Not Your ?Typical Island Woman?: Anorexia Nervosa is Reported Only in Subcultures in Cura�ao

Abstract

Anorexia nervosa (AN), once thought to be a problem of wealthier, Western countries has now been documented in survey studies and case reports across geographic and economic groups; however, few epidemiological studies including interview have been done on these populations. We report on a comprehensive study on Curaçao, a Caribbean island in economic transition, where the majority of the population is of predominantly black African origin. As part of an epidemiological study on the island of Curaçao indigenous cases of AN were identified. Participants were interviewed and asked to complete standardized measures of eating behaviors and cultural attitudes. In addition, matched controls completed the same measures and were seen in a focus group to assess their knowledge of eating disorders and perceived current and future challenges to young Curaçao women. Six of the nine indigenous cases of AN were successfully traced; all were of mixed race. No cases of anorexia were found among the majority black population. The women with AN were from the high-education and high-income sectors of the society and the majority had spent time overseas. The women with a history of anorexia reported higher levels of perfectionism and anxiety than the matched controls. All of the women reported challenges to maintaining an active professional and personal life and viewed themselves as different from the norm. Women who presented with AN evidenced vulnerability to a triple threat to identity formation: (1) they were of mixed race, aspiring to fit into the mobile elite (and mostly white) subgroup while distancing themselves from the black majority; (2) they had the means for education and travel that left them caught between modern and traditional constructs of femininity; and (3) they had lived overseas, and therefore struggled upon reentry with the frustrations of what was possible within the island culture. The race, class and overseas exposures of the women with anorexia were anything but typical on the island. Cases of anorexia in other developing countries may similarly be limited to specific subgroups, which require specialized treatment and planning efforts.

Sociocultural factors in the development of anorexia nervosa in a black woman

“…8 Our findings are consistent with the assumption that acculturation plays a role in the development of eating disorders and that women in ethnic minorities are at greater risk of developing eating disorders when they identify more with White, middle-class values. 1,7,9 This case report shows that, under the right circumstances, Black women who are vulnerable to AN do indeed develop the disorder. It illustrates that the internalization of the Western thinness ideal can play an important mediating role in diet restriction, leading eventually to AN.…”

“…They were of mixed race, were more highly educated, and had lived overseas, all of which made them quite different from the Black majority on the island. 7 The illness history of our case illustrates that her ethnic background did not protect her from developing AN. It highlights the contribution of sociocultural influences in the form of local norms regarding body size and shape to the development of AN.…”

Meanings of thinness and dysfunctional eating in black South African females: A qualitative study

“…This is consistent with research which has found that social comparison with white peers may promote body dissatisfaction amongst nonwestern schoolgirls 20 who may overcorrect 21 their body shape in order to be accepted by their western peers. Research 14,15 has also suggested that women may use the body as a vehicle for the expression of identity, particularly during times of rapid social change when they may need to redefine themselves. 16,22 Black, South African schoolgirls may thus be particularly at risk for the development of body dissatisfaction and dysfunctional eating attitudes and behaviors, during the period of ethno-cultural integration and rapid socio-cultural transition that is occurring in post-apartheid South Africa.…”

It would not have happened to me at home: qualitative exploration of sojourns abroad and eating disorders in young Czech women

“…For example, in the Curacao study, the effect of migration is difficult to separate from race, socio-economic class and educational factors (Katzman et al, 2004). To explore these and other possibilities, we conducted an in-depth qualitative study of subjective accounts of such events among young Czech women with eating disorders.…”