Eating disorders in Chinese women

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Bulimia nervosa and anorexia nervosa are prevalent in Western countries, such as the United States, but recent studies have shown that they are also on the rise in Asian countries such as China. [1] There are several reasons for this, such as, Chinese culture and westernization. [2] [3] Researchers are looking into these causes, so they can know how to treat and prevent them. [1] [2]

Contents

Background

Body Dissatisfaction

Eating disorders, once thought prevalent only in Western cultures such as that of the United States, are now seen in Chinese women. Body dissatisfaction and eating disorders are almost as common now as they are in Western countries. [1] [2]

Causes

Cultural

In China, many traditional people hold to a collectivistic cultural tradition (or Confucianism). They learn to conform as an interdependent whole rather than as unique independent beings. [4] This dependency starts in the family, where a parent to child hierarchy is enforced and children are taught to be submissive and obedient. This can cause feelings of rebellion in the child which is why some of them may turn to eating disorders. The child wants to have some control, but they also do not want to disrespect their parents by pursuing autonomy, and so restricting food or binging and purging is, in a way, their way of making decisions. [5]

Several studies confirmed that cultural factors resulting in rebelliousness caused eating disorder symptoms. Ulrike Schmidt, a professor in eating disorders, studied three patients with Chinese heritage who participated in binging and purging behaviours. Her first patient, patient A, grew up in England. As a teenager, patient A's parents expected her to help them with their business since they did not speak fluent English. On top of this she gave them most of her earnings from her job, and she was expected to participate in family life. Dr. Schmidt found that her bulimia symptoms came about because she was seeking independence, and yet she wanted to remain obedient to her parents. This conclusion supports the idea that loyalty versus independence played a conflicting role that lead to eating disorder symptoms. [5]

Moreover, Dr. Schmidt also concluded that patient A's mother nurtured her when she started losing weight. As a result, patient A exploited this in order to make up the deprivations from her childhood. [5] This correlation between conflicting feelings of growing up or remaining young is the other studied cause of why eating disorders arise in young Chinese women. Joyce L. C. did a study in Shenzhen and she reported that some Chinese woman struggle with growing up and so they turn to eating disorders as a control. One such girl relates her feelings when she said,

“I like to be a little girl. In being an adult, you need to care about people's feelings and interact with others. They tend to disappoint me. I met two senior students in college and they seemed to treat me well at first. However, suddenly they had become unfriendly and hostile to me. I felt being betrayed. I hid myself in my dormitory, the only place where I felt safe and secure. I indulged in binge eating and vomiting. I don't wish to be hurt by them again.” [3]

She turns to bulimia as a way of hiding from reality and indulging herself. Because of societal norms in China, it is seen that some women are turning to eating disorders as a way out from their stress and worry.

Westernization

Eating disorders in China were primarily thought to have come about because of the Westernization of their cities through the media. Western media idolizes thin, beautiful woman. This unrealistic standard entices women to lose weight through dieting, exercising, and if necessary surgery, so as to meet it. [6] Because of the body dissatisfaction that this standard causes it can lead to eating disorders. [3]

Many researchers studied westernization as a cause of eating disorders in Chinese women and it is one of the main theories believed today. Lee and Lee, in a study of different levels of socioeconomic development in three Chinese communities, compared the aptitude of disordered eating among females in high school. He found that females in the higher income cities, even though they were slimmer than the other females in the less modernized cities, desired a lower body mass index (BMI), had greater levels of body dissatisfaction, and overall had more symptoms that relate to risk factors for eating disorders. [7] Thus, from their results, westernization is a probable cause of increased eating disorders. However, some studies suggest other factors account for higher eating disorders in Chinese woman, so even though western media may be one of the causes, it may not be the primary one.

'Little fatty' was once a term of endearment for children in China, but today dieting is popular and thinness is the ideal. [8]

Social Change

One of the other factors scientist have come up with that may contribute to higher eating disorders in Chinese woman, are sociocultural factors that include gender roles, economic opportunities, religious values, and the cultural objectification of women. When disruptive social change comes about, women are more likely to have disordered eating. Naomi Wolf observed this when she said, “The more legal and material hindrances women have broken through, the more strictly and heavily and cruelly images of female beauty have come to weigh upon us.” [9] As women seek equality, the extreme of ideal body shape arise. [1] [2]

This is seen in many cases throughout history in Western and non—Western cultures. For example, in America, during the 1920s and the 1970s when the role of women were changed the most, “models in US fashion magazines were the most slender and least curvaceous.” [1] [2] In contrast to the Western culture, a study showed that Korean woman, since the economic, social, and political changes in the 1980s to 2000, are more dissatisfied with their bodies (Tsai, 2000). In another study, Jaehee Jung and Gordon B. Forbes, found that among University female students from Korea and the United States, Koreans had greater eating disorder risk factors than the Americans. They concluded this was because of the more recent social changes for woman in Korea. [6] Thus, because both groups of women were equally exposed to Western media, this theory is a contender with the westernization theory as a cause of higher eating disorders.

