Research Korner: External And Internal Environment

A CROSS-SECTIONAL STUDY OF EATING ATTITUDES ASSOCIATED WITH PSYCHOSOCIAL FACTORS AMONG CHINESE ADOLESCENTS IN HONG KONG     1.      A CROSS-SECTIONAL STUDY OF EATING ATTITUDES ASSOCIATED WITH PSYCHOSOCIAL FACTORS AMONG CHINESE ADOLESCENTS IN HONG KONG 2.      CONTENTS 1.     A CROSS-SECTIONAL STUDY OF EATING ATTITUDES ASSOCIATED WITH PSYCHOSOCIAL FACTORS AMONG CHINESE ADOLESCENTS IN HONG KONG.. 2 2.     CONTENTS. 2 3.     ACKNOWLEDGEMENTS. 4 4.     ABSTRACT (SUMMARY) 4 5.     INTRODUCTION.. 4 5.1.      Background of the Study.. 5 5.2.      Research Question.. 5 5.3.      Dissertation Aims and Objectives. 6 5.4.      Plan of the Dissertation.. 7 5.5.      Rationale of the Study.. 8 5.6.      Significance of the Study.. 9 5.7.      Scope and Limitations. 10 6.     PRELIMINARY LITERATURE REVIEW... 11 6.1.      Eating Disorders. 11 6.1.1.       Anorexia Nervosa.. 11 6.1.2.       Binge Eating.. 12 6.1.3.       Bulimia Nervosa.. 13 6.2.      Possible Causes of Eating Disorders. 14 6.2.1.       Sociocultural Causes. 14 6.2.2.       Familial Influence.. 15 6.3.      Possible Risks of Eating Disorders. 16 6.3.1.       Stress and Negative Mood.. 16 6.3.2.       Affected Self-Esteem... 17 6.4.      Eating Disorders in the Asian Region.. 18 7.     METHODOLOGY.. 18 7.1.      Being Methodical.. 19 7.2.      Analysing Research Findings through Thematic Analysis. 19 7.3.      Methodology and Critiquing Framework.. 20 8.     METHOD.. 21 8.1.      Search Strategy.. 22 8.2.      Selection Criteria.. 23 8.3.      Boolean Search.. 25 8.3.1.       Reduction Strategy.. 26 8.3.1.1.     Review of Conceptual Frameworks. 26 8.3.1.2.     Review of Empirical Analyses. 26 8.3.1.3.     Review of the Impact of the Research.. 27 8.4.      Data Extraction.. 27 8.5.      Ethical Implications. 28 9.     Familiarising with the data.. 28 9.1.      Body type preferences in Asian and Caucasian college students. 28 9.2.      Anorexia nervosa in Singapore.. 29 9.3.      Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape   30 9.4.      Three different presentations of bulimia nervosa.. 32 9.5.      Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong.. 33 9.6.      Anorexic Eating: Two Case Studies in Hong Kong.. 34 10.       ANALYSIS. 35 10.1.    Generating Initial Codes. 36 10.2.    Searching, Reviewing, and Defining for Themes in the Studies. 36 10.2.1.      Body type preferences in Asian and Caucasian college students. 37 10.2.2.      Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong.. 38 10.2.3.      Anorexic Eating: Two Case Studies in Hong Kong.. 39 10.2.4.      Three different presentations of bulimia nervosa.. 40 10.2.5.      Anorexia nervosa in Singapore.. 41 10.2.6.      Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape   43 10.3.    Thematic Analysis. 44 10.3.1.      General Discussions. 44 10.3.2.      Analysis of the Objectives. 46 10.3.3.      Analysis of the Conceptual frameworks. 47 11.       DISCUSSION.. 48 11.1.    In Comparison with the Preliminary Literature Review... 49 11.2.    Implications on the Issue of Eating Disorders. 49 11.3.    Perceived Limitations of the Study.. 50 11.4.    Implications for Practice.. 51 11.5.    Personal Reflections. 52 12.       RECOMMENDATIONS. 53 13.       CONCLUSION.. 55 14.       REFERENCES. 56   3.      ACKNOWLEDGEMENTS The author desires to offer the most heartfelt appreciation to my friends, family, and relatives for making the completion of this paper possible.   4.      ABSTRACT (SUMMARY) The issue of eating disorders is fast becoming a universal phenomenon. This study discussed the implications of the external environment on the eating attitudes of the adolescents in the Hong Kong setting. The study used thematic analysis to provide a critical literature review on the matter. It has established that media images and familial influence tends to cover the bulk of the reasons for eating disorders.   5.      INTRODUCTION This part of the dissertation will serve as an introductory part, providing a general description of the intentions in making the paper as well as the theoretical foundations that the discussions will be based on. The discussions below shall outline the underlying principles in conducting the study.   5.1.  Background of the Study A huge part of existing psychological studies focuses on the rather sensitive years of adolescence. This may be the case possibly because these are the most formative years in a person’s life. As seen in many textbooks and studies relating to adolescents, this period is peppered with numerous problems psychological in nature. One of the most pressing issues among the youth today is the emergence of eating disorders. Most studies relate this problem to issues of body image, self-esteem, and even social acceptance. This paper will attempt to provide a summary of these existing studies relating to eating disorders. Specifically, the study will look into the possible causes and implications of eating disorders among adolescents. However, an early discussion on the established conditions relating to eating disorders will be taken into consideration. Specific attributes of anorexia, bulimia, and binge eating will be described and discussed to provide a clear image of the medical maladies offered by eating disorders. With regards to the possible causes of eating disorders, the study will look on the sociocultural factors as well as those relating to the family. On the possible implications of the condition, the discussions will revolve around stress, self-esteem, and negative body image. All in all, the observations and arguments made in this paper will be backed up by scholarly and academic articles dealing with psychological problems and eating disorders. 