TABLE OF CONTENTS
1. Introduction …………………………………………………………………3
2. Anorexia nervosa
2.1 Diagnostic criteria of anorexia nervosa.………………………….……....3
2.2 Subtypes of anorexia nervosa……………………………………….……4
2.3 Hallmark features of anorexia nervosa………………………….….……4
2.4 Physical complications……………………………………………………..5
2.5 Prevalence and course…………………………………………………….5
3. Bulimia Nervosa
3.1 Diagnostic criteria of bulimia nervosa………………………..………..….6
3.2 Hallmark features of bulimia nervosa……………………………..…..….7
3.3 Physical complications………………………………………..…….……...8
3.4 Prevalence and course………………………………………….….………8
4. Binge-eating disorder
4.1 Diagnostic criteria of binge-eating disorder………………………………9
4.2 Hallmark features of binge-eating disorder…………………………...... 9
4.3 Physical complications………………………………………………….….10
4.4 Prevalence and course…………………………………………………….10
5. Differentiation between anorexia nervosa, bulimia nervosa and
binge-eating disorder………………………………………………………….11
6. Are black South African females no longer ‘immune’ from eating
disorders?
6.1 The emergence of eating disorders in black South African
females ………………………………………………………………………….12
6.2 Socio-political changes in a post-apartheid South Africa.……………..14
6.3 Acculturation………………………………………………………. ………15
6.4 Urbanization and exposure to Western media………………………….17
7. Conclusion…………………………………………………………………..17
8. Reference list……………………………………………………………….19-22
1
,1. Introduction
Generally in the modern Western culture thinness is emphasized and often equated
with ideal beauty, success and popularity and acknowledged from an optimistic lens.
Mass media plays a substantial role in setting a standard to which many girls look up to,
often employing what has been termed ‘thin-ideal media’ – imagery of very thin females.
This can be observed in fashion magazines, clothing catalogues, films and popular
culture television shows. A study by Hawkins, Richards, Granley and Stein (2004) has
revealed that exposure to thin-ideal media images causes’ body dissatisfaction,
negative moods, low self-esteem and eating disorder symptoms among women. Eating
disorders are serious, psychological disorders characterised by an obsessive
preoccupation with weight and body shape, as well as abnormal eating behaviour that
can at times even be fatal. It permeates all areas of the individual’s life and eventually
takes over the person’s life, leading to physical as well as emotional destruction. It
consumes the sufferer’s time, money and affects their relationships with their loved
ones (Ives, 2013). Three main types of eating disorders have been identified and
classified in the DSM-5 (American Psychiatric Association, 2013). These three eating
disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder will be
discussed here.
2. Anorexia nervosa
2.1 Diagnostic criteria of anorexia nervosa
The word ‘anorexia nervosa’ means ‘nervous loss of appetite’. Anorexia nervosa is a
severe and potentially life threatening mental illness grouped under feeding and eating
disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5).
Anorexia nervosa has been associated with one of the highest rates of mortality among
all psychiatric disorders (Bodell & Keel, 2010). According to the DSM-5 the diagnostic
criteria of anorexia nervosa is characterised by three core areas (American Psychiatric
Association, 2013). This diagnostic criteria is set out below:
A. “Restriction of energy intake relative to requirements, leading to a significantly low
body weight in the context of age, sex, development trajectory, and physical health”
(APA, 2013, p. 338). Significantly low bodyweight is defined as “less than minimally
2
, normal or, for children and adolescents, less than that minimally expected” (APA, 2013,
p. 340). Body mass index (BMI; calculated as weight in kilograms/ height in meters) is
used as a guideline here, although the individual’s body build, weight history, and any
physiological disturbances must also be taken into account.
B. “Intense fear of gaining weight or of becoming fat, or persistent behaviour that
interferes with weight gain, even though at a significantly low weight” (APA, 2013, p.
338). This fear does not diminish even with weight loss.
C. “Disturbance in the way in which one’s body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or persistent lack of recognition of
the seriousness of the current low body weight” (APA, 2013, p. 339).
2.2 Subtypes of Anorexia Nervosa
According to the American Psychiatric Association (2013) there are two anorexia
nervosa subtypes namely the restricting type and binge-eating/purging type. With the
restricting type weight loss is accomplished primarily through severe dieting, fasting or
excessive exercise. During the current episode, binge eating or purging behaviour is not
regularly present (APA, 2013). The binge-eating/purging type is where the individual
regularly (at least weekly) engages in binge eating or purging (or both) during the
current episode. Purging techniques used include self-induced vomiting, misuse of
laxatives, diuretics or enemas. The purging behaviour relieves some of the guilt
associated with eating forbidden food and alleviates the fear of gaining weight.
Individuals diagnosed with this type are more impulsive and more likely to engage in
substance abuse (APA, 2013).
