Anorexia Nervosa Was Once Considered

¶ … Anorexia nervosa was once considered a psychological disorder that was prevalent in more affluent Western societies. However, psychologists have been reporting more incidences of anorexia nervosa among developing societies, challenging this dominant interpretation of eating disorders. This paper examines an example of such a research, Hoek et al.'s (2005) paper entitled "The Incidence of Anorexia Nervosa on Curacao." In this research, Hoek et al. (2005) conduct an investigation into incidences of anorexia nervosa in the Caribbean island of Curacao. The research design of this study is evaluated, and the implications of the findings are discussed. In the last section, this paper looks at this study's contributions to a wider understanding of eating disorders in general.

Overview of study

Is anorexia nervosa a disease of affluence? Or does the disease occur across the globe as well? In their study, Hoek et al. (2005) look at the growing incidences of anorexia nervosa in Curacao, an island in the Caribbean. The major goal of this research is to look at how anorexia nervosa incidences are manifested in societies that are undergoing socio-economic transition.

The island of Curacao was chosen because it fits into the category of "new affluence." The island has its origins in plantation slavery and continues to be part of the Netherlands Antilles. After its humble beginnings, however, Curacao is enjoying an economic resurgence. It has been classified as a "high income" country by the World Bank, and is increasingly showing cultural influences from Europe as well as the United States. Such socio-cultural changes are fairly recent, however, and could readily be classified as an economy in transition.

There are also other important factors that make Curacao a good choice for the authors of this study. Given that the spoils of socio-economic development are unevenly spread across the population, the researchers have an opportunity to compare the incidences of anorexia nervosa among the wealthy minority population and the "relatively" poor majority. Furthermore, the presence of health professionals who were mostly trained in the Netherlands allows the authors to gather ample data regarding anorexia nervosa diagnosis in the island. The result is a study design that is both comprehensive and sound.

The findings of the Hoek et al. (2005) study are quite telling. First, the authors found that anorexia nervosa did occur in Curacao, identifying 11 verified cases in an island with a total population of less than 700,000. This translates of a rate of incidence of 1.82 per 100,000, much lower than the 8.3 per 100,000 cases in the United States and 8.1 per 100,000 in the Netherlands. Among the "high risk" group of females aged 15-24 years, the anorexia nervosa incidences climb to 17.5 per 100,000. This figure, however, is still much lower than the comparable averages in the United States (48.8 per 100,000) and the Netherlands (55.5 per 100,000).

Despite the different rates of incidences, however, it is interesting to note that all 11 cases identified in Curacao occurred in female patients. No males were diagnosed with this eating disorder. Also, similar to the populations in the United States and the Netherlands, the disorder presented largely among younger females, between the ages of 15 through 24 years old.

Another major finding of this study is that socio-cultural differences were related to anorexia nervosa. The soundness of the resarch design allowed the authors to gather comprehensive case-findings regarding anorexia incidences. Among the mixed-race population, the anorexia rate was at 9.1 per 100,000. However, it is significant to note that there were no cases of anorexia found among the black population, who constituted the largest racial group in Curacao.

Contrary to the hypothesis, however, Hoek et al. (2005) found no evidence that socioeconomic transition caused the emergence of anorexia nervosa in Curacao. After all, if there was a positive correlation, then the fact that Curacao is a "high income" country would raise its anorexia rate to a level comparable to the United States and the Netherlands. The two latter countries have similar anorexia rates, while Curacao's is much lower.

The authors present three possible explanations for this lack of a positive correlation. First, they consider that economic transition has been fairly recent, and that the effects of affluence will not be felt for a few more years. Their other explanation is that economic affluence is unevenly spread across Curacao society, with the benefits limited only to an elite. Curacao, state the authors, still has a high level of unemployment and a lack of social services.

While both explanations have merit, they do not fully-explain the lower anorexia nervosa rate in Curacao. After all, anorexia nervosa rates did not grow gradually in the United States as the country gained affluence after the war. In fact, the incidences seemed to suddenly spike in the 1980s. Furthermore, uneven affluence, on the other hand, is a characteristic that exists in many Western nations, including the United States and the Netherlands.

The authors present a third - and most likely - explanation for the differences lie in socio-cultural differences. There is a telling absence of anorexia among the black population, hinting at different cultural interpretations regarding beauty, size and what is considered healthy and attractive. Being heavier or even overweight is more socially-acceptable among the African-Cuban population. These norms remained resilient among the population, in contrast to the emphasis on thinness in American and Dutch media. These local norms therefore may help "protect" young Curacao women from developing anorexia nervosa.