5.2.  Research Question The issue of eating attitudes and the consequent eating disorders tends to manifest a rather universalistic phenomenon especially among the members of the teenage and adolescent populations. The intention that this study seeks to resolve is to determine the psychological and social factors that influence the eating attitudes of adolescents. More specifically the research question is “does the external environment contributes to the psychosocial factors affecting the eating disorders of adolescents?” In this context, the external environment is delineated by sociocultural causes (body image and media) and familial influence (family environment and genetics).     To a certain extent, the study will be tackling the issues of social, cultural, and familial factors as causes of bulimia, anorexia, and binge eating. The articles that will be used in the critical literature review will similarly be focused on Chinese adolescents. Though there may be a certain difficulty in determining and acquiring such studies, given the limited access to these specific studies, the research will try to get a hold of studies pertaining to Hong Kong-based adolescents. At any rate, general studies and internationally published articles pertaining to the said eating disorders will continuously be consulted to establish the foundation to the subsequent claims provided in the findings of the study. 5.3.  Dissertation Aims and Objectives The findings of the dissertation seek to accomplish the following objectives: ·         Provide a discussion that will give a basic understanding of the effects of the external environment on the eating behaviours of adolescents. ·         Establish the specific factors of the external elements that influence the eating behaviours of the adolescent. ·         Present the condition of the Chinese adolescents about their eating disorders. ·         Establish the external factors present in the Hong Kong setting influencing the eating behaviours of the Chinese adolescent. ·         Provide a critical literature review on the articles discussing eating disorders of adolescents.    5.4.  Plan of the Dissertation The study will provide a preliminary literature review of the topic. The discussions on this part are based on journals and academic papers relating to eating disorders. In the same manner, the preliminary literature review will establish the accepted observations and arguments that may have an implication on the topic. At the same time, the literature review will help in establishing the basic knowledge that the researcher needs in the critical literature review that will be done on the later part of the paper. The dissertation will also provide a discussion on the methodology that will be employed in the research process. It is in this part of the paper that will discuss how the acquired literature will be analysed. Elements like the inclusion and exclusion criteria as well as the databases that will be used in the study will be noted in the methodology. The study will also provide a section describing the methods used in the analysis. This differs from the methodology part on the point that this part discusses the actions done to implement the contents of the methodology and the consequent justifications. This means that the Method part outlines the actions done to establish the analysis in the critical literature review. Subsequent to this part, a summary of the results will also be provided. This part of the dissertation will be outlining the possible findings that the researcher acquired in the course of implementing the methods indicated in the previous part. In any case, this part will be a brief presentation of the findings based on the articles acquired for the dissertation. In the same manner, the findings will be analysed which similarly requires its separate segment in the dissertation. Specifically, the existing themes found on the acquired literature will be presented in this part of the study. A discussion on the analysis will be conducted such that it will be examined in line with the objectives and research question presented in the earlier parts of the dissertation. In the same account, the discussions will be a chance for the writer to relate it to the accepted claims on eating disorders presented in the preliminary literature review. In the same way, a discussion on the possible practical use of the findings will be established in the said part. At the end of the paper, a set of recommendation and conclusion will be formulated based on the critical literature review made in the study. At this point, the study will be advocating the need for change in relation with the topic.     