Abstract
Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People´s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.
Highlights
Biological and environmental factors have been found to play an important role in the development of anorexia nervosa (AN) [1]
AN patients from United Kingdom (UK) and Spain were significantly older than Chinese AN patients
This study extend previous research comparing non-Western versus Western populations living in their respective countries [9], and identifies whether abnormal eating patterns, anorexic cognitions and general psychopathology are more influenced by Western/Eastern or Collectivism/Individualism cultural attitudes
Summary
Biological and environmental factors have been found to play an important role in the development of anorexia nervosa (AN) [1]. In the last few years there has been a growing interest in the clinical presentation of AN across different non-Western societies This has been reflected by an increased number of studies, describing the prevalence and manifestation of AN, from African and Latin American/Hispanic groups [8] with few studies from Asian individuals [8]. These studies have been part of the debate regarding whether the clinical manifestation of AN differ across cultures [3]. As many of the cross-cultural studies analysing AN in non-Western societies have been carried out within Western countries [9] these studies have been inconclusive
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