INTERNATIONAL JOURNAL OF PSYCHOLOGY, 2007, 42 (1), 5968

A review of eating disorders research in Mexico

Claudia Unikel Ietza Bojorquez

National Institute of Psychiatry, Mexico City, National Institute of Public Health, Cuernavaca,
Mexico Mexico

T he objective of this paper is to summarize research findings on eating disorders and the current state of the
field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using
eating disorders, anorexia nervosa, bulimia nervosa, body image, binge eating, restrained eating,
weight and shape concern, and dieting as keywords. These were combined with the Boolean operator
AND with Mexico and Latin America. Findings are presented for epidemiology, the validity of
assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of
1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory
clinical interview and other national or regional representative samples makes it difficult to reach conclusions
about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating
have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug
and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and
cultural pressure to be thin. Future lines of research should include epidemiological studies with representative
samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors
specific to this population.

E l objetivo de este trabajo es el de resumir los hallazgos de investigacion sobre los trastornos alimentarios y el
estado actual del campo en Mexico. Se recupero la obra publicada en revistas indizadas y tesis de grado,
mediante los descriptores trastorno alimentario, anorexia nervosa, bulimia nervosa, imagen corporal,
stos se
atracones, restriccion alimentaria, preocupacion por el peso y la figura, y conducta de dieta. E
combinaron con el operador Booleano AND con Mexico y America Latina. Se presentan los hallazgos
para la epidemiologa, la validez de los instrumentos de medicion, comorbilidad, y factores de riesgo. Una
encuesta nacional representativa encontro una prevalencia de 1.8% para la bulimia nervosa, y ningun caso de
anorexia nervosa. No obstante, la carencia de estudios con una entrevista clnica confirmatoria y de otras
muestras nacionales o regionales dificulta el arribo a conclusiones acerca de la prevalencia real. Varios
instrumentos para la deteccion de los trastornos alimentarios y de la alimentacion desordenada se han validado
en poblacion mexicana. La comorbilidad de los trastornos alimentarios en Mexico incluye el uso y abuso de
alcohol, la obesidad y el trastorno de personalidad limtrofe. Los factores de riesgo referidos incluyen el peso
corporal y la presion cultural para estar delgado. Las lneas de investigacion futuras deberan incluir estudios
epidemiologicos con muestras representativas y la confirmacion del diagnostico, estudios longitudinales, y la
exploracion de factores de riesgo y protectores especficos a esta poblacion.

L objectif de cet article est de resumer les resultats de recherche et letat actuel des connaissances sur les
troubles alimentaires au Mexique. Les articles publies dans des revues indexees et les the`ses de doctorat ont
ete recenses en utilisant les mots-cles eating disorders , anorexia nervosa , bulimia nervosa , body image
, binge eating , restrained eating , weight and shape concern et dieting . Ceux-ci furent combines, en
utilisant la conjonction AND , avec les termes Mexico et Latin America . Les resultats sont presentes de
facon a` decrire lepidemiologie, la validite des instruments devaluation, la comorbidite et les facteurs de risque.
Une enquete normative nationale a indique un taux de prevalence de 1,8% pour la nevrose boulimique et aucun

Correspondence should be addressed to Dr. Claudia Unikel Santoncini, Direccion de Investigaciones Epidemiologicas y Psicosociales,
Instituto Nacional de Psiquiatra Ramon de la Fuente Muniz, Calzada Mexico-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan,
14370, Mexico, DF (E-mail: unikels@imp.edu.mx).
We want to acknowledge Dr Richard A. Gordons encouragement to write this manuscript and his accurate comments on its
preliminary and final versions. We also want to thank the participants of the seminar on publications held at the Office of
Epidemiological and Psychosocial Studies of the National Institute of Psychiatry for the comments they made to this article.

# 2007 International Union of Psychological Science

http://www.psypress.com/ijp DOI: 10.1080/00207590600760277
60 UNIKEL AND BOJORQUEZ

cas de nevrose anorexique. Cependant, le manque detudes utilisant des entrevues cliniques confirmatoires et
dautres echantillons normatifs nationaux et regionaux limite les conclusions sur la prevalence actuelle. Un
nombre important dinstruments pour depister les troubles alimentaires et lalimentation inadequate ont ete
valides aupre`s de la population mexicaine. Les principaux proble`mes de comorbidite avec les troubles
alimentaires au Mexique incluent labus de drogue ou dalcool, lobesite et le trouble de personnalite etat-limite.
Les facteurs de risque incluent le poids corporel et la pression culturelle a` etre mince. Les avenues de recherche
futures devraient inclure des etudes epidemiologiques aupre`s dechantillons representatifs, de la confirmation de
diagnostic, des etudes longitudinales et de lexploration de facteurs de protection et de facteurs de risque
specifiques a` cette population.