5.5.  Rationale of the Study The context of eating disorders tends to have been covered a lot during the past decades. Attention on the psychological implications and causes of these disorders and attitudes has also bee tackled immensely in the past. This is also true on the context of studies pertaining to adolescents, which normally goes hand-in-hand with issues like self-image. However, the majority of the studies have the propensity to focus on a more general discussion on the subject. This dissertation will use the quantity of these studies on its favour. Specifically, the study will provide a much-needed critical perspective on the studies made in the area of eating disorders. In the same manner, the study will attempt to focus its attention on studies that has focused its attention to the Hong Kong setting and those pertaining to the environment of Chinese adolescents. This will provide a level of specificity that will help the study limit its attention to the environment of a certain population. On the same account, the use of primarily qualitative data will help in determining the kind of environment where the Chinese adolescents are subjected. In a sense, this will be a considerable step in resolving the research question of this dissertation. Ultimately, the findings of this dissertation will be a welcome addition on the sum of all literature pertaining to eating disorders and adolescence.   5.6.  Significance of the Study The dissertation will provide a qualitative analysis of the existing works relating to eating disorders among adolescents. With the findings of this paper, aside from resolving the research question, the discussions will essentially provide the audience some level of understanding regarding the basic attributes and relationship with the external environment. In the same manner, the eating behaviours of adolescents will be discussed in detail with particular focus on the Chinese setting. More importantly, the critical literature review provided in this study will benefit students and learners of psychology and those studying the adolescent psyche. The provision of an in-depth analysis on the way these studies are structured and the possible flaws of their claims may serve as an impetus for future research regarding the issues discussed. In the same manner, the findings of this paper may also be valuable for parents, counsellors and social workers dealing with adolescents with problems on their eating attitudes. This is especially true for those who are situated in the Hong Kong Special Administrative region given that the focus and the findings of this study are directly applicable on their situations. Thus, the study will benefit a lot of sectors of society however one must realise that  the conduct of the study is imperative such that the quantity of studies relating to eating disorders have acquired different findings and different ways of using theories to validate their hypotheses has been so varied such that a critical review is in order. Though this study may well be considered a simple dissertation on the topic, this could trigger other academics in building an initiative to analyse the rest of the studies relating to eating disorders in general.      5.7.  Scope and Limitations The dissertation will cover the general literature on the topic of eating disorders. Moreover, a specific focus on several studies pertaining to the studies on the Hong Kong setting will be similarly provided. Particularly, these studies will be critically reviewed based on criteria that will be discussed in detail in the later part of this dissertation. The study will employ a qualitative approach in tackling the issues and resolving the research question posed in the earlier part of the paper. To this end, much of the content of the paper will be based on the analysis of the researcher. This means that the interpretation, presentation, and discussion of the data may be subjected to some level of bias in favour to the ideas and regard of the writer. Nevertheless, this may be offset as a group of standards will be made even before the analysis of the data is made. In a similar, given that the dissertation is more qualitative in nature, the findings of this study may fail to be used as a means to generalise a theory with regards to the subject of eating disorders.    6.      PRELIMINARY LITERATURE REVIEW 6.1.  Eating Disorders A considerable number of individuals all over the world suffer from eating disorders. The following discussions will focus on the three most accounted for cases of eating disorders: anorexia, bulimia, and binge eating. Descriptions of these medical cases as well as conducted studies will be pointed out in this part of the paper.   6.1.1.     