Anne E. Becker

Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders.

OBJECTIVE The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non-Latino Whites. METHOD Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used. RESULTS The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non-Latino Whites for respondents with a lifetime history of any eating disorder. DISCUSSION These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States.

Mental Health and the Global Agenda

This article reviews the impact of mental health on overall health on a global level. The authors suggest changes that could lead to improved identification and treatment of mental illness in countries with limited resources.

Whatever feels good in my soul: body ethics and aesthetics among African American and Latina women.

Ethnicity-specific differences in body aesthetic ideals and body satisfaction have been cited as a potential explanation for interethnic differences in the prevalence and presentation of eating disorders. It has been widely hypothesized that such ethnically based differences in aesthetic body ideals mitigate cultural pressures that contribute to body disparagement and disordered eating among white women. However, mechanisms by which a cultural milieu may be protective against the development of disordered eating remain poorly understood. This study investigated relationships among ethnicity, self-representation, and body aesthetic ideals among 18 college-educated black and Latina women through analysis of focus group discussion data. Rather than confirming body aesthetic ideals different from those of white culture, study respondents reframed the discussion about body aesthetics to one of body ethics. That is, study subjects both contested ideologies defining thinness and whiteness as inherently beautiful and espoused a body ethic of self-acceptance and nurturance that rejects mainstream cultural pressures to reshape bodies to approximate aesthetic ideals promulgated in the media. We conclude that understanding body image concerns from the standpoint of body ethics, rather than body aesthetics, may be a more productive and inclusive approach to the study of ethnically diverse womens embodied experience. Ultimately it is anticipated that this will better illuminate the complex relationships among ethnicity, culture, and risk for body image and eating disorders.

Suicide in Contemporary China: A Review of China's Distinctive Suicide Demographics in Their Sociocultural Context

Suicide is a complex phenomenon--arguably a social and a moral deed--occurring within associated psychological, biological, and cultural contexts. We present data on suicide rates in China for 1988, 1990, and 1992 and provide an analysis of their social context. These figures, from the Chinese Public Health Annuals, have never before been publicly reported. These and other recent data indicate that suicide rates in China, although reportedly low in the past, are by global standards alarmingly high among certain demographic groups. They also reveal distinctive epidemiological patterns of suicide in China that contrast with the patterns characteristic of Western societies-for example, higher rates in rural than in urban areas and, among some demographic groups, higher among women than among men. As in the West, however, suicide among the elderly is a major problem in China. The sociocultural context of these data is examined as a means toward understanding their distinctive patterning.

Pregnancy: Outcome and impact on symptomatology in a cohort of eating‐disordered women

OBJECTIVE This study investigates both the impact of eating disorders (ED) on pregnancy outcome and the impact of pregnancy on cognitive and behavioral symptoms of EDs. METHOD Data on pregnancy outcome (live birth [LB], therapeutic abortion [TAB], and spontaneous abortion [SAB]) and ED symptomatology were collected as part of a large, prospective longitudinal study of anorexia nervosa (AN) and bulimia nervosa (BN). Data were gathered using a semistructured interview administered every 6 months to 246 subjects. RESULTS We identified 54 women who reported 82 pregnancies (46 LB, 25 TAB, and 11 SAB). Pregnancy outcome was not significantly related to any of the clinical variables studied. Women with BN showed a significant decrease in the severity of their ED symptoms during pregnancy, and this decrease was sustained through 9 months postpartum. Women with AN also demonstrated a significant reduction in ED symptoms, however, these symptoms returned to prepregnancy levels by 6 months postpartum. CONCLUSIONS Our prospective findings reveal an elevated TAB rate for ED women along with a general reduction in the severity of ED symptoms during pregnancy.

Should non‐fat‐phobic anorexia nervosa be included in DSM‐V?

OBJECTIVE Cross-cultural data suggest that rationales for food refusal vary in anorexia nervosa (AN), and a variant, termed non-fat-phobic AN (NFP-AN), has been described. This review evaluates whether data support modification of the requirement for intense fear of weight gain to meet AN criterion B in DSM-V. METHOD We performed a systematic search of the Medline and PsychInfo literature and evaluated the relevant publications by Robins and Guzes (Am J Psychiatry 126, 983-987, 1970) criteria as a standard for diagnostic validity. We also performed a meta-analysis comparing the severity of eating pathology in AN to (a) NFP-AN and (b) AN with low drive for thinness (low-DT-AN). RESULTS A modest literature indicates that NFP-AN has wide geographic distribution and occurs in both Western and non-Western populations alongside cases of typical AN. Aggregating across eligible studies, patients with NFP-AN or low-DT-AN score at least 2/3 of a standard deviation lower on measures of eating pathology than patients with conventional AN. Transcultural comparison of drive for thinness suggests significantly lower norms in non-Western cultures. DISCUSSION NFP-AN occurs with wide distribution. Further research is necessary on the course and outcomes of NFP-AN to characterize its congruence with, or distinction from, conventional AN. We discuss several options for including a description of NFP-AN in DSM-V.

