Is the Diagnostic Prototype for Anorexia Nervosa Universal? Evidence from the Middle East and Implications for ICD-11

Background: The new classification of mental disorders in the eleventh revision of the International Classification Diseases and Health Related Problems (ICD-11) is currently being developed and is due to be released in 2015. The inclusion of presentations of mental distress from the non-Western world is essential to the global applicability of ICD-11. There is a paucity of studies examining how disordered eating and disturbed body image is presented and understood in the
context of Arab and other non-Western populations.
Objectives: This article aims at critically review the diagnostic concept of anorexia nervosa using empirical evidence from Oman. Methods: This study compares the performance of four groups of adolescent girls—Omani, Euro-American, Indian, and Filipina—on indices of deliberate food restriction, fear of fatness and somatization.
Results: The data show Omani, Indian, and Filipina adolescent girls have increased propensity toward deliberate food restriction and somatization compared to Euro-American adolescent girls, but reported less fear of fatness.
Conclusion: The present data suggest that the existing diagnostic description of anorexia nervosa in ICD-10 does not fully describe the corresponding phenomena in Arab and other non-Western countries. On this ground, the centrality of fatphobia as the sine qua non of anorexia nervosa should be questioned. Instead, culturally determined non-fat phobic presentations should be considered for inclusion in the ICD-11. An alternative is to create two subtypes, one to describe fatphobic presentations and the other for anorexia nervosa without