Research has disclosed a significant cultural effect on the pat-terning and distribution of the eating disorders. An important de-terminant appears to be the Western premium on thinness as an esthetic and moral value (Ritenbaugh, 1982; Nichter and Nichter, 1991; Banks, 1992). Cases of eating disorder have been found in many nonWestern societies and several ethnic minorities in the USA, but their presenting features often differ somewhat from the DSM-IV-TR criteria for anorexia nervosa and bulimia ner-vosa (Shisslak et al., 1989).
Groups at high risk include those experiencing rapid ac-culturation to the Western society, such as immigrants or those living in areas undergoing accelerated industrialization (Riten-baugh et al., 1997). For example, one study found a 12% preva-lence of DSM-III eating disorders among the Egyptian female college students in London and no evidence of these conditions among a similar sample in Cairo (Nasser, 1986). Although it is as yet unclear exactly how acculturation predisposes the nonCau-casians to eating disorders, as a rule these conditions are more prevalent among the Caucasians than persons of other ethnic backgrounds (Wildes et al., 2001). Bulimia nervosa appears more common than anorexia nervosa among the US minorities and is often associated with higher than average weight, female sex and sometimes older age, for example, among the American Indian groups (Rosen et al., 1988). Anorexia nervosa has been found among lower socioeconomic class samples in several cultures but often characterized by atypical features, such as the absence of distorted body image or of the fear of gaining weight (Suematsu et al., 1985; Lee et al., 1989). Cross-cultural studies have pro-posed more flexible diagnostic criteria for anorexia nervosa so that abdominal fullness, epigastric pain, or distaste for food may be accepted instead of intense fear of weight gain to account for the severe restriction of food intake or other weight-losing behav-ior (Lee, 1991).