I thought about writing a post about the factor structure of popular eating disorder scales to celebrate my completion of an advanced statistics course in structural equation modelling. When I sat down to read some articles about that, though, I found myself side-tracked– and thoroughly uninterested in deconstructing scale psychometrics. So with a promise to do that at some point, I return to a favourite topic of mine: culture and eating disorders.
When I was writing about culture and eating disorders for the blog last year, I received quite a few requests for articles about eating disorders in developing countries. I suspect that the desire for this kind of article stems from a need to highlight (for the doubters) that eating disorders are serious mental health issues that can impact anyone who is predisposed, regardless of whether they live in a media-saturated landscape or not. As I noted in the series, eating disorders and culture live in complex relation – saying that eating disorders are solely caused by either biology or culture is to miss the point of the complex interrelationship between bodies and worlds.
What I have also tried to highlight in this work, though, is how culture doesn’t mean media. Culture is a whole lot more than the popular magazines that litter our doctors’ offices and coffee tables. Culture includes all manner of beliefs and customs, arts and intellectual endeavours. Thinking about eating disorders requires that we expand what we mean by culture, and also to situate eating disorders not only within “culture” as such but also social context including political and economic milieu.
None of these things are static; as we are a part of our sociocultural and political-economic milieu, we are continually and actively involved in creating and re-creating these fields ourselves. Though we might not feel powerful or even able to make any change at all (particularly in the face of capitalism, which has a history and metamorphosis as rich as it is troubled), the things that we do are continually holding up, changing, or breaking down social contexts (often all three at once).
So, you might ask, why is this important to eating disorders? In my view, it is important because when we engage in debate about “whether eating disorders are culture bound” or talk about the sociocultural aspects of eating disorders, we need to look beyond the TV set, computer screen, and magazine page. Media literacy, as I’ve said many times, is no guarantee against a) feeling bad about yourself or b) developing an eating disorder, if you’re so predisposed. Neither are genes alone enough to cause an eating disorder. There is more going on in this picture, so let’s unpack it a little more.
Pilecki, Salapa & Józefik published an article in the Journal of Eating Disorders this year, looking at eating disorders in Poland. From the outset, the authors align themselves with those who consider eating disorders “culture-bound” – that is, tied to a particular kind of culture. The authors do focus primarily on the trappings of culture that I just noted were not the only aspects of culture relevant to our understanding of eating disorders: mass media, thinness ideals, and a hyper-focus on body scrutiny. They also consider how others in the lives of those with eating disorders may perpetuate problematic body relationships through comments and teasing, or by exhibiting disordered eating patterns themselves.
We’ve heard all of this before – we know that body ideals aren’t helpful, we know that they are not enough to cause eating disorders and that a body positive environment is not enough to protect against all eating disorders. Where things start to get interesting, in my opinion, is when the authors begin to explore Poland as a former Eastern Bloc country.
For those who didn’t pay attention in history class – or who are younger than I am (I was born in 1989, the year of the revolutions that led to the dissolution of communist rule in these nation-states) – the Eastern Bloc was comprised of a number of countries that were under Communist leadership from the late 1940s until the late 1980s/early 1990s. In 1989, a series of revolutions brought about massive change in the social, political and economic structure of many Eastern Bloc states, including what is often referred to as Westernization (a thinly veiled term for capitalization, really, meaning a huge intensification of trade with nations outside of the Eastern bloc, restructuring of social services, work, and class structures, etc.).
Pilecki et al. note that prior to 1989, the prevalence of eating disorders in Poland was quite low; they attribute an uptick in cases to media sources primarily, but were interested in continuing to explore other Westernization-related socio-cultural correlates. To me, it is much more interesting to think about how people relate to their bodies as individualistic, productivity-machines in Western political-economic context, but that’s just me. In this article, they explored socio-cultural risk factors for eating disorders in the Polish context, using data collected between 2002 and 2004, some 20 years post-Eastern Bloc.
The authors surveyed:
- 47 women with anorexia-nervosa restrictive subtype (AN-R)
- 16 women with anorexia-nervosa binge-purge subtype (AN-BP)
- 34 women with bulimia nervosa (BN)
- 19 women with eating disorder not otherwise specified (ED-NOS)
- A control group of 85 girls and their parents
They asked these individuals about their beliefs about issues that have been considered risk factors for eating disorders. I’ll flag this methodological issue right away as one that irks me and yet seems somewhat unavoidable in social research: using pre-determined “risk factors” without leaving open the possibility of factors not often considered a part of “socio-cultural” (like oh I don’t know… political economic factors).
Here’s a sample of some of the questions, so you can get a sense of what they asked (the article is open access so you can see all of the questions on page 4 here):
- A person should control his various weaknesses
- It is important to the members of my family that we be “up to date”
- I know many people who have problems with food”
- In my social circles, appearance is crucial to a successful social life
- When I see a thin model, I feel fat and unattractive
- My greatest desire is to know how to control my life
- What my family considers delicious food is unhealthy in my opinion
An important note: this is not meant to be a scale that assesses for eating disorders or to be used as a diagnostic instrument. Nor was this study a comparative prevalence study, though the authors write a lot about prevalence.
Most of the people they surveyed who had BN and AN-R were situated in rural villages (about 30%) and those with AN-BP lived in small towns (about 56%) whereas the control group lived in Krakow (about 77%). I think this is a fascinating finding that runs counter to what we might expect if we assume that Westernization is directly tied to the prevalence of eating disorders. Assuming that big cities like Krakow are more “Westernized,” if we assume that Westernization increases the prevalence of eating disorders we would expect to see fewer eating disorders in rural settings. While this is not a study specifically exploring prevalence, and so we can’t and shouldn’t read too much into this finding, it is still interesting.
The authors suggest that this difference might be tied to how living in rural areas may actually reflect social privilege. I’m not sure I get behind this argument, as it seems to reflect an assumption that eating disorders are more common in middle to upper class groups, which contradicts their other key finding that “social affiliation” was not actually different between ED and non-ED groups (i.e., there was not a strong association between being lower or middle or upper class and being in the ED group or control group).
Other markers of social class were somewhat conflicting. Parents of those with eating disorders in this study were more highly educated than national average. Those in the BN group were more likely to come from single parent families. It is hard, from this kind of conflicting information, to draw solid conclusions about “what kind” of person in Poland has an eating disorder – which in my view reflects the heterogeneity of those with EDs.
It’s also interesting to look at how the families of those with EDs related to food. In general, the parents of those with EDs were not more appearance or food focused than those without. The authors note that in the 1980s, Poland was in the midst of a serious economic crisis. During this time, having more access to food signalled economic success. In the movement out of the economic shift, the meaning of food consumption and bodies shifts – but slowly. The authors suggest that parents and children might orient differently to bodies and the meanings associated with different bodies – possibly, they argue, children consider thinness desirable where their parents might continue to see thinness as indicative of economic loss.
I would love to see these results analyzed more thoroughly in the context of what it means to be an adolescent in a country still recovering, years later, from serious economic crisis. Beyond valuing or not valuing thinness, what kinds of pressures exist to be a productive citizen? What is the specific meaning of social class in a formerly communist nation? This kind of thing fascinates me far more than whether people buy into thinness ideals.
Overall, this study provides an interesting look at eating disorders in a context I had not read much about. It reminded me how much of a nerd I can be about the political economy and history, so that’s also fun. What’s your take?
Pilecki MW, Sałapa K, & Józefik B (2016). Socio-cultural context of eating disorders in Poland. Journal of eating disorders, 4 PMID: 26998306