Eating disorders (ED) have long been recognized TABLE 1

as a public health problem in the USA and Diagnosis distribution of patients at the ED Unit of the Instituto
Nacional de Psiquiatra Ramon de la Fuente Muniz
Europe. In Mexico, the attention they receive is
only marginal thus far, an attitude supported by Diagnosis n %
the small number of ED patients attending 45 7.7
Restricting type anorexia nervosa
medical facilities. Records of the Health Ministry Binge eating/Purging type anorexia nervosa 33 5.7
(SSA) report no ED cases for the 19811992 Purging type bulimia nervosa 248 42.2
period, but they do report 55 deaths (23 males and Nonpurging type bulimia nervosa 10 2.2
32 females) caused by anorexia nervosa as defined Eating disorder not otherwise specified 248 42.2
Total 584 100.0
by the CIE-9 (Organizacion Mundial de la Salud,
1978) diagnostic criteria. Still, as the ages of death
ranged from 30 to 85 years, it is probable that the is still low. Patients living in small cities must
diagnoses were not accurate. travel in search of attention, thus increasing
The apparent absence of cases of ED, however, the emotional and economical cost of the treat-
might have been produced by a number of ment, and many patients just can not afford it.
situations. First, it could be true that, until On the other hand, new specialty courses
the 1980s, ED were very rare in Mexico. Second, for health professionals, such as that of the
at a time when knowledge about ED was National Autonomous University of Mexico
not widely spread, it was possible for a girl to (UNAM), promote the diffusion of basic know-
suffer from an ED with no-one close to her ledge on case detection and treatment. Another
considering it to be a condition needing mental indicator of the growing interest on ED is the
health attention. Third, medical services in number of dissertations on the subject. At
Mexico do not reach a large proportion of the UNAM, the countrys oldest and largest univer-
population, and this is especially true for psychia- sity, only five dissertations about ED had been
tric services. Fourth, even if a patient showed up written before 1990. From then on, the number
at a doctors office, the lack of knowledge about increased to seven between 19901996, to 32 in the
ED made it unlikely that she would be diagnosed 19972000 period, and to 74 in the 20012005
as a case. period (Direccion General de Bibliotecas, UNAM,
During the last decade there have been increases 2005, web page).
in the number of ED patients seeking attention For more than a decade, a number of Mexican
and in the number of public and private services researchers have adopted ED as a research
providing specialist care. Up until 1992, there was specialty. The purpose of this paper is to
only one clinic specializing in ED: the Anorexia review and introduce the results of their
Nervosa Clinic at the National Institute of work. We will highlight the main subjects
Nutrition (INN), founded in 1985. The National addressed by researchers and the results they
Institute of Psychiatry opened its Eating Disorders found, and discuss questions for future research.
Unit in 1996, where a mean of 200 cases are cared It is worth noting that Mexican researchers
for each year using a multidisciplinary approach. publish important parts of their work in journals
Of those patients, 95% are women. Table 1 not covered by search engines, and Mexican
shows the distribution of diagnoses. According universities and research centres do not always
to a Web search conducted in July 2004, there were have their librarys catalogues on the Internet. As
at least 10 private clinics, six in Mexico City and we conducted our search mainly through the Web,
one each in Guadalajara, Mazatlan, Monterrey, it is possible that we may have overlooked some
and Tijuana; the number of services, however, high quality research.
 EATING DISORDER RESEARCH IN MEXICO 61

METHOD lifetime prevalence of bulimia nervosa was found

for women and men respectively. No cases of
We conducted a search with the Ovid search anorexia nervosa were found (Medina-Mora et al.,
engine (Ovid Technologies, Inc., 2000) in the 2003). Such a low prevalence of ED (in other
Medline and PsychINFO databases. Keywords countries, prevalence ranges between 13% for
introduced were eating disorders, anorexia bulimia and 0.20.6% for anorexia; Van Hoeken,
nervosa, bulimia nervosa, body image, Lucas, & Hoek, 1998) could be explained by the
binge eating, restrained eating, weight and fact that the sample did not include teenage girls,
shape concern, and dieting, combined with the the population in which the highest rates would be
Boolean operator AND with Mexico and expected (Van Hoeken et al., 1998).
Latin America. In addition, we searched the In the second study (Unikel, Villatoro, Medina-
Internet for catalogues of Mexican universities Mora, Fleiz, Alcantara, & Hernandez, 2000), a
libraries, looking for Masters and PhD degree questionnaire for the detection of ED (Unikel,
dissertations, as well as medical specialty disserta- Bojorquez, & Carreno, 2004) was completed by a
tions, using the same keywords. representative sample of high school students in
Mexico City. Results showed a prevalence of
RESULTS dieting of 4% among girls and 2% among boys.
According to the authors, 2.8% of the girls and
The first strategy retrieved 33 papers from journals 0.9% of the boys were at risk of an ED.
published in Mexico and other countries. With the As for nonrepresentative samples, in a study
second strategy, we found 22 dissertations, 18 of conducted with 9- to 13-year-old girls (M 5 11.0
them Masters and Specialties in Medicine degrees years, SD 5 1.0), it was found that, during the past
and four PhD degrees. All of these were from year, 23% of them had introduced changes to their
UNAM, the only university with open online eating habits with the intention of losing weight
access to its catalogue of dissertations. (Gomez-Peresmitre, 1999). In a group of 4148
boys and 4525 girls aged 619 years, Gomez-
Peresmitre, Alvarado, Moreno, Saloma, and
Epidemiology Pineda (2001) found that 50% of the girls and
around 30% of the boys had modified their eating
In this section we present results about the
habits to lose weight during the previous year.
frequency of eating disorders and other manifesta-
tions that, without fulfilling the criteria for an ED,
include the same attitudes and behaviours, such as Assessment instruments
dieting, binging or purging, fear of fatness, etc.
Throughout this paper, the term disordered One of the most frequent subjects of research into
eating (DE) (Chamorro & Flores-Ortiz, 2000; ED in Mexico has been the testing of psychometric
Murnen & Smolak, 1997) will be used to describe characteristics of questionnaires for the detection
such attitudes and behaviours. of ED and DE. The Eating Attitudes Test-40
The first reports on ED in Mexico are case (EAT-40; Garner & Garfinkel, 1979) is composed
studies (Morales, 1971; Reyes, 1986; Zumaya, of 40 items with six answer options in a Likert
1981). In 1981, Sosa and Castanedo published a format. It has three subscales: dieting, bulimia,
summary of data from a private hospital in and food preoccupation and oral control. Alvarez,
Mexico City for the 19701980 period. They Vazquez, Mancilla, and Gomez-Peresmitre (2002)
reviewed clinical files according to the DSM-III applied the EAT-40 to a group of female high-
(Asociacion Psiquiatrica Americana, 1980) diag- school and college students (N 5 2168), obtaining
nostic criteria, and found that only 12 out of the 18 a Cronbachs alpha of .72 and a factorial solution
cases diagnosed as anorexia nervosa fulfilled the almost identical to the original. As for validity, a
criteria. All of the 12 cases were single 14- to 39- score of 28 in the EAT-40 correctly classified 85%
year-old women. of the ED cases in a sample composed of known
Only two studies with a probabilistic sampling patients and high-school and college students, all
method have been conducted. In the first one, the females (Alvarez, Mancilla, Vazquez, Unikel,
National Survey on Psychiatric Epidemiology, a Caballero, & Mercado, 2004), with alphas of .88
nationally representative sample of adults living in for the nonclinical and .84 for the clinical samples.
urban settings, completed the Composite The Bulimia Test (BULIT; Smith & Thelen,
International Diagnostic Interview (CIDI; World 1984) is a 36-item instrument with five answer
Health Organization, 2001). A 1.8% and 0.6% options in a Likert scale. Its three factors are:
62 UNIKEL AND BOJORQUEZ