Treatment

Many people have difficulty seeking treatment in China because receiving help from a therapist is personally looked down on as a mark against one's dignity because if a person needs help, then they cannot help themselves and that is shameful. Thus, reaching out to those who have eating disorders or eating disorder symptoms may be difficult. [10] Moreover, most patients with eating disorders will initially find it difficult to find the motivation to overcome their eating disorder because they are not sure whether they want to change, and yet they know that they need to because it will help them in their lifestyles. When a therapist starts treating a new patient they need to make sure to connect with the patient and create a professional, but helpful client to therapist bond because that connection will help the patient. [11]

Family Therapy

A common method for helping eating disordered persons is to involve the family. Researchers found that in Western places, like England, family therapy was useful and effective. However, in China, because of the difference in culture, some underage patients refuse help and they will not trust the therapist because they see it as another way of their parents controlling them. In a case study done by Joyce L. C. Ma, she was treating a 17-year-old girl who would not accept her help. The girl said,

“It's my father's session, not my session. My father has a problem and I don't have any. He arranged everything for me. He did too much. I am sick of his over–interference in my life. I knew the sessions were his arrangement too. I dislike being at his disposal any more. So I refuse to meet you.”

In order for the patient to receive help, the therapist needs to create a bond with them first, so that they can voice their needs and the cause of their disorder. [12]

Family therapy in China has also proven beneficial because families can talk about issues in the family. This in turn strengthens the patient and creates a foundation for them to hold onto. Accomplishing this kind of therapeutic bond though is the difficult part for some Chinese people because of the collectivistic culture in which they live in where the children are afraid to speak up against their parents because they do not want to bring shame upon them. Once the therapist can overcome this though, overcoming their eating disorder will be much easier than if it were individual therapy. [12]

See also

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Overeating occurs when an individual consumes more calories in relation to the energy that is expended via physical activity or expelled via excretion, leading to weight gain and often obesity. Overeating is the defining characteristic of binge eating disorder.

Muscle dysmorphia is a subtype of the obsessive mental disorder body dysmorphic disorder, but is often also grouped with eating disorders. In muscle dysmorphia, which is sometimes called "bigorexia", "megarexia", or "reverse anorexia", the delusional or exaggerated belief is that one's own body is too small, too skinny, insufficiently muscular, or insufficiently lean, although in most cases, the individual's build is normal or even exceptionally large and muscular already.

<span class="mw-page-title-main">Rumination syndrome</span> Medical condition

Rumination syndrome, or merycism, is a chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation as there is with typical vomiting, and the regurgitated food is undigested. The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities . It is increasingly being diagnosed in a greater number of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients, and the general public.

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Ellen West (1888–1921) was a patient of Dr. Ludwig Binswanger who had anorexia nervosa. She became a famous example of Daseinsanalysis who died by suicide at age 33 by poisoning herself.

Diabulimia, also known as ED-DMT1 in the US or T1ED in the UK, is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss. Diabulimia is not recognized as a formal psychiatric diagnosis in the DSM-5. Because of this, some in the medical or psychiatric communities use the phrases "disturbed eating behavior" or "disordered eating behavior" and disordered eating (DE) are quite common in medical and psychiatric literature addressing patients who have type 1 diabetes and manipulate insulin doses to control weight along with exhibiting bulimic behavior.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

Maudsley family therapy also known as family-based treatment or Maudsley approach, is a family therapy for the treatment of anorexia nervosa devised by Christopher Dare and colleagues at the Maudsley Hospital in London. A comparison of family to individual therapy was conducted with eighty anorexia patients. The study showed family therapy to be the more effective approach in patients under 18 and within 3 years of the onset of their illness. Subsequent research confirmed the efficacy of family-based treatment for teens with anorexia nervosa. Family-based treatment has been adapted for bulimia nervosa and showed promising results in a randomized controlled trial comparing it to supportive individual therapy.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

<span class="mw-page-title-main">Eating disorders and memory</span> Memory impairments linked to eating disorders

Many memory impairments exist as a result from or cause of eating disorders. Eating disorders (EDs) are characterized by abnormal and disturbed eating patterns that affect the lives of the individuals who worry about their weight to the extreme. These abnormal eating patterns involve either inadequate or excessive food intake, affecting the individual's physical and mental health.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Atypical anorexia nervosa is an eating disorder in which individuals meet all the qualifications for anorexia nervosa, including a body image disturbance and a history of restrictive eating and weight loss, except that they are not currently underweight. Atypical anorexia qualifies as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), under the category Other Specified Feeding and Eating Disorders (OSFED). The characteristics of people with atypical anorexia generally do not differ significantly from anorexia nervosa patients except for their current weight.

