title: Eating symptomatology and general psychopathology in patients with anorexia nervosa from China, UK and Spain: A cross-cultural study examining the role of social attitudes.
abstract: Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People´s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN; CB06/03), Instituto Salud Carlos III, Barcelona, Spain.|Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Zaida
authors.identifier: http://orcid.org/0000-0003-4453-4939
authors.initials: Z
authors.lastname: Agüera
authors.affiliation: Leicestershire Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Brewin
authors.affiliation: Department of clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC.
authors.forename: Jue
authors.initials: J
authors.lastname: Chen
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN; CB06/03), Instituto Salud Carlos III, Barcelona, Spain.|Departament de Psicobiologia i Metodologia. Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Granero
authors.affiliation: Department of clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC.
authors.forename: Qing
authors.initials: Q
authors.lastname: Kang
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN; CB06/03), Instituto Salud Carlos III, Barcelona, Spain.|Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Aranda
authors.affiliation: Leicestershire Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, United Kingdom.|Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Arcelus
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology*; D001290:Attitude; D002681:China; D003431:Cross-Cultural Comparison; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D013030:Spain; D006113:United Kingdom