overeating and feelings of lack of control of suicide ideation, self-esteem, attitudes and beliefs
overeating, negative feelings after eating binges, about obesity, maturity fears, body image dis-
and compensatory behaviours. In a sample of satisfaction, and relations with men, brothers,
female students and ED patients, Alvarez, mother, and father. Cronbachs alphas for the
Mancilla, and Vazquez (2000) found alphas of subscales ranged from .80 to .94, but their
.68 for the nonclinical and .90 for the clinical concurrent or criteria validity have not been
groups. They found the same three factors as the confirmed. Gomez-Peresmitre, Granados,
original, and statistically significant correlations of Jauregui, Pineda, and Tafoya (2000) also devel-
the BULIT with the EDI and the EAT, supporting oped two versions of an instrument to evaluate
the instruments validity. elements of body image that could place subjects
The Eating Disorders Inventory, second version at risk of ED (difference between desired and
(EDI-2; Garner, Olmsted, & Polivy, 1983), is perceived body shape, satisfaction with body
composed of 91 items with 11 factors: drive for parts), in two versions: paper and pencil, and
thinness, bulimia, body dissatisfaction, ineffective- computerized. Their respective alpha values were
ness, perfectionism, interpersonal distrust, intero- .85 and .90.
ceptive awareness, maturity fears, ascetism, drive Unikel et al. (2004) developed a brief ques-
regulation, and social insecurity. In a sample of tionnaire for the assessment of DE based on the
female ED patients and students, it showed DSM-IV diagnostic criteria (APA, 1994). The 10-
reliability with an alpha of .94. The EDI-2 showed question instrument with four answer options
sensitivity scores ranging from 68.2% to 86.4%, showed high reliability (a 5 .83) and a three-
and specificity ranging from 76% to 88% (Garca- factor structure that explained 64.7% of the
Garca, Vazquez-Velazquez, Lopez-Alvarenga, & variance. A discriminant analysis classified cor-
Arcila-Martnez, 2003). rectly 90% of cases, and yielded a sensibility score
The Questionnaire of Sociocultural Influences of .81 and a specificity score of .78 at a cut-off
on the Aesthetic Body Shape Model (CIMEC) value of 10. It also showed significant and positive
(Toro, Salamero, & Martnez, 1994) is an instru- correlations with a Depression (CES-D; Radloff,
ment developed in Spain for the assessment of the 1977) and a Suicidal Ideation (Roberts, 1980)
influence of persons and situations that promote scale, both of them highly reliable among the
the thin beauty ideal. It is a 40-item scale, covering Mexican population.
five areas: dislike of body image, influence of As a result of these works, we now have a
publicity, influence of verbal messages, influence number of instruments of proven usefulness to
of social models, and influence of social situations. use among the urban and schooled sector of the
It was tested in Mexico (Vazquez, Lopez, Alvarez, Mexican population. With the aid of these tools,
Ocampo, & Mancilla, 2000b) with a nonprobabil- the field of research on ED will certainly be
istic sample of 14- to 33-year-old female high- enhanced in the years to come.
school and college students (M 5 19 years, SD 5
2.5). The questionnaire obtained a high reliability
(a 5 .94), which was similar to the one obtained by Comorbidity
the original. The mean scores obtained were higher
than those of Toro et al., but lower than those The aforementioned study by Sosa and Castanedo
obtained for dance students in Mexico without an (1981) found that 50% of ED cases presented as
eating disorder. Four factors were found: influence comorbid with drug dependency and schizophreni-
of publicity, disliking of body image and weight form symptoms, as well as alcoholism, depression,
losing behaviour, influence of social models, and suicide attempts, and borderline personality dis-
influence of social relations, with Cronbachs order, the latter being present in 33.3% of ED
alphas ranging from .63 to .92. cases.
Unikel and Gomez-Peresmitre (2004) developed Gutierrez, Mora, Unikel, Villatoro, and
an instrument for the detection of risk factors, Medina-Mora (2001) analysed data from a repre-
using subscales from other instruments and items sentative survey of high-school students in Mexico
assessing categories appearing in a series of inter- City, classified as at-risk of an ED (N 5 143) and
views with ED patients. The final version of this not at-risk of an ED (N 5 143) according to an
questionnaire has 149 questions, and showed good algorithm developed by one of the authors of this
reliability, and construct and predictive validity in paper, which was based on the DSM-IV diagnostic
a sample of female high-school and college criteria (Unikel et al., 2000). They found that
students (N 5 468) and ED patients (N 5 88). It 70.6% of the female drug users were also at risk of
is composed of 10 subscales: depressive symptoms, an ED.
 EATING DISORDER RESEARCH IN MEXICO 63