Body checking is a compulsive behaviour related but not exclusive to various forms of body dysmorphic disorders. It involves frequently collecting various information about one’s own body in terms of size, shape, appearance or weight. Frequent expressions of this form of behaviour entails for example mirror checking, trying to feel one’s own bones, pinching the abdomen, frequent body weight measurement and comparing your own body to that of others. Studies have shown that an increased rate of body checking correlates with an overall increased dissatisfaction with the own body.

References

  1. 1 2 3 4 5 Humphry, T. A.; Ricciardelli, L. A. (2004). "The development of eating pathology in Chinese-Australian women: Acculturation versus culture clash". The International Journal of Eating Disorders. 35 (4): 579–88. doi:10.1002/eat.10269. hdl: 10536/DRO/DU:30005230 . PMID   15101073.
  2. 1 2 3 4 5 Jung, Jaehee; Forbes, Gordon B. (Dec 2007). "Body Dissatisfaction And Disordered Eating Among College Women In China, South Korea, And The United States: Contrasting Predictions From Sociocultural And Feminist Theories". Psychology of Women Quarterly. 31 (4): 381–393. doi:10.1111/j.1471-6402.2007.00387.x. S2CID   145427845.
  3. 1 2 3 Ma, J.L.C. (2007). "Meanings Of Eating Disorders Discerned From Family Treatment And Its Implications For Family Education: The Case Of Shenzhen". Child & Family Social Work. 12 (4): 409–416. doi:10.1111/j.1365-2206.2007.00496.x.
  4. ↑ Chang, Sandy Chih-Ann (2006). Eating disorder symptomatology, self-construal, and dimensions of perfectionism in Chinese American women. San Francisco Bay: Alliant International University. p. 97.
  5. 1 2 3 Schmidt, Ulrike; U London (Dec 1993). "Bulimia nervosa in the Chinese". International Journal of Eating Disorders. 14 (4): 505–509. doi:10.1002/1098-108X(199312)14:4<505::AID-EAT2260140415>3.0.CO;2-N. PMID   8293034.
  6. 1 2 Jung, Jaehee; Forbes, Gordon B. (Jul 2006). "Multidimensional Assessment of Body Dissatisfaction and Disordered Eating in Korean and US College Women: A Comparative Study". Sex Roles. 55 (1/2): 39–50. doi:10.1007/s11199-006-9058-3. S2CID   143015560.
  7. ↑ Lee, Sing; Antoinette M. Lee (Apr 2000). "Disordered Eating in Three Communities of China: A Comparative Study of Female High School Students in Hong Kong, Shenzhen, and Rural Hunan". International Journal of Eating Disorders. 27 (3): 317–327. doi:10.1002/(SICI)1098-108X(200004)27:3<317::AID-EAT9>3.0.CO;2-2. PMID   10694718.
  8. ↑ Bordo, Susan (January 2004). Unbearable weight: feminism, Western culture, and the body. ISBN   9780520930711.
  9. ↑ Silverstein, Brett (1995). The Cost of Competence: Why Inequality Causes Depression, Eating Disorders and Illness in Women . New York: Oxford University Press. pp.  214. ISBN   978-0-19-506986-0.
  10. ↑ Conlin, Michelle; Dexter Roberts (Apr 23, 2007). "Go-Go-Going to Pieces in China". BusinessWeek. 4031: 88.
  11. ↑ Ma, Joyce L.C. (Mar 2008). "Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context". Australian & New Zealand Journal of Family Therapy. 29 (1): 10–16. doi:10.1375/anft.29.1.10.
  12. 1 2 Ma, Joyce L.C. (Nov 2007). "Journey Of Acculturation: Developing A Therapeutic Alliance With Chinese Adolescents Suffering From Eating Disorders In Shenzhen, China". Journal of Family Therapy. 29 (4): 389–402. doi:10.1111/j.1467-6427.2007.00407.x.
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