Anorexia Nervosa This type of eating disorder is characterised with a considerably low body weight and a distorted image of the body. (, 1996) There are also indications that the person suffering from anorexia has this compulsive apprehension about gaining weight. In most cases, the person suffering from anorexia engage in abnormal acts like starving themselves, purging and vomiting, and excessive weight loss measures. There are also accounts where these people tend to overdo diet pills and other weight-loss drugs to keep the weight away. (, , and , 2002) In some instances, the eating disorder tends to be unchecked thus triggering severe outcomes. To illustrate, anorectics tends to die prematurely of starvation and the consequent effects of lack of nutrients in the body. (, 1994) There was a misnomer about this condition that the sole sufferers are females. However, recent studies have revealed that it is also prevalent in males. (,  and , 2005)  , , , , , (1997) stated in their study that there are three causes of this condition to individuals: biogenetic predisposition, individual characteristics, and family functioning. This means an anorectic may exude “feelings of ineffectiveness,” high dependence to the family, and possibly have other anorexic relatives.  6.1.2.     Binge Eating Binge eating is an eating disorder that displays a compulsive overeating behaviour among the individuals suffering from it. ( and , 2000,) Other studies indicate that binge eating is a precursor to another type of eating disorder, bulimia nervosa. (. 1997) The same study indicated that males binge eat more as compared to females. This indicates that most adolescents suffering from this disorder are male. However, recent studies have indicated that the phenomenon called the “yoyo trap” among females has been attributed to both dieting and binge eating. (, , and , 2005) This shows that the recent trends present a rather slight difference in gender in binge eating. In the same manner, there are some studies that have attributed binge eating disorder to genetics of the individual. ( and , 2006) This is in line with other studies in obesity and other overweight issues in society. They claim that binge eating that occurs at least twice a week contributes to the onset of obesity among these individuals. Treatments on this disorder range from therapy to the extreme measures of surgery. Recent trends indicate that “stomach stapling” or bariatric surgery has become the sought after medical procedure of overweight individuals in the United States. ( and , 2006) However, there are instances where those who have undergone the procedure gain the weight back because they continue to suffer from binge eating disorders. ()      6.1.3.     Bulimia Nervosa This type of eating disorder is described as a combination of binge eating and deliberate vomiting of the taken nutrition. ( and , 1998) Essentially, the condition reflects the disorder relating to the lack of control of the person with regards to eating. Initially, this condition is considered as an offshoot of anorexia; however it is recently recognised as a distinct disorder. (, , , , , , , , , and , 1998) The study of  (1998) indicated that the major implication of this condition is depression. This is shown on the low serotonin and high plasma norepinephrine of those suffering from this condition. (., 1998) For some reason, this condition is rather limited to Western countries. (, , , , and , 2006) This is seen primarily because of the emphasis of these societies to thinness as connected to beauty. In the study made by  (2006) among adolescents in Turkey, they claimed that there is a significantly low prevalence of bulimia in the population. However, they recognise that the existing environments in western countries and Turkey were significantly unlike. They pointed out that as the country tends to become more developed they foresee a similar change in the eating behaviour of the adolescents of the country. In the same way, changes in the existing eating disorders will similarly entail. 6.2.  Possible Causes of Eating Disorders The following discussions will provide a collection of claims regarding the possible causes of eating disorders in general. The discussion is divided into a couple of parts: sociocultural causes and familial influence. The first part will point towards the implications of body image in society while the other will consider the implications of genetic and other reinforcements taken by the family on the occurrence of eating disorders.   6.2.1.     Sociocultural Causes There are numerous studies that point to body image as a primary cause of eating disorders. Studies tend to focus on media images seen by adolescents as a means of benchmarking their body image. ,  and  (2004) defined body image as the way individuals “think, feel and behave” as they consider the individual features of their physical being. In the same way, the study also indicated that it is the nature of human beings to carry out things that would eventually improve their body image. However, recent studies have indicated that boys and girls who look at magazines tend to criticise images of muscular and skinny models as opposed to admiring them. (, 2003) The same study also indicated that adolescents tend to consider the articles more as compared to the actual images appended in these periodicals. This shows that there may have been a shift in the consciousness of adolescence from imagery to the actual contents of the reading materials. In the same manner, it also shows the importance of media literacy so as to avert any form of body image disturbance among the youth.   