Villagomez, Cortes, Barrera, Saucedo, and image perception, compulsive eating, and com-
Alcocer (2003) studied the comorbidity of obesity pensatory behaviours.
and ED in a sample of patients attending a weight Saucedo and Gomez-Peresmitre (2004) assessed
control clinic in Mexico City (N 5 97): 67 females a model in a transversal study with 497 female
and 30 males. More than half of their sample junior high-school students in Mexico City.
showed symptoms of binge eating disorder and Results from the structural equation modelling
20% of bulimia nervosa according to the DSM-IV showed that the influence of publicity, body mass
diagnostic criteria. index, and concern about weight and food were
Cervantes (2004) studied 43 ED patients (23 the main variables for the prediction of restrictive
with anorexia nervosa and 20 with bulimia dieting in these girls.
nervosa, M 5 21 years). Participants completed
the Structured Clinical Interview for DSM-IV Axis
Body mass index
II (SCID-II; First, Gibbon, Spitzer, Williams, &
Benjamim, 1997) and the SCL-90-R (Derogatis, Unikel, Saucedo, Villatoro, and Fleiz (2002)
Lipman, & Covi, 1973). Among those patients, analysed results from a random sample of male
86% had a personality disorder. None of the (N 5 3640) and female (N 5 3957) 13- to 18-year-
anorexia nervosa patients showed paranoid or old students in Mexico City. They found that the
histrionic personality disorder. Likewise, narcissis- frequency of DE (dieting, binging, vomiting, etc.)
tic, passive-aggressive, and borderline disorders increased as body mass index increased.
were more common among bulimia nervosa
compared to anorexia nervosa patients (61% vs
Family
25%; 43.5% vs 10%; 87% vs 25%). Obsessive-
compulsive disorder was more frequent among In a sample of 540 junior-high female and male
anorexia nervosa patients. students from public and private schools in
Mexico City (M 5 14.2 years, SD 5 6.0),
Saucedo (1996) found an association between
Risk factors hostile rearing styles, critiques and authoritarian-
ism on the part of the father, over-involvement
Predictive models
on the part of the mother, and being a low
Unikel (2003) and Unikel, Aguilar, and Gomez- weight 13- to 15-year-old child. On the other hand,
Peresmitre (2005) explored the relationship of families of overweight children tended to be
social-cultural, psychological, and individual permissive, conformist, and lacking discipline.
variables with the development of eating beha- Another association was found between body
viour in a nonprobabilistic, cross-sectional weight and physical activity and the teenagers
sample of female teenagers and young adults perception of his/her own performance in sports.
(M 5 19.3 years, SD 5 3.9) from Mexico City As weight increased, negative self-perception as
(N 5 425), using structural equation modelling being clumsy, useless, and a bad performer was
for the data analysis. According to their results, raised.
parents critiques of their daughters physical In a study by Chavez (2001), a group of male
appearance and girls body mass index conform and female patients aged 1455 years filled out the
to a social pressure factor; the impact of social Yale Brown Cornell Eating Disorders Scale
pressure was mediated by negative beliefs and (Sunday, Halmi, & Einhorn, 1995) and a ques-
attitudes towards fatness, depression, and body tionnaire to assess expressed emotion (Guanilo &
dissatisfaction, and resulted in anomalous Seclen, 1993). A high expressed emotion was more
eating practices. One important finding from this common among relatives of patients who were not
work is the influence of the fatherdaughter working or at school. Expressed emotion was
relationship in the daughters eating behaviour, a higher for anorexia nervosa and eating disorders
conclusion that should be explored in further not otherwise specified patients.
work.
In a doctoral dissertation by Saucedo (2003), the
Culture
main factor related to restricted eating in boys and
girls at puberty (M 5 12.1 years, SD 5 1.2) was A cultural risk factor was explored in a
the influence of publicity, which was assessed by comparison study of female dance students (N 5
the CIMEC (Vazquez, Alvarez, & Mancilla, 48, M 5 15.4 years, SD 5 1.6), public and private
2000a). Other important variables that predicted school high-school students (N 5 107, M 5 15.2
restricted dieting were body mass index, body years, SD 5 1.9), professional dancers (N 5 43,
64 UNIKEL AND BOJORQUEZ

