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Garner, D. M. & Garfinkel, P.E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine, 10, 647-656.

Author’s Note: This was the first empirical paper demonstrating that increased cultural pressures for thinness was highly associated with increased risk of anorexia nervosa and excessive dieting concerns.  Professional dance (N=183) and modelling (N=56) students, who by career choice must focus increased attention and control over their body shapes, were studied. The Eating Attitudes Test (EAT-40) was developed for this study and it was administered to assess for symptoms of anorexia nervosa. Results of the test were compared to normal college students and the results indicated that anorexia nervosa was quite common (12 cases or 6.5%) in the dancers and all but one of the dancers developed the disorder while studying dance. Within the dance group, those from the most competitive environments had the greatest frequency of anorexia nervosa. These results suggest that both pressures to be thin and achievement expectations are risk factors in the development of anorexia nervosa. The influence of socio-cultural factors were discussed within the context of anorexia nervosa as a multi-determined disorder. This paper was quite controversial at the time but introduced the concept of culture as a risk factor that is now widely accepted.

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