BACKGROUND: We set out to determine whether anorexia nervosa exists in a culture where the pressure to be thin is less pervasive. AIMS: To determine whether there were any cases of anorexia nervosa in female students attending two secondary schools in the north-east region of Ghana. METHOD: The body mass index (BMI) of consenting students was calculated after measuring their height and weight. Those with a BMI </=19 kg/m(2) underwent a structured clinical assessment including mental state, physical examination and completion of the Eating Attitudes Test and the Bulimic Investigatory Test, Edinburgh. Participants nominated a best friend to serve as a comparison group, and these young women under went the same assessments. RESULTS: Of the 668 students who were screened for BMI, 10 with a BMI <17.5 kg/m(2) appeared to have self-starvation as the only cause of their low weight. All 10 viewed their food restriction positively and in religious terms. The beliefs of these individuals included ideas of self-control and denial of hunger, without the typical anorexic concerns about weight or shape. CONCLUSIONS: Morbid self-starvation may be the core feature of anorexia nervosa, with the attribution for the self-starvation behaviour varying between cultures


Journal article



Publication Date





312 - 317


anorexia, assessment, attitude, attitudes, attribution, behaviour, belief, beliefs, case, CLINICAL, concerns, culture, denial, examination, Female, group, individual, physical, Physical Examination, school, Scotland, secondary, Students, test, WHO, Women