9. CULTURAL PRESENTATIONS OF ANOREXIA NERVOSA

Anorexia Nervosa in Blacks

Anorexia nervosa has been reported in American Blacks [52, 53, 54, 55] and in Blacks of Afro-Caribbean extraction from the West Indies [56]. The incidence of black anorexic patients in a total population of patients with anorexia nervosa is less than five percent [53]. Case reports from lower socioeconomic groups of West Indian patients living in England [56] and middle-to-upper-class patients [52] are noted.

Anorexia Nervosa in Hispanics

Hispanic females, described by Silber [52], experienced significant disruption moving from South America to Washington, D.C. with resultant object losses of friends and family, including grandparents. The onset of anorexia nervosa in these cases was associated with family disturbance and sexual abuse. Family dynamics in the Hispanic cases included severe disruption, infidelity by the father, alcoholism, depression, suicide attempts, and parental separation, creating a chaotic environment for the patient.

Silber [52] noted that the Hispanic females had high personal ideals. Being raised in a more traditional Latin culture, they may have had difficulty when expected to assimilate into the American culture, where thinness and academic achievement were highly valued. In addition, they had to contend with contrasting sexual attitudes, which may have exacerbated their own conflicts. Development of anorexia nervosa, with its regression to a prepubertal psychological structure, served as a maladaptive attempt to cope with issues of identity and cultural and sexual conflict.