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.