eating disorders. For
example, although anorexic patients have been identified in Hong Kong
(Lee, Chiu, and Chen, 1989; Hsu and Lee, 1993), such individuals avoid
food and show weight loss but show only a minor or absent fear of fatness.
Lee, Chiu, and Chen (1989) pointed out that the pursuit of thinness is much
less in Hong Kong than in the West, and Hsu and Lee (1993) argued that
by imposing strict classification criteria on anorexia nervosa we may be
committing a “contextual fallacy” by failing “to understand the illness in
the context of its culture.” Therefore, from a medico-clinical perspective
the definition of anorexia nervosa involves a simple and clear set of criteria.
From a sociocultural perspective such criteria may miss the potential for
the expression of anorexia to vary across time and space.
The prevalence and incidenceEstimating the prevalence of anorexia is problematic, and attempts to do
so have been hindered by several factors. First, it is rare, which means that
large samples are needed; second, its illness course is variable, which means
identifying who has the problem and for how long can be difficult; and
third, sufferers are often reluctant to take part in population studies. However,
one study in Sweden managed to overcome many of these problems and used
growth charts recorded by school nurses, together with interview assessment.
They concluded that 0.7 percent of girls up to the age of 16 fulfilled the
criteria for anorexia nervosa. This is generally considered an accurate
estimate of prevalence in a Western population (Szmukler and Patton, 1995).
In terms of the incidence of anorexia, estimates face similar problems, with
rates ranging from 4 per 100,000 per year to 14 per 100,000 per year depend-
ing on the time and place of survey (Russell, 1995).
Changes in incidenceThe popular belief is that the incidence of anorexia nervosa has increased
dramatically over the past 30 years. Many studies have addressed how com-
mon anorexia is using different definitions, different measurement tools,
and different populations. As a means to control for these factors, Russell
(1995) summarized the data from studies which had collected data using
the same definitions and measurement tools of the same populations at