Anorexia Nervosa: Cultural and Social Dynamıcs in Western, Asian, African, and Middle Eastern Societies

Öz

Eating disorders are pathological conditions in which individuals’ healthy eating behaviors are severely disrupted. Among these disorders, Anorexia Nervosa (AN) stands out as one that can lead to the most fatal consequences. AN is characterized by a distorted body image, fear of gaining weight, and an intense desire to lose weight. Symptoms of this disorder may include extreme dieting, excessive exercise, and sometimes vomiting or the use of laxatives. Cultural and social dynamics play a significant role in the development of AN. In Western societies, a slim body shape is idealized due to the influence of the media and the fashion industry. Mass media, such as social media, TV shows, movies, and advertisements, can negatively affect individuals’ body perception. The prevalence of AN is higher in Western societies, particularly in the United States and Europe. The media and fashion industry frequently associate thinness with success and beauty, which may contribute to the development of AN. In Asian societies, traditional beauty ideals have started to change under the influence of Western culture. In Japan and South Korea, popular culture and the media emphasize having a slim body. In these cultures, the prevalence of AN, particularly among university students, has been increasing. The development of AN in Asia is influenced not only by the impact of Western culture and media but also by traditional family structures, societal norms, and academic achievement pressures. However, while the prevalence of AN in Asia is lower than in the West, modernization and globalization are increasing these rates. In African and Middle Eastern societies, AN has a lower prevalence compared to Western societies. In African cultures, a fuller body is traditionally considered a sign of health and prosperity, although urbanization and globalization are changing this perception. Additionally, in the Middle East, religious norms and rituals may make it difficult to recognize the symptoms of AN. Religious practices such as fasting may overlap with the symptoms of AN and delay individuals from seeking professional help. In conclusion, AN is not only a biological and psychological disorder but is also influenced by cultural and social factors. This study highlights how AN is shaped by cultural and social dynamics in the West, Asia, Africa, and the Middle East. In this context, AN is presented as an issue that arises not only from individual experiences but also from the value systems and social structures of societies. Understanding cultural differences can contribute to the development of more effective and culturally sensitive treatment approaches for AN.

Anahtar Kelimeler

• Anorexia Nervosa
• Diagnosis
• Treatment
• Cultural Differences
• Social Dynamics

Anoreksiya Nervoza: Batı, Asya, Afrika Ve Orta Doğu Toplumlarında Kültürel Ve Sosyal Dinamikler

Öz

Anoreksiya Nervoza (AN), beden algısında bozulmalara ve aşırı zayıflama isteğine sebep olan bir yeme bozukluğudur. Bu yeme bozukluğu, genellikle Batı toplumlarıyla ilişkilendirilir. Ancak, küreselleşme, kentleşme ve medyanın etkisiyle bu bozukluk, Asya, Afrika ve Orta Doğu toplumlarında da giderek yaygınlaşmaktadır. Her bir kültür, AN’nin ortaya çıkış biçimlerini, prevalansını ve klinik sunumunu farklı şekillerde etkilemektedir. Batı toplumlarında AN, genellikle medya, moda endüstrisi etkisi ve ideal vücut algısı ile ilişkilendirilir.  Bu gibi toplumlarda, güzellik ve başarı ile ince bir vücut yapısı arasında doğrudan bir ilişki olduğu kabul edilir. Asya’da ise topluluk merkezli kültür, akademik baskılar ve aile değerleri bu bozukluğun seyrini şekillendirmektedir. Bunun yanı sıra kozmetik sektörü ve pop kültürünün, zayıflığı idealleştirmesi AN’nin Asya toplumlarında görülme sıklığını etkilediği söylenebilir. Afrika ve Orta Doğu’da ise oruç gibi dini ritüel ve inanışlara ek olarak, değişen geleneksel güzellik algıları ve sosyal yapı bu hastalığın tanınmasını, ortaya çıkışını ve tedavisini etkilemektedir. Bu makale, farklı kültürel ve sosyal bağlamlarda AN’nin dinamiklerini kapsamlı bir şekilde ele almayı ve incelemeyi amaçlamaktadır.