M 5 26.8 years, SD 5 5.6), and working women Exploring the presence of DE among teenage
with a college degree (N 5 45, M 5 26.2 years, SD girls who were members of the Purepecha ethnic
5 3.6) (Unikel, 1998; Unikel & Gomez-Peresmitre, group in a nonurban area, Bojorquez and Unikel
1999). Disordered eating was more frequent (2004) found a prevalence of DE of 1.7%. A
among dancers; they were more worried about dissertation by Bojorquez (2004) employed quali-
gaining weight, and overestimated their body tative techniques to explore the meaning of DE in
weight. Another study (Unikel, Mora, & Gomez- this sample. DE appeared in the context of a desire
Peresmitre, 1999), carried out with adolescent to be different from the former generation. While
(M 5 14.7 years, SD 5 1.3) dance students (N 5 subjects mothers dressed in the traditional way
70), also showed that they were more prone to and spoke the Purepecha language, daughters
adherence to the thin ideal than other students adopted a modern physical appearance, following
(N 5 78), and they more frequently associated models seen on television. Girls who accepted the
negative attributes with fatness. traditional role, who had no conflicts between
Studies comparing the symptoms of ED their ideal role and the one promoted by their
between Mexicans and other populations have parents, and those who valued motherhood,
also been conducted. One (Caballero, Sunday, & religion, and community life showed less interest
Halmi, 2003) compared the severity and types of in weight-losing practices.
ED symptoms between Mexican (N 5 87) and
American (N 5 87) patients, using the Yale- Body image
Brown-Cornells ED scale (YBC-EDS; Sunday et
al., 1995). It also compared motivation to change. Some studies have been conducted on the
Mexican patients showed higher scores in YBC- subject of body image satisfaction, body ideal,
EDS. American patients were less ritualistic and and dietary changes related to the desire to have a
showed better adaptability, whereas Mexicans thinner body (Gomez-Peresmitre, 1997; Gomez-
Peresmitre et al., 2001). The results from pre-
showed rituals with a more egosyntonic quality,
pubescent and teenage girls showed that around
and were less motivated to change. Those differ-
50% of them were dissatisfied with their body
ences, however, could be explained by the duration
image, and that dissatisfaction increased with age.
of the treatment, which was different between
Also, girls from 6 years old have attitudes similar
samples.
to those of teenagers, such as lipophobia, desiring
In a comparison of Spanish (N 5 64) and
a thin body, body image dissatisfaction (wanting
Mexican (N 5 69) males and females, with a mean
to be thinner), and considering themselves fat
age of 13.7 (SD 5 0.96) and 13.3 (SD 5 0.95) years
when they are not. About 50% of these girls seem
respectively, using visual body satisfaction/dissa-
to be discontent with their body image, and 30%
tisfaction scales and items measuring weight overestimate their weight. Almost all of them
estimation, ideal weight, self-perception of body prefer having a thin body. They also stigmatize
weight, and body mass index, Gomez-Peresmitre fatness, associating it with the negative attributes
and Acosta (2002) found that Mexicans were less of a lack of intellectual capacity and skin colour.
satisfied with their bodies. Another comparison of Among 6- to 9-year-old children, boys and girls
Mexican (N 5 386) and Spanish (N 5 384) boys show similar concerns about their body weight.
and girls aged 1518 years (Acosta & Gomez-
Peresmitre, 2003) found similar body dissatisfac-
tion. Mexicans reported beginning dieting at a Sexual abuse
younger age (10 to 11 years) than their Spanish Sexual abuse has been addressed in two studies.
counterparts (between 12 and 14 years). On the Unikel (2003), in a sample of ED patients and
other hand, a study evaluating body dissatisfaction students (see the predictive models section for
and DE among women (18.7 to 19.7 years) from more data), found that 29% of the patients and
Mexico and Spain (N 5 826) (Raich et al., 2001), 12% of the students mentioned had been victims of
using the EAT (Garner & Garfinkel, 1979) and the sexual abuse. In 80% of the cases the aggressor was
Body Shape Questionnaire (BSQ; Cooper, Taylor, a male, and in 63% of cases he was a family
Cooper, & Fairburn, 1987), found that Mexicans member. On the other hand, in a sample of 375
were less dissatisfied and showed less DE. In turn, female ED patients from an eating disorders clinic
Crandall and Martnez (1996) compared American in Mexico City, Contreras (2003) found that 23%
and Mexican students (N 5 406). Results showed of them had experienced sexual abuse. In most
that the latter were less concerned by their weight cases the abuse was repeated, and performed by a
and rejected obese people less than Americans. male member of their families (90%). The author
 EATING DISORDER RESEARCH IN MEXICO 65

also found that 68% of the patients who reported the related behaviours need to be investigated
experience of sexual abuse were bulimic, 25% had further.
an eating disorder not otherwise specified, and 7% From the aforesaid, we suggest that future lines
were anorexic. In the anorexia nervosa patients the of research on eating disorders in Mexico should
perpetrator was not a member of the family in 50% include sound epidemiological studies of their true
of the cases, a family member in 33% of the cases, frequency, through double-stage screening of
and a stranger in 17% of the cases, while in bulimia representative samples. Also, risk factors should
nervosa and eating disorder not otherwise speci- be investigated by longitudinal designs, and gene-
fied patients, the perpetrator was a family member tic influences should also be considered. Treatment
in most cases. and prevention options should be tested. Finally,
the cultural diversity of Mexico offers a privileged
opportunity to look at the cultural aspects related
DISCUSSION to eating disorders, a field that should bring
forward valuable information in the years to
In this paper, we have examined the state of the come. As more and more reports on the emergency
ED research field in Mexico. The magnitude of the of eating disorders and disordered eating (Gordon,
ED problem in this country is unknown for a 2001) come from non-Western and poor countries,
number of reasons. First, most of the studies have this information will be needed in order to under-
used a nonprobabilistic sampling and are not stand the specificities of the problem in culturally
representative of the countrys population. There and socially diverse regions of the world.
is also only scarce information about nonurban
Manuscript received July 2005
and nonstudent populations. The only representa-
Revised manuscript accepted April 2006
tive sample that was not limited to students
(Medina-Mora et al., 2003) was restricted to adults
REFERENCES
over 18 years of age, and sampled only locations
with over 2500 inhabitants, thus leaving out the Acosta, M. V., & Gomez-Peresmitre, G. (2003).
rural population and the age group in which ED Insatisfaccion corporal y seguimiento de dieta. Una
are more frequent. Likewise, the use of different comparacion transcultural entre adolescentes de
instruments, cut-off points, and case definitions Espana y Mexico. [Body dissatisfaction and dieting.
A transcultural comparison between Spanish and
prevents comparisons among data.
Mexican adolescents]. Revista Internacional de
As for risk factors, there seems to be evidence Psicologa Clnica y de la Salud, 3, 921.
that a high body mass index and negative personal Alvarez, G. L., Mancilla, J. M., & Vazquez, R. (2000).
and cultural attitudes towards fatness, among Propiedades psicometricas del Test de Bulimia
other factors, are related to the presence of (BULIT). [Psychometric properties of the Bulimia
Test (BULIT)]. Revista Psicologa Contemporanea, 7,
disordered eating attitudes and behaviours. 7485.
However, all the studies reviewed are cross- Alvarez, G. L., Mancilla, J. M., Vazquez, R., Unikel, C.,
sectional, relying on the subjects memory for Caballero, A., & Mercado, D. (2004). Validity of the
information of past events, and failing to fulfil the Eating Attitudes Test: A study of Mexican eating
temporality criterion to prove a causal relation- disorders patients. Eating and Weight Disorders.
Studies on Anorexia, Bulimia and Obesity, 9,
ship. 243248.
The study of ED in Mexico benefits from the Alvarez, G., Vazquez, R., Mancilla, J. M., & Gomez-
opportunity to work with a population that is Peresmitre, G. (2002). Evaluacion de las propiedades
culturally different to those that have been more psicometricas del Test de Actitudes Alimentarias
(EAT-40) en mujeres mexicanas. [Assessment of the
amply studied. Some authors have postulated
psychometric properties of the Eating Attitudes Test
that eating manifestations in non-Western coun- (EAT-40) in Mexican women]. Revista Mexicana de
tries do not always contain fear of fatness as a Psicologa, 19, 4756.
component (Gordon, 2001; Lee, Lee, Ngai, Lee, & American Psychiatric Association. (1994). Diagnostic
Wing, 2001). ED symptoms would be a language and statistical manual of mental disorders DSM-IV
(4th ed.). Washington, DC: Author.
vehicle to express personal and interpersonal Asociacion Psiquiatrica Americana. (1980). Manual
conflicts, not always using the drive for thinness estadstico y diagnostico de las enfermedades mentales.
as a justification. According to this view, similar DSM-III. [Diagnostic and statistical manual of
symptoms could have different meanings in mental disorders DSM-III]. Barcelona, Spain:
different cultural contexts (Davis & Yager, 1992; Masson Editores.
Bojorquez, I. (2004). Construccion de genero, actitudes y
Root, 1990; Silber, 1986). As we have seen, DE in conductas alimentarias de riesgo en mujeres adoles-
Mexico is accompanied by admiration of the thin centes mexicanas. [Gender construction, attitudes
body ideal. Even so, the meaning of that ideal and and risky eating behaviors in Mexican adolescent
66 UNIKEL AND BOJORQUEZ

