218 Eating Disorders
blacks (Taylor et al., 2007). Research also suggests that eating disorders may
be more common in those individuals who have moved away from their
background environment to a new society. For example, Fichter et al. (1988)
reported that anorexia was more common in Greek girls living in Germany
than in two Greek towns. Likewise, Nasser (1986) reported higher levels
of disordered eating in Arab female undergraduates living in London than
in those living in Cairo. Mumford, Whitehouse, and Platts (1991) have
described these results in terms of acculturation, and have argued that
eating disorders may emerge as one group attempts to acculturate to its
new environment. In a similar vein, DiNicola (1990) has suggested that
eating disorders can be considered a “culture change syndrome” which
emerges during periods of rapid social change. However, the incidence of
cases in these studies was so small that only tentative conclusions can be
made. Much research has also examined the relationship between ethnicity
and measures of dieting, body dissatisfaction, and attitudes towards food.
These data have been considered in detail in chapter 6.
Research has also examined the prevalence of anorexia in non-Western
populations. Such research has included anecdotal clinical evidence, cross-
sectional community studies, and the use of case registers, and has generally
shown that the prevalence of anorexia nervosa is very low. For example,
Lee, Chiu, and Chen (1989) reported 10 cases out of a population of 500,000
psychiatric patients in China, and Mumford and colleagues reported no cases
of anorexia in a sample of 640 Pakistani schoolgirls (Choudry and Mumford,
1992; Mumford, Whitehouse, and Choudry, 1992). The prevalence appears
to be higher among Westernized segments of non-Western populations such
as in Hong Kong (Lee, 1991) and areas of India, Africa, Malaysia, and New
Guinea (DiNicola, 1990), and Mumford (1993) argued that higher rates
were apparent in countries undergoing rapid Westernization. The preva-
lence is also particularly high in Japan (Suematsu, Ishikawa, and Inaba, 1986).
Research exploring the relationship between ethnicity is made difficult, how-
ever, by problems with applying one definition of caseness across a range
of cultures and using assessment tools which have been translated into dif-
ferent languages. The problem of language was specifically studied by King
and Bhugra (1989), who concluded from their study that misinterpreta-
tions of Western-based questions by non-English-speaking participants are
common. For example, while statements such as “Cut my food into small
pieces” and “Display self-control around food” may reflect disturbed eating
in the West, they can be interpreted as desirable behaviors in other cultures.
Similarly, while “Eat diet foods” and “Engage in dieting behaviors” are used