Psychological Medicine

Research Article

Socio-cultural factors in the development of anorexia nervosa

David M. Garnera1 c1 and Paul E. Garfinkela1

a1 Psychosomatic Medicine Unit, Clarke Institute of Psychiatry, Department of Psychiatry, University of Toronto, Canada


A population of professional dance (N = 183) and modelling (N = 56) students, who by career choice must focus increased attention and control over their body shapes, was studied. Height and weight data were obtained on all subjects. In addition, a questionnaire that is useful in assessing the symptoms of anorexia nervosa, the Eating Attitudes Test (EAT), was administered. Results of these tests were compared with those of normal female university students (N = 59), patients with anorexia nervosa (N = 68), and music students (N = 35).

Anorexia nervosa and excessive dieting concerns were overrepresented in the dance and modelling students. Twelve cases (6·5%) of primary anexoria nervosa were detected in the dance group. All but one case developed the disorder while studying dance. Within the dance group those from the most competitive environments had the greatest frequency of anorexia nervosa. These data suggest that both pressures to be slim and achievement expectations are risk factors in the development of anorexia nervosa. The influence of socio-cultural determinants are discussed within the context of anorexia nervosa as a multidetermined disorder.


c1 Address for correspondence: Dr D. M. Garner, Clarke Institute of Psychiatry, 250 College Street, Toronto, Canada, M5T 1R8.