6.2.2.     Familial Influence Other studies have similarly pointed out the role of the family in triggering the occurrence of eating disorders among adolescents. There are certain studies that imply that the family environment and genetics have some influence on this area. In the study of , , , and  (1994), they indicated that family difficulties tend to influence eating disorders among the youth, especially in the female population.  and  (1994) claimed in their study that elements like interpersonal skills, self-concept, and organizational skills tend to be deficient in families with adolescents having eating disorders. They also claimed that the effects of such inadequacies in the family environment are able to be averted through education. This shows not only the fact that additional learning will make these adolescents aware that what they are doing is wrong, it will also provide them the opportunity to acquire a level of independence from their families. Interaction with other people and educators could change certain perspective that adolescents have acquired in their family environment. In the context of being genetic, studies have also indicated that obesity, the effect of binge eating disorders, may have been caused by genes of the family. ( and , 2006) In the same study, they claimed that the cause is primarily based on the energy imbalance that parents may have passed to their children. On another study, it claimed that genetic and personality factors of the parents have the tendency to be hardwired to the child. (, 2004) This shows that certain abnormalities tend to come from familial lines, which in turn affect the eating patterns of adolescents. 6.3.  Possible Risks of Eating Disorders In line with the discussions of the possible causes of eating disorders, the following will deal with the possible risks and outcomes that the individual may acquire if he/she suffers from an eating disorder.    6.3.1.     Stress and Negative Mood In the study of  and  (2002), they noted that individuals suffering from eating disorders tend to similarly suffer from stress and acquire a very negative disposition. Other studies even noted that having eating disorders tend to be expressions of anger on the part of the adolescent. ( and , 2000) Other forms of negative effects of eating disorder is established in the paper of , , and  (2005) which indicated that general effects of these tend to sum up to depression. Indications of depression are also seen as an implication of these disorders by an earlier article made by , , and  (2002). They even claimed that these eating disorders tend to co-exist with other psychiatric disorders, particularly frequent is depression. It is also their claim that this co-existence of depression and eating disorders tend to be more prevalent among adolescents.    6.3.2.     Affected Self-Esteem Studies have been made liking the individual’s self-esteem and the occurrence of eating disorders. In the study of  (2000) she focused on the implications of eating disorders on women. In this context, she pointed out that the media messages indicating the “importance of appearance” tend to push women into engaging in eating disorders. She noted in her study that college women with anorexia and college women with bulimia tend to suffer from low levels of self-esteem. This indicates that women tend to engage more in eating disorders when they have low levels of self-esteem. In addition, it has been earlier pointed out that the primary effect of bulimia is depression. (., 1998) Along with the affected level of self-esteem, body dissatisfaction is also deemed as a considerable risk and implication of eating disorders. However, in considering this implication, it must be noted that there were studies that have established the fact that body dissatisfaction is bound by culture. ( and , 2002) This means that the context of an acceptable body image on a particular culture affect as to whether an individual is dissatisfied with his/her physical appearance or not. To illustrate, in a study in Latin American countries, body dissatisfaction tends to be based on slenderness on the part of women and muscularity with regards to men. (, , and , 2005) This same study has also indicated that with such level of body dissatisfaction, adolescents tend to engage in body-change strategies to address this dissatisfaction.     6.4.  Eating Disorders in the Asian Region The phenomenon of eating disorders is seen as more cultural, particularly with the concern of body image. In Korea, media representations of thin models have spawned negative body image with the adolescents in the country. (, 2003) This shows that media has a huge part in incurring this level of sensuousness to the public regardless of the region. As  and  (2004) claimed in their work, mass media could double as an intermediary to the consciousness of society. Though they pointed out that media is just a conduit, it could still supply both direct and circuitous effects on the existing circumstances in society. Thus the images of what is considered beautiful in media tend to indicate the ideal body image for adolescents in that region. 