on Eating Disorders
MELANIE A. KATZMAN
A decade ago, eating disorders in the forms of anorexia nervosa and bulimia nervosa were predominantly confined to the developed West. However, anorexia nervosa and, more recently, bulimia nervosa are becoming common clinical problems among young females in high-income Asian societies such as Japan, Hong Kong, Singapore, Taiwan, and the Republic of Korea. They have also appeared in major cities in low-income Asian countries such as China, Malaysia, the Philippines, and Indonesia. They have even been identified in unexpected places such as India and Africa.
Drawing on clinical and research experience in Asian and, in particular, Chinese populations, this chapter addresses four main questions: (1) How common are eating disorders, and why are they emerging in Asian females? (2) Are eating disorders more likely to present atypically in Asian patients? (3) Are Western research instruments valid in Asian populations? (4) What are the implications of atypical eating disorders for the etiology, diagnosis, treatment, and prevention of eating disorders in general?
Accurate, two-stage community estimates of eating disorders are even rarer in Asian than Western populations, but rough estimates provide good reason for concern. Several community studies in Hong Kong have indicated that 3–10% of young females suffer from disordered eating. Rates of referrals to clinics suggest that eating disorders increased in prevalence in the 1990s and are affecting ever younger subjects. In several Asian countries, the mass media have repeatedly informed the public about the increased use of extreme weight-control behavior, dramatic cases of women who have died from untreated eating disorders, and celebrities who suffered from or recovered from anorexia nervosa.