And I look forward to advancing #bodyimage and #eatingdisorders research through rigorous and emically valid approaches to culture, so we can do a better job of addressing this increasingly global issue.

I’ve found that cognitive anthropological methods like cultural domain analysis and cultural consonance analysis are extremely effective for characterizing local needs systematically.

I’m most interested in maximizing “emic validity” - how well a measure assesses an issue in a community’s own terms

And (3) always starting from peoples’ own understandings of the world, their experiences, and their expectations.

My work tries to address this with
(1) greater attention to intercultural differences in eating disorders
(2) recognition intracultural differences (not treating culture as monolithic), and relating these differences to other social, political and economic factors…

The point of all this is, culture matters immensely and has gone under-appreciated in body image and eating disorders.

They find that Interpersonal Psychotherapy tends to be more effective, because their distress often lies not in conflicts within the bounded individual or individual toleration of outside stressors, but in relationships within the extended self.

This may be because of different conceptions of The Self (e.g. bounded [like in the US, *me* stops at the skin] vs extended [in many cultures, *me* includes my family, friends, nation, natural environment, built environment etc.]). Damage to these = damage to me.

The same goes for treatment. Cognitive-behavioral therapy (CBT) is one of the most common treatments for eating disorders. But some Asia-based practitioners report that it doesn’t work for their patients.

Ironically, the DSM-5 describes these as “atypical” presentations, even though recent evidence suggests they’re far and away the most common, especially outside of Western white female populations.

Diagnosis is biased too. Around the world and throughout history, people have exhibited all of the other symptoms of anorexia and bulimia as currently understood, without also exhibiting the extreme drive for thinness. The same goes for any other symptom.

*I say validated loosely, as the Korean validation study found a totally different factor structure from the US sample, but it gets used anyways.

But they contain inherent biases that may hamper their meaningfulness, usefulness, and interpretability across cultures.

Ex: a popular US-originating measure, validated* in Korea, has an item “음식을 작은 조각으로 나누어 먹는다“ (I divide my food into small pieces and eat it).

Korean meals are served pre-cut.

Usually, cross-cultural mental health research transplants measures developed using a combination of (English-biased) literature reviews, (Western-trained) expert consensus, and testing in primarily White college student samples to other locations and assumes they function similarly.

Eating disorders are rising in men and in all genders across the world. So, they’re not just “white women” illnesses.

Other groups appear to have lower rates of eating disorders, but this may be because they experience eating disorders differently. Current practices don’t/can’t account for this.

However, research agendas, measures, diagnostic criteria, and treatment options for eating disorders were all developed with primarily white, Western samples.

Most were developed for women in particular, and don’t account for men’s experiences adequately to begin with.

South Korea is interesting from a body image perspective because Korean men and women have some of the highest body dissatisfaction in the world.

Koreans’ male body ideals tended to be slimmer than in the West, and masculinity ideals favored more ornamental than instrumental body practices.

Only about 1% of published eating disorders research meaningfully addresses men’s experiences, and only 2.5% meaningfully addresses nonwhite peoples’ experiences.

Culture is almost universally neglected, even though it impacts gender expression and experience, body ideals, and illness experiences