7.      METHODOLOGY This type of study basically covers a qualitative research. Using the existing literature to come up with a study that will provide a critical perspective on the existing condition allows the researcher to “elicit understanding” on the issues of eating disorders and the influence of the environment. ( and , 2005, ) Based on the study of  (2001) there are several methods of carrying out qualitative studies: interview; participant observation; and document analysis. With regards to the one employed in this paper, it falls on the third indicated type wherein the documents rendered here are those that pertain to the milieu of eating disorders in the Chinese setting. 7.1.  Being Methodical In doing a critical literature review, it is important to maintain a level of methodical pattern such that the discussions will not make a detour and veer away from the actual topic. One means of doing this is to state a set of inclusion and exclusion criteria. (, , , , and , 2003) Basically, these are the set of standards that will be followed by the researcher in gathering data for the study. When these set of criteria is already in place, choosing the appropriate databases and relevant keywords are also deemed important in the process. (, , and , 2002) 7.2.  Analysing Research Findings through Thematic Analysis The paper will predominantly use thematic analysis in processing and examining the data acquired from the searched articles on the topic. In using this method, the study allows to preserve the perspective provided by the studies and in the same time uncover the prevailing themes that they have employed. ( and , 1998) In addition, the symbolic constructions of the studies used and the discursive accounts tend to contribute greatly on the interpretations of the data.   7.3.  Methodology and Critiquing Framework This paper will be using the thematic framework used by  and  (2006, ) in their study. Specifically, their study looked into the use of thematic analysis in the field of psychology. They divided the process into phases where processes are further examined. These phases are summarised in the figure below.                       Figure 1.  and ’s (2006) Phases of Thematic Analysis Framework   The first phase, familiarising yourself with the data, indicates the need of the researcher to immerse himself/herself with the acquired information needed for the thematic analysis.  and  (2006) even encouraged repeated reading on this area. It is at this point that taking down notes on particular areas occurs. The second phase provides the creation of codes which is basically tantamount to the interesting elements of the data which could be then considered as the eventual themes of the study. These codes are differentiated from the theme by their raw nature; basically these are mere notes extracted directly from the data. Themes, on the other hand, come to the third phase of the process. It is at this point that the codes are processed. In this paper, the notes are processed through the creation of thematic maps in order to make sense of the acquired data. The fourth phase requires the author to review the themes that sprung out from the thematic maps. It is at this point that the themes are reviewed on their coherence with the study and its objectives.  The fifth phase, defining and naming themes, indicates that the structure of such themes should be taken into account. Specifically, the identification of the essence of the theme is required. The fifth phase of the thematic analysis is doing the report of the analysis. This phase fundamentally creates the analytic narrative of the individual themes pointed out through the process.   8.      METHOD The following discussions will be describing the search strategy employed in the acquiring the documents analysed. In the same manner, the criteria on which these studies are gauged will also be taken into consideration. Using online libraries and major search engines, the researcher used certain key words like “eating”, “disorders”, “anorexia”, “bulimia”, “binge”, “Chinese”, and “Hong Kong.” Moreover, the use of the two stages of the selection process has also been employed to provide a system for acquiring sources of data in the dissertation.     8.1.  Search Strategy The study will employ several sources, primarily from the web, so as to cover a much wider area and minimise the possibility of partiality on the part of the researcher. There are rather few articles that actually points out directly to the topic. Thus, using a considerable number of search engines and online libraries would be an acceptable act to complete the study. The searches that will be made in this paper are going to be cross-sectoral in nature. This means that the studies that will be taken into consideration will all be based on the issue of eating disorders but efforts will be taken such that the chosen