women]. Unpublished Masters degree dissertation, anorexia nervosa. Psychological Medicine, 9,

Facultad de Medicina, UNAM, Mexico. 273279.
Bojorquez, I., & Unikel, C. (2004). Presence of Garner, D., Olmsted, M., & Polivy, J. (1983).
disordered eating among Mexican teenage women Development and validation of a multidimensional
from a semi-urban area: Its relation to the cultural eating disorder inventory for anorexia nervosa and
hypothesis. European Eating Disorders Review, 12, bulimia. International Journal of Eating Disorders, 2,
197202. 1534.
Caballero, A., Sunday, R. S., & Halmi, A. K. (2003). A Gomez-Peresmitre, G. (1997). Alteraciones de la imagen
comparison of cognitive and behavioral symptoms corporal en una muestra de escolares mexicanos
between Mexican and American eating disorder preadolescentes. [Body image disturbances in a
patients. International Journal of Eating Disorders, Mexican sample of preadolescent students]. Revista
34, 136141. Mexicana de Psicologa, 14, 3140.
Cervantes, J. M. (2004). Trastornos de personalidad en Gomez-Peresmitre, G. (1999). Preadolescentes mexica-
mujeres con diagnostico de trastornos de la conducta nas y la cultura de la delgadez: figura ideal anorectica
alimentaria. [Personality disorders in women with y preocupacion excesiva por el peso corporal.
eating disorders]. Unpublished Specialty in Psychiatry [Mexican preadolescent girls and thickness culture:
Degree dissertation, Facultad de Medicina, UNAM, Anorectic ideal figure and excesive concern about
Mexico. body weight]. Revista Mexicana de Psicologa, 16,
Chamorro, R., & Flores-Ortiz, Y. (2000). Acculturation 153165.
and disordered eating patterns among Mexican Gomez-Peresmitre, G., & Acosta, M. V. (2002).
American women. International Journal of Eating Valoracion de la delgadez. Un estudio transcultural
Disorders, 28, 125129. (Mexico/Espana). [Thinness evaluation. A cross-
Chavez, A. (2001). Correlacion entre el nivel de emocion cultural study (Mexico/Spain)]. Psicothema, 14,
expresada por el familiar y el grado de severidad 221226.
sintomatologica en pacientes con trastorno de la Gomez-Peresmitre, G., Alvarado, G., Moreno, L.,
alimentacion. [Correlation between the level of Saloma, S., & Pineda, G. (2001). Trastornos de la
expressed emotion by the family member and the alimentacion. Factores de riesgo en tres diferentes
severity of symptoms in patients with eating dis- grupos de edad: pre-puberes, puberes y adolescentes.
orders]. Unpublished Specialty in Psychiatry Degree [Eating disorders. Risk factors in three different age
dissertation, Facultad de Medicina, UNAM, Mexico. groups: Prebubescent, pubescent and adolescent].
Revista Mexicana de Psicologa, 18, 313324.
Contreras, M. A. (2003). Relacion del antecedente de
Gomez-Peresmitre, G., Granados, A., Jauregui, J.,
abuso sexual y la sintomatologa en pacientes con
Pineda, G., & Tafoya, S. A. (2000). Un instrumento
trastorno de la conducta alimentaria [The relationship
para medir imagen corporal: version computarizada
of the experience of sexual abuse and sympto-
y de papel y lapiz. [Body image measurement: Paper
matology in eating disorders patients]. Unpublished
and pencil and computerized test versions]. Revista
Specialty in Psychiatry Degree dissertation, Facultad
Mexicana de Psicologa, 17, 8999.
de Medicina, UNAM, Mexico.
Gordon, R. A. (2001). Eating disorders east and west: A
Cooper, P. J., Taylor, M., Cooper, Z., & Fairburn, C. G.
culture-bound syndrome unbound. In M. Nasser,
(1987). The development and validation of the Body
M. A. Katzman, & R. A. Gordon (Eds.), Eating
Shape Questionnaire. The Journal of Eating disorders and cultures in transition (pp. 116). New
Disorders, 6, 485494. York: Taylor & Francis.
Crandall, C. S., & Martnez, R. (1996). Culture, Guanilo, J. V., & Seclen, Y. M. (1993). Relacion entre el
ideology and anti-fat attitudes. Personality and nivel de conocimientos sobre enfermedad mental y el
Social Psychology Bulletin, 22, 11651176. nivel de emocion expresada de los familiares de
Davis, C., & Yager, J. (1992). Transcultural aspects of pacientes esquizofrenicos de consultorios externos del
eating disorders. A critical literature review. Culture, INSM HD-HN. [Relationship between the level of
Medicine and Psychiatry, 16, 377394. knowledge about mental health and the level of
Derogatis, L. P., Lipman, R. S., & Covi, L. (1973). SCL- schizophrenic outpatients INSM HD-HN relatives
90 an outpatient psychiatric rating scaleprelimin- expressed emotion]. Unpublished Bachelor Degree
ary report. Psychopharmacological Bulletin, 9, 1328. dissertation, Universidad Nacional de San Marcos,
Direccion General de Bibliotecas, UNAM. (2005). Facultad de Medicina, Lima, Peru.
Retrieved January 2005 from www.dgbiblio. Gutierrez, R., Mora, J., Unikel, C., Villatoro, J., &
unam.mx Medina-Mora, M. E. (2001). El consumo de drogas
First, M. B., Gibbon, M., Spitzer, R., Williams, J. D. en una muestra de mujeres estudiantes que presentan
W., & Benjamim, L. S. (1997). Structured Clinical conductas alimentarias de riesgo. [Drug use in a
Interview for DSM-IV Axis II (SCID-II). sample of Mexican female students with risk of
Washington, DC: American Psychiatric Press. eating behaviours]. Salud Mental, 24, 5561.
Garca-Garca, E., Vazquez-Velazquez, V., Lopez- Lee, S., Lee, A., Ngai, E., Lee, D., & Wing, Y. K.
Alvarenga, J. C., & Arcila-Martnez, D. (2003). (2001). Rationales for food refusal in Chinese
Validez interna y utilidad diagnostica del Eating patients with anorexia nervosa. International
Disorder Inventory en mujeres mexicanas. [Internal Journal of Eating Disorders, 29, 224229.
validity and diagnostic utility of the Eating Disorder Medina-Mora, M. E., Borges, G., Lara, C., Benjet, C.,
Inventory in Mexican women]. Salud Publica de Blanco, J., Fleiz, C., et al. (2003). Prevalencia de
Mexico, 45, 206210. trastornos mentales y uso de servicios: Resultados de
Garner, D., & Garfinkel, P. (1979). The Eating la Encuesta Nacional de Epidemiologa Psiquiatrica
Attitudes Test: An index of the symptoms of en Mexico. [Prevalence of mental disorders and use
 EATING DISORDER RESEARCH IN MEXICO 67