A Qualitative Study of Perceived Social Barriers to Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers

Objective: The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample. Method: We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment (n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined by ethnic minority and non-minority participants. We then examined the influence of key social barriers—including stigma and social stereotypes—on perceived impact on care. Results: The majority of respondents (78%) endorsed at least one social barrier to care for an eating or weight concern. Perceived stigma (or shame) and social stereotyping—identified both within social networks and among clinicians—had adversely impacted care for 59% and 19% of respondents, respectively. Discussion: Social barriers to care for eating and weight related concerns may be prevalent in the U.S. and impact both ethnic minority and non-minority health care consumers.

Oxytocin secretion is associated with severity of disordered eating psychopathology and insular cortex hypoactivation in anorexia nervosa.

CONTEXT Animal data suggest that oxytocin is a satiety hormone. We have demonstrated that anorexia nervosa (anorexia), a disorder characterized by food restriction, low weight, and hypoleptinemia, is associated with decreased nocturnal oxytocin secretion. We have also reported functional magnetic resonance imaging (fMRI) hypoactivation in anorexia in brain regions involved in food motivation. The relationships between oxytocin, food-motivation neurocircuitry, and disordered eating psychopathology have not been investigated in humans. OBJECTIVE The objective of the study was to determine whether the oxytocin response to feeding in anorexia differs from healthy women and to establish the relationship between oxytocin secretion and disordered eating psychopathology and food-motivation neurocircuitry. DESIGN This was a cross-sectional study. SETTING The study was conducted at a clinical research center. PARTICIPANTS Participants included 35 women: 13 anorexia (AN), nine weight-recovered anorexia (ANWR), and 13 healthy controls (HC). MEASURES Peripheral oxytocin and leptin levels were measured fasting and 30, 60, and 120 min after a standardized mixed meal. The Eating Disorder Examination-Questionnaire was used to assess disordered eating psychopathology. fMRI was performed during visual processing of food and nonfood stimuli to measure brain activation before and after the meal. RESULTS Mean oxytocin levels were higher in AN than HC at 60 and 120 min and lower in ANWR than HC at 0, 30, and 120 min and AN at all time points. Mean oxytocin area under the curve (AUC) was highest in AN, intermediate in HC, and lowest in ANWR. Mean leptin levels at all time points and AUC were lower in AN than HC and ANWR. Oxytocin AUC was associated with leptin AUC in ANWR and HC but not in AN. Oxytocin AUC was associated with the severity of disordered eating psychopathology in AN and ANWR, independent of leptin secretion, and was associated with between-group variance in fMRI activation in food motivation brain regions, including the hypothalamus, amygdala, hippocampus, orbitofrontal cortex, and insula. CONCLUSIONS Oxytocin may be involved in the pathophysiology of anorexia.

Culture, the Media, and Eating Disorders

The epidemiology of eating disorders, with far greater prevalence in Westernized than developing nations, provides suggestive evidence for their cultural mediation. Although cross-ethnic differences in the phenomenology of anorexia and bulimia nervosa have been invoked as a partial explanation for this, more attention has focused on features of Western societies that could allow disordered eating and the overvaluation of body shape to flourish. In particular, a cultural “pressure to be thin” and the role of the media in perpetuating and escalating this pressure have been perceived as instrumental in setting the stage for the dieting and body disparagement that often precede an eating disorder in American society. Although there has been some uncertainty as to whether the media merely reflect or actually create pathogenic values, we join many of our colleagues in the belief that they play a vital role in supporting attitudes about body and self in our culture that enhance the risk of developing an eating disorder. We argue, however, that the presumed mechanism by which this occurs (i.e., dieting in response to powerful messages that slenderness is desirable leads to disordered eating) is a gross oversimplification of the role of the media based upon reflex assumptions about human motivation and behavior. Since our position is that preventive measures will not be possible until these culturally embedded assumptions are unearthed, we will examine some of the conventional hypotheses and offer an alternative to them. Specifically, we argue that the issue at stake is not so much which images are presented as ideal, but how they are rendered so compelling. The widespread dissemination and endorsement of particular images of women’s bodies have been conceived of as “pressure” to remake the body to match cultural aesthetic (and moral) ideals, without exam

Social network media exposure and adolescent eating pathology in Fiji.

BACKGROUND Mass media exposure has been associated with an increased risk of eating pathology. It is unknown whether indirect media exposure--such as the proliferation of media exposure in an individuals social network--is also associated with eating disorders. AIMS To test hypotheses that both individual (direct) and social network (indirect) mass media exposures were associated with eating pathology in Fiji. METHOD We assessed several kinds of mass media exposure, media influence, cultural orientation and eating pathology by self-report among adolescent female ethnic Fijians (n=523). We fitted a series of multiple regression models of eating pathology, assessed by the Eating Disorder Examination Questionnaire (EDE-Q), in which mass media exposures, sociodemographic characteristics and body mass index were entered as predictors. RESULTS Both direct and indirect mass media exposures were associated with eating pathology in unadjusted analyses, whereas in adjusted analyses only social network media exposure was associated with eating pathology. This result was similar when eating pathology was operationalised as either a continuous or a categorical dependent variable (e.g. odds ratio OR=1.60, 95% CI 1.15-2.23 relating social network media exposure to upper-quartile EDE-Q scores). Subsequent analyses pointed to individual media influence as an important explanatory variable in this association. CONCLUSIONS Social network media exposure was associated with eating pathology in this Fijian study sample, independent of direct media exposure and other cultural exposures. Findings warrant further investigation of its health impact in other populations.