Background: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. Methods: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. Results: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. Conclusions: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.

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Background: The structured clinical interview for DSM-5 has recently been revised to reflect the new findings in the diagnostic criteria of psychological disorders. Objectives: The present study aimed to evaluate the reliability and validity of the Persian translation of structured clinical interview for diagnostic and statistical manual of mental disorders-fifth edition (DSM-5)-research version (SCID-5-RV) on Iranian adult population. Methods: In the current diagnostic accuracy study a total of 305 clinical samples were admitted to fifteen adult clinical settings and a subsample of these participants (n = 50, with a mean age of 34.31 and a standard deviation of 11.96) was recruited to evaluate test-retest reliability, and 40 non-clinical participants were recruited to examine construct validity. All participants completed the Millon Clinical Multiaxial inventory-III (MCMI-III) and Brief Symptom inventory (BSI). Results: SCID psychometric properties indicated an acceptable range for internal consistency (0.95 - 0.99), test-retest reliability (0.60 - 0.79), and Kappa reliability (0.57 - 0.72). Further, the agreement between interviewer and psychiatrist diagnoses was assessed using the Kappa index, and the result was satisfactory. The current diagnostic accuracy study used sensitivity and specificity indexes to assess the diagnostic validity of SCID by positive predictive value and also negative predictive value under the “likelihood ratio” domain. Specificity values for most psychiatric disorders were high; the sensitivity values were to somewhat lower. Furthermore, SCID-5-RV categorical diagnoses demonstrated an acceptable construct validity based on the significant differences between the clinical and non-clinical samples in all subscales of BSI except for phobia as well as all clinical subscales of MCMI-III. Conclusions: In general, the Persian translation of SCID-5-RV represented acceptable reliability and validity for various categorical diagnoses in different clinical settings.

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