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.6.Nasser M.(1986) Comparative study of the prevalence of abnormal eatingattitudes among Arab female students of both London and Cairo universities.Psychol.Med., 16: 621 625.7.Rathner G., Messner K.(1993) Detection of eating disorders in a small ruraltown: an epidemiological study.Psychol.Med., 23: 175 184.8.Mumford D.B., Whitehouse A.M., Platts M.(1991) Sociocultural correlates ofeating disorders among Asian schoolgirls in Bradford.Br.J.Psychiatry, 158:222 228.9.Ford K.A., Dolan B.M., Evans C.(1990) Cultural factors in the eating disorders:a study of body shape preferences of Arab students.J.Psychosom.Res., 34: 501507.10.Johnson-Sabine E., Wood K., Patton G., Mann A., Wakeling A.(1988) Abnormaleating attitudes in London schoolgirls.A prospective epidemiological study: 134 ___________________________________________________________________________ EATING DISORDERSfactors associated with abnormal responses on screening questionnaires.Psychol.Med., 18: 615 622.11.Rathner G., Tury F., Szabo P., Geyer M., Rumpold G., Forgacs A., Sollner W.,Plottner G.(1995) Prevalence of eating disorders and minor psychiatricmorbidity in Central Europe before the political changes in 1989: a cross-cultural study.Psychol.Med., 25: 1027 1035.12.Halmi K.A., Falk J.R., Schwartz E.(1981) Binge eating and vomiting: a survey ofcollege population.Psychol.Med., 11: 697 706.13.Fairburn C.G., Cooper P.J.(1982) Self-induced vomiting and bulimia nervosa:an undetected problem.Br.Med.J., 284: 1153 1155.14.Beumont P., Al-Alami M., Touyz S.(1988) Relevance of a standard measure-ment of under nutrition to the diagnosis of anorexia nervosa: use of Quetelet sBody Mass Index (BMI).Int.J.Eat.Disord., 7: 399 405.15.Killen J.D., Taylor C.B., Telch M.J., Saylor K.E., Maron D.J., Robinson T.N.(1986) Self-induced vomiting and laxative and diuretic use among teenagers.Precursors of the binge-purge syndrome? JAMA, 255: 1447 1449.2.13The Search for Influences on Eating DisordersMerry N.Miller1Aetiological factors leading to the development of eating disorders havelong been a source of study and speculation.Hoek et al.have provided athorough and useful review of the epidemiology of eating disorders, whichcan provide clues to aetiology.As they discuss, potential risk factors can beidentified through examination of epidemiological and cultural associa-tions, and this has the potential to improve understanding of thedevelopment of eating disorders.Controversy exists about the true occurrence rates of both anorexianervosa and bulimia nervosa.As Hoek et al.mention, true prevalence andincidence rates are obscured by the fact that many individuals with thesedisorders deny and conceal their pathology.In addition, their overall lowprevalence in the general population presents a methodological challenge.The use of two-stage screens and studies of population subsets at higherrisk are methods reviewed that provide useful data.An apparent increase in the incidence of anorexia nervosa over thelast half of the 20th century is discussed.Less information is availableabout changes in rates of bulimia nervosa owing to its relatively recentidentification.Nevertheless, evidence is cited suggesting that these ratesalso have increased since the original description of bulimia nervosa as1Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Box 70567,Johnson City, TN 37614, USA EPIDEMIOLOGY AND CULTURAL ASPECTS: COMMENTARIES ___________________ 135a separate disorder in 1979 [1].Such a presumable expansion in eatingdisorder pathology often has been referenced as evidence for a culturalinfluence on the development of these disorders, particularly in light ofthe emphasis on thinness in the Western ideals of the late 20thcentury.Unfortunately, determination of true prevalence and incidence rates foreating disorders is even more problematic in earlier periods of history.Areview of historical evidence suggests the possible existence of eatingdisorders in previous eras, and raises questions about the true impact ofcurrent social pressures on the development of eating disorders [2].The role of contemporary social factors in the development of eatingdisorders has been debated.It was believed previously that eating disordersoccurred almost exclusively in upper socio-economic groups withinWestern nations, and primarily among Caucasian females [3]
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