of services: Results from the Mexican National en un hospital general privado. [Anorexia nervosa,
Survey of Psychiatric Epidemiology]. Salud Mental, bibliographic review and research in a general private
26, 116. hospital]. Unpublished Psychiatry Degree disserta-
Morales, E. (1971). Aplicacion de los principios de la tion, Facultad de Medicina, UNAM, Mexico.
metodologa operante, en un caso de anorexia. [The Sunday, S., Halmi, K. A., & Einhorn, A. (1995). The
use of the operating methodology principles in a case Yale-Brown-Cornell Eating Disorder Scale. A new
of anorexia nervosa]. Unpublished Bachelor Degree scale to assess eating disorders symptomatology.
dissertation, Facultad de Psicologa, UNAM, International Journal of Eating Disorders, 18,
Mexico. 237245.
Murnen, S. K., & Smolak, L. (1997). Femininity, Toro, J., Salamero, M., & Martnez, E. (1994).
masculinity, and disordered eating: A meta-analytic Assessment of sociocultural influences on the aes-
review. International Journal of Eating Disorders, 22, thetic body shape model in anorexia nervosa. Acta
231242. Psychiatrica Scandinavica, 89, 147151.
Organizacion Mundial de la Salud. (1978). Clasificacion Unikel, C. (1998). Desordenes de la alimentacion en
Internacional de Enfermedades. Manual de estudiantes y profesionales del ballet. [Eating
Clasificacion Estadstica Internacional de disorders in student and professional ballet dancers].
Enfermedades, Traumatismos y Causas de Unpublished Masters Degree dissertation, Facultad
Defuncion. [International classification of illness. de Psicologa, UNAM, Mexico.
International manual of statistical classification of Unikel, C. (2003). Factores de riesgo en los trastornos de
illness, trauma and death causes]. Publicacion la conducta alimentaria. [Risk factors in eating
cientfica 353. Washington, DC: OPS/OMS. disorders]. Unpublished PhD dissertation, Facultad
Ovid Technologies, Inc. (2000). http://gateway.ovid. de Psicologa, UNAM, Mexico.
com/ Unikel, C., Aguilar, J., & Gomez-Peresmitre, G. (2005).
Radloff, L. (1977). The CES-D Scale: A self-report Predictors of eating behaviors in a sample of
depression scale for research in the general popula- Mexican women. Eating and Weight Disorders.
tion. Applied Psychological Meassurement, 1, Studies on Anorexia, Bulimia and Obesity, 10, 3339.
385401. Unikel, C., Bojorquez, I., & Carreno, S. (2004).
Raich, R. M., Mora, M., Sanchez-Carracedo, D., Validacion de un cuestionario breve para medir
Torras, J., Viladrich, M. C., Zapater, L., et al. conductas alimentarias de riesgo. [Validation of a
(2001). A cross-cultural study on eating attitudes and brief questionnaire to measure the risk of abnormal
behaviors in two Spanish-speaking countries: Spain eating behaviors]. Salud Publica de Mexico, 46,
and Mexico. European Eating Disorders Review, 9, 509515.
5363. Unikel, C., & Gomez-Peresmitre, G. (1999). Trastornos
Reyes, N. I. (1986). Anorexia nervosa: una investigacion de la conducta alimentaria: Formas indiferenciadas y
psicodinamica. [Anorexia nervosa: A psychodynamic conductas alimentarias patologicas en mujeres
investigation]. Unpublished PhD degree dissertation, Mexicanas. [Eating disorders: Undifferentiated forms
Facultad de Psicologa, UNAM, Mexico. and pathological eating behaviors in Mexican
Roberts, E. (1980). The reliability of the CES-D Scale in women]. Psicologia Conductual, 7, 417429.
different ethnic contexts. Psychiatry Research, 2, Unikel, C., & Gomez-Peresmitre, G. (2004). Validez de
125134. constructo de un instrumento para la deteccion de
Root, M. P. (1990). Disordered eating in women of factores de riesgo en los trastornos de la conducta
color. Sex Roles, 22, 525536. alimentaria en mujeres mexicanas. [Construct valid-
Saucedo, T. J. (1996). Factores de crianza e interaccion ity of an instrument to search for eating disorder risk
familiar: predictores de trastorno de la conducta factors in Mexican women]. Salud Mental, 27,
alimentaria. [Rearing practices and family interac- 3849.
tion: Predictors of disordered eating behaviours]. Unikel, C., Mora, J., & Gomez-Peresmitre, G. (1999).
Unpublished Masters Degree dissertation, Facultad Percepcion de la gordura en adolescentes y su
de Psicologa, UNAM, Mexico. relacion con las conductas anomalas del comer.
Saucedo, T. J. (2003). Modelos predictivos de dieta [Fatness perception in adolescents and its relation-
restringida en puberes, hombres y mujeres y en sus ship with abnormal eating behaviours]. Revista
madres. [Predictive models of restrictive dieting in Interamericana de Psicologa, 33, 1129.
pubescents, males and females and in their mothers]. Unikel, C., Saucedo, T., Villatoro, J. A., & Fleiz, C.
Unpublished PhD dissertation, Facultad de (2002). Conductas alimentarias de riesgo y distribu-
Psicologa UNAM, Mexico. cion del Indice de Masa Corporal. [Risk of eating
Saucedo, T. J., & Gomez-Peresmitre, G. (2004). Modelo behaviours and body mass index distribution in
predictivo de dieta restringida en puberes mexicanas. students between 13 and 18 years]. Salud Mental, 25,
[A predictive model of restrictive dieting in Mexican 4957.
pubescent females]. Revista de Psiquiatra de la Unikel, C., Villatoro, J., Medina-Mora, M. E., Fleiz, C.,
Facultad de Medicina de Barcelona, 31, 6974. Alcantara, E., & Hernandez, S. (2000). Conductas
Silber, T. J. (1986). Anorexia nervosa in Blacks and alimentarias de riesgo en adolescentes mexicanos.
Hispanics. International Journal of Eating Disorders, Datos en poblacion estudiantil del Distrito Federal.
5, 121128. [Risk of eating behaviours in Mexican adolescents.
Smith, M. C., & Thelen, M. H. (1984). Development and Data from Mexico City student populations]. Revista
validation of a test for bulimia. Journal of Consulting de Investigacion Clnica, 52, 140147.
and Clinical Psychology, 52, 863872. Van Hoeken, D., Lucas, A. R., & Hoek, H. W. (1998).
Sosa, A. L., & Castanedo, L. A. (1981). Anorexia Epidemiology. In H. W. Hoek, J. L. Treasure, &
nervosa, revision bibliografica e investigacion realizada M. A. Katzman (Eds.), Neurobiology in the treatment
68 UNIKEL AND BOJORQUEZ