Anahtar Kelimeler

• Anoreksiya Nervoza
• Tanı
• Tedavi
• Kültürel Farklılıklar
• Sosyal Dinamikler

Kaynakça

1. Abrams, K. K., Allen, L. R., & Gray, J. J. (1993). Disordered eating attitudes and behaviors, psychological adjustment, and ethnic identity: A comparison of Black and White female college students. International Journal of Eating Disorders, 14(1), 49–57.
2. Adebimpe Oluwafisayo, A., Idehen, E. E., Mosaku, S. K., Muoghalu, C. O., & Opakunle, T. Prevalence of Eating Disorders among Female Undergraduates at a Nigerian University.
3. Al-Adawi, S., Dorvlo, A. S. S., Burke, D. T., Moosa, S., & Al-Bahlani, S. (2002). A survey of anorexia nervosa using the Arabic version of the EAT-26 and “gold standard” interviews among Omani adolescents. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 7, 304-311.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
5. Avinash, P., Victor, R., Prasad, A., & Singhania, R. (2025). Dreading Weight: A Case Series on Eating Disorders from North India. Indian Journal of Behavioural Sciences, 28(1), 45-49.
6. Balogun, S. K., Nwankwo, B. E., Okehie, H. U., & Aruoture, E. U. (2024). Beauty and Sexuality in African Setting. Nigerian Journal of Social Psychology, 7(2).
7. Chen, X., Luo, Y. J., & Chen, H. (2020). Body image victimization experiences and disordered eating behaviors among Chinese female adolescents: the role of body dissatisfaction and depression. Sex Roles, 83(7), 442-452.
8. Cummins, L. H., Simmons, A. M., & Zane, N. W. (2005). Eating disorders in Asian populations: A critique of current approaches to the study of culture, ethnicity, and eating disorders. American Journal of Orthopsychiatry, 75(4), 553–574.

