ABSTRACT
Since the early 1980s, when papers on cultural influences on eating disorders began to appear in the literature, it has been evident to many observers that eating disorders are unique among psychiatric disorders in the degree to which social and cultural factors influence their epidemiology, development and perhaps their etiology (Barlow and Durand, 1999). Hilde Bruch (1978) was one of the first to implicate cultural factors in the increasing incidence of eating disorders, citing both the fashionable emphasis on slenderness as well as the conflicting demands on contemporary young women that created severe identity confusion. The incidence of eating disorders appeared to increase sharply in the United States, the United Kingdom and many Western European countries beginning in the mid-to late 1960s and then in accelerating fashion into the 1970s and through the late 1980s (Willi and Grossman, 1982; Lucas et al., 1991, 1999; Eagles et al., 1995). This was remarkable for anorexia nervosa, which had been identified as a medical syndrome since the 1870s in Europe and the United States but had been considered a relatively obscure, almost exotic, condition over the first 100 years of its medical history (Bruch, 1973). The situation was even more startling for bulimia nervosa, which had been virtually unknown prior to the 1970s until its description by Boskind-Lodahl (1976) and Russell (1979). By the 1980s, however, it was widely agreed that bulimia nervosa was considerably more common than anorexia nervosa (Pope et al., 1984).
