Sociological and Cultural
Anorexia nervosa can be traced back to or connected with 19th-century American society. In her article "The Appetite as Voice," Cornell University professor Joan Jacobs Brumberg stresses the importance of the history of anorexia nervosa. "A history of anorexia nervosa must consider the ways in which different societies create their own symptom repertoires and how the changing cultural context gives meaning to a symptom such as non-eating" (Brumberg, p.159). During the Victorian era, medical examiners were more interested in physical characterics, or what the patient's body had to say, rather than his or her description of the illness. Young women were also viewed as non-reliable sources of information. Related to the section below on contemporary culture, doctors of the 19th century viewed the connection between culture and the disease very differently. "In effect, nineteenth-century medicine did not relate anorexia nervosa to the cultural milieu that surrounded the Victorian girl. The ideas of Victorian women and girls about appetite, food, and eating, as well as the cultural categories of fat and thin, were not mentioned as contributing to the disease. Only in the twentieth century has medicine come to understand that society plays a role in shaping the form of psychological disorders and that behavior and physical symptoms are related to cultural systems." (Brumberg, p.160)
The mass media and advertorial marketing, such as beauty advertising, are also frequently viewed as being implicated in triggering eating disorders in teenage girls. And although anorexia nervosa is usually associated with western cultures, exposure to western media seems to have caused the disease to appear in some third-world nations. In addition, it has recently come to light that there appear to be girls exhibiting anorexic behaviours in remote parts of Africa that have not been exposed to modern forms of advertising. These girls link their self-starvation to religious causes.
In recent years, the Internet has enabled anorexics and bulimics to contact and communicate with each other outside of a treatment environment, with much lower risks of rejection by mainstream society. If an anorexic is already socially withdrawn, such a network of friends can be very helpful in bringing him or her back. On the other hand, the Internet is also a powerful tool with which people can isolate themselves. A variety of websites exist, some run by sufferers, some former sufferers, and some by professionals; attitudes on these sites range from a no-holds-barred, tough-love "put it in your mouth" approach to simple acceptance and even to promotion of anorexia nervosa as an "alternate lifestyle" (see pro-ana).