9. Davis, C., & Katzman, M. A. (1998). Chinese men and women in the United States and Hong Kong: Body and self‐esteem ratings as a prelude to dieting and exercise. International Journal of Eating Disorders, 23(1), 99-102.
10. Demirer, B., & Yardımcı, H. (2020). Güncel DSM-V kılavuzuna göre yeme bozukluklarının incelenmesi. Sağlık Bilimlerinde Multidisipliner Araştırmalar, 1(2), 275–290
11. Fadipe, B., Oyelohunnu, M. A., Olagunju, A. T., Aina, O. F., Akinbode, A. A., & Suleiman, T. F. (2017). Disordered eating attitudes: demographic and clinico-anthropometric correlates among a sample of Nigerian students. African health sciences, 17(2), 513–523. https://doi.org/10.4314/ahs.v17i2.27
12. Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407–416. https://doi.org/10.1016/S0140-6736(03)12378-1
13. Faujdar, R., Sharma, A., Sharma, A., Jeswani, M., & Chhari, A. (2024). Prevalence of Eating Disorder among Indian Adolescent Students Res. J. Med. Sci, 18, 304-307.
14. Freeman, A. C., & Szabo, C. P. (2005). Eating disorders in South African males: A review of the clinical presentation of hospitalised patients. South African Journal of Psychology, 35(4), 601-622.
15. Furnham, A. ve Baguma, P. (1994). Cross- cultural differences in the evaluation of male and female body shapes. International Journal of Eating Disorders, 15(1), 81- 89.
16. Garfinkel, P. E., Lin, E., Goering, P., Spegg, C., Goldbloom, D. S., Kennedy, S., ... & Woodside, D. B. (1996). Purging and nonpurging forms of bulimia nervosa in a community sample. International Journal of Eating Disorders, 20(3), 231-238.
17. Hall, C. C. I. (1995). Asian Eyes: Body Image and Eating Disorders of Asian and Asian American Women. Eating Disorders, 3(1), 8–19. https://doi.org/10.1080/10640269508249141
18. Hoek, H. W. (2006). Anoreksiya nervoza ve diğer yeme bozukluklarının sıklığı, yaygınlığı ve mortalitesi. Current Opinion in Psychiatry, 2(3), 166–173.
19. Horuzcu, Ü (2016). Kutsal Açlık Yeme Riyazeti ve Anoreksiya Nervoza. Milel ve Nihal, 14(2), 218–225.
20. Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
21. Jung, J., & Forbes, G. B. (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.
22. Keski-Rahkonen, A., Raevuori, A., & Hoek, H. W. (2018). Epidemiology of eating disorders: an update. Annual Review of eating disorders, 66-76.
23. Kim, J. H., & Lennon, S. J. (2007). Mass media and self-esteem, body image, and eating disorder tendencies. Clothing and Textiles Research Journal, 25(1), 3-23.
24. Kring, A. M., Johnson, S. L., Davison, G. C. ve Neale, J. M. (2019). Anormal Psikoloji (M. Şahin, Çev.). Ankara: Nobel Akademik Yayıncılık.
25. Lee, H. R., Lee, H. E., Choi, J., Kim, J. H., & Han, H. L. (2014). Social Media Use, Body Image, and Psychological Well-Being: A Cross-Cultural Comparison of Korea and the United States. Journal of Health Communication, 19(12), 1343–1358. https://doi.org/10.1080/10810730.2014.904022
26. Lee, K. H., Bong, S. H., Kang, D. H., Choi, T. Y., & Kim, J. W. (2020). Association between weight misperception and some mental health-related characteristics in Korean adolescents. Neuropsychiatric disease and treatment, 3053-3062.
27. Lee, S., Ho, T. P., & Hsu, L. K. G. (2019). Eating disorders in Asia: Implications of culture on prevalence and practice. Psychological Medicine, 49(3), 487–498. https://doi.org/10.1017/S0033291718002514
28. Lee, Y. Y., & Wan Abdul Manan, W. M. (2014). Mutritional status, academic performance and parental feeding practices of primary school children in a rural district in Kelantan, Malaysia. Progress in Health Sciences, 4(1), 144-152.
29. Levine, M. P., & Smolak, L. (2018). The role of protective factors in the prevention of negative body image and disordered eating. Eating Disorders, 26(1), 32–39. https://doi.org/10.1080/10640266.2018.1418323
30. Liang, Y., et al. (2020). “Cultural and family dynamics in eating disorders: The case of China.” Journal of Eating Disorders.
31. Lopez, E., Martinez-Gonzalez, M. A., & Sanchez-Villegas, A. (2021). Cultural influences on the expression and management of eating disorders: A review. International Journal of Eating Disorders, 54(4), 511–524. https://doi.org/10.1002/eat.23591
32. Makino, M., Tsuboi, K., & Dennerstein, L. (2004). Prevalence of eating disorders: a comparison of Western and non-Western countries. Medscape general medicine, 6(3), 49.
33. Mastamet-Mason, A., Sokhetye, P. N., & Tilahum, Y. D. (2024, December). Female Body Beauty Ideals and Their Impact on Fashion Size Standards: A Comparative Study of Western and South African Perspectives. In International Conference on Multidisciplinary Research (Vol. 2024, pp. 205-221).
34. Nasser, M. (1997). The EAT speaks many languages: Review of the use of the EAT in eating disorders research. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 2, 174-181.
35. Neale, J., & Hudson, L. D. (2020). Anorexia nervosa in adolescents. British Journal of Hospital Medicine, 81(6), 1–8.
36. Nielsen, S., & Vilmar, J. W. (2021). What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? A Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970–2014). Psychiatry Research, 303, 114081. https://doi.org/10.1016/j.psychres.2021.114081
37. Pike, G., Thomas, C., Lee, E. E. J., Thachil, A., & Schmidt, U. (2020). Severe electrolyte disturbance in anorexia nervosa with gastrointestinal complications: reading both the clinical evidence and the patient. British Journal of Hospital Medicine, 81(5), 1-3.
38. Pike, K. M., & Borovoy, A. (2004). The rise of eating disorders in Japan: Issues of culture and limitations of the model of “Westernization”. Culture, medicine and psychiatry, 28, 493-531.
39. Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of eating disorders, 3, 1-14.
40. Pike, K. M., Hoek, H. W., & Dunne, P. E. (2014). Cultural trends and eating disorders. Current Opinion in Psychiatry, 27(6), 436–442. https://doi.org/10.1097/YCO.0000000000000113
41. Safiri, S., Noori, M., Nejadghaderi, S. A., Mousavi, S. E., Karamzad, N., Sullman, M. J., ... & Kolahi, A. A. (2022). Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019. Journal of Eating Disorders, 10(1), 192.
42. Schroeder, M., & Behm-Morawitz, E. (2025). Digitally curated beauty: The impact of slimming beauty filters on body image, weight loss desire, self-objectification, and anti-fat attitudes. Computers in Human Behavior, 165, 108519.
43. Slater, A., & Tiggemann, M. (2010). Body image and disordered eating in adolescent girls and boys: A test of objectification theory. Sex roles, 63, 42-49.
44. Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53(5), 985–993. https://doi.org/10.1016/S0022-3999(02)00488-9
45. Şengönül, M., & Aydın, B. N. (2023). Genç yetişkinlerde sosyal medya kullanımına dair özellikler ile sosyal görünüş kaygısı ve yeme tutumları ilişkisi. Haliç Üniversitesi Sosyal Bilimler Dergisi, 6(1), 113-134.
46. Tareen, A., Hodes, M. ve Rangel, L. (2005). Non-fat-phobic anorexia nervosa in British South Asian adolescents. International Journal of Eating Disorders, 37(2), 161- 165.
47. Uzun, Ö., Güleç, N., Özşahin, A., Doruk, A., Özdemir, B., & Çalışkan, U. (2006). Screening disordered eating attitudes and eating disorders in a sample of Turkish female college students. Comprehensive psychiatry, 47(2), 123-126.
48. Van Durme, K., Goossens, L., Braet, C., & Van Vlierberghe, L. (2015). The role of self-esteem in the relationship between body dissatisfaction and eating pathology: A longitudinal study. Journal of Abnormal Child Psychology, 43(5), 899–908. https://doi.org/10.1007/s10802-014-9955-6
49. Yang, C., Li, F., & Khalid, N. F. (2025). Disordered eating in young Chinese adults: role of parenting styles, attachment anxiety, and negative coping styles. BMC Public Health, 25(1), 1-18.
50. Yücel, B. (2009). Estetik bir kaygıdan hastalığa uzanan yol: Yeme bozuklukları. İlk Söz, 22(4), 39-45.
51. Kendler, K. S., Walters, E. E., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1995). The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Archives of general psychiatry, 52(5), 374-383.
52. Wildes, J. E., Emery, R. E. ve Simons, A. D. (2001). The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: A meta- analytic review. Clinical Psychology Review, 21(4), 521-551.
53. Wilson, G. T. (2010). Eating disorders, obesity and addiction. European Eating Disorders Review, 18(5), 341-351.