of eating disorders (pp. 97126). Chichester, UK: Preliminary study]. Psicologa Contemporanea, 7,
Wiley. 5665.
Vazquez, R., Alvarez, G., & Mancilla, J. M. (2000a). Villagomez, L., Cortes, J., Barrera, E., Saucedo, D., &
Consistencia interna y estructura factorial del Alcocer, L. (2003). Comorbilidad de la obesidad con
Cuestionario de Influencia de los Modelos Esteticos los trastornos de la conducta alimentaria.
Corporales (CIMEC), en poblacion mexicana. [Comorbidity of obesity and eating behavior dis-
[Internal consistency and factorial structure of the orders]. Revista de Investigacion Clinica, 55, 535545.
questionnaire of Sociocultural Influences of the World Health Organization. (2001). Composite
Aesthetic Body Shape Model in the Mexican International Diagnostic Interview (CIDI) (Version
population]. Salud Mental, 23, 1824. 15). Geneva: WHO.
Vazquez, R., Lopez, X., Alvarez, G. L., Ocampo, M. T., Zumaya, M. A. (1981). Anorexia nervosa un estudio de
& Mancilla, J. M. (2000b). Trastornos alimentarios y caso en monocigotas. [Anorexia nervosa; a case study
factores asociados en estudiantes mexicanas de in monozigotic twins]. Unpublished Psychiatry
danza: estudio preliminar. [Eating disorders and Degree dissertation, Facultad de Medicina,
associated factors in Mexican dance students: UNAM, Mexico.