2.3 Hallmark features of anorexia nervosa
Anorexia nervosa is a very frightening disorder where the individual basically starves
himself or herself and becomes extremely thin and malnourished. Although binge eating
and purging can occur within the one subtype, weight loss is primarily achieved by
restricting food intake (Sue, Sue, Sue & Sue, 2016). Some individuals with anorexia
nervosa also engage in excessive exercise (APA, 2013). The individual is
characteristically obsessed about calories and the fat content of food and often engages
3
1. Introduction …………………………………………………………………3
2. Anorexia nervosa
2.1 Diagnostic criteria of anorexia nervosa.………………………….……....3
2.2 Subtypes of anorexia nervosa……………………………………….……4
2.3 Hallmark features of anorexia nervosa………………………….….……4
2.4 Physical complications……………………………………………………..5
2.5 Prevalence and course…………………………………………………….5
3. Bulimia Nervosa
3.1 Diagnostic criteria of bulimia nervosa………………………..………..….6
3.2 Hallmark features of bulimia nervosa……………………………..…..….7
3.3 Physical complications………………………………………..…….……...8
3.4 Prevalence and course………………………………………….….………8
4. Binge-eating disorder
4.1 Diagnostic criteria of binge-eating disorder………………………………9
4.2 Hallmark features of binge-eating disorder…………………………...... 9
4.3 Physical complications………………………………………………….….10
4.4 Prevalence and course…………………………………………………….10
5. Differentiation between anorexia nervosa, bulimia nervosa and
binge-eating disorder………………………………………………………….11
6. Are black South African females no longer ‘immune’ from eating
disorders?
6.1 The emergence of eating disorders in black South African
females ………………………………………………………………………….12
6.2 Socio-political changes in a post-apartheid South Africa.……………..14
6.3 Acculturation………………………………………………………. ………15
6.4 Urbanization and exposure to Western media………………………….17
7. Conclusion…………………………………………………………………..17
8. Reference list……………………………………………………………….19-22
1
,1. Introduction
Generally in the modern Western culture thinness is emphasized and often equated
with ideal beauty, success and popularity and acknowledged from an optimistic lens.
Mass media plays a substantial role in setting a standard to which many girls look up to,
often employing what has been termed ‘thin-ideal media’ – imagery of very thin females.
This can be observed in fashion magazines, clothing catalogues, films and popular
culture television shows. A study by Hawkins, Richards, Granley and Stein (2004) has
revealed that exposure to thin-ideal media images causes’ body dissatisfaction,
negative moods, low self-esteem and eating disorder symptoms among women. Eating
disorders are serious, psychological disorders characterised by an obsessive
preoccupation with weight and body shape, as well as abnormal eating behaviour that
can at times even be fatal. It permeates all areas of the individual’s life and eventually
takes over the person’s life, leading to physical as well as emotional destruction. It
consumes the sufferer’s time, money and affects their relationships with their loved
ones (Ives, 2013). Three main types of eating disorders have been identified and
classified in the DSM-5 (American Psychiatric Association, 2013). These three eating
disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder will be
discussed here.
2. Anorexia nervosa
2.1 Diagnostic criteria of anorexia nervosa
The word ‘anorexia nervosa’ means ‘nervous loss of appetite’. Anorexia nervosa is a
severe and potentially life threatening mental illness grouped under feeding and eating
disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5).
Anorexia nervosa has been associated with one of the highest rates of mortality among
all psychiatric disorders (Bodell & Keel, 2010). According to the DSM-5 the diagnostic
criteria of anorexia nervosa is characterised by three core areas (American Psychiatric
Association, 2013). This diagnostic criteria is set out below:
A. “Restriction of energy intake relative to requirements, leading to a significantly low
body weight in the context of age, sex, development trajectory, and physical health”
(APA, 2013, p. 338). Significantly low bodyweight is defined as “less than minimally
2
, normal or, for children and adolescents, less than that minimally expected” (APA, 2013,
p. 340). Body mass index (BMI; calculated as weight in kilograms/ height in meters) is
used as a guideline here, although the individual’s body build, weight history, and any
physiological disturbances must also be taken into account.
B. “Intense fear of gaining weight or of becoming fat, or persistent behaviour that
interferes with weight gain, even though at a significantly low weight” (APA, 2013, p.
338). This fear does not diminish even with weight loss.
C. “Disturbance in the way in which one’s body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or persistent lack of recognition of
the seriousness of the current low body weight” (APA, 2013, p. 339).
2.2 Subtypes of Anorexia Nervosa
According to the American Psychiatric Association (2013) there are two anorexia
nervosa subtypes namely the restricting type and binge-eating/purging type. With the
restricting type weight loss is accomplished primarily through severe dieting, fasting or
excessive exercise. During the current episode, binge eating or purging behaviour is not
regularly present (APA, 2013). The binge-eating/purging type is where the individual
regularly (at least weekly) engages in binge eating or purging (or both) during the
current episode. Purging techniques used include self-induced vomiting, misuse of
laxatives, diuretics or enemas. The purging behaviour relieves some of the guilt
associated with eating forbidden food and alleviates the fear of gaining weight.
Individuals diagnosed with this type are more impulsive and more likely to engage in
substance abuse (APA, 2013).
2.3 Hallmark features of anorexia nervosa
Anorexia nervosa is a very frightening disorder where the individual basically starves
himself or herself and becomes extremely thin and malnourished. Although binge eating
and purging can occur within the one subtype, weight loss is primarily achieved by
restricting food intake (Sue, Sue, Sue & Sue, 2016). Some individuals with anorexia
nervosa also engage in excessive exercise (APA, 2013). The individual is
characteristically obsessed about calories and the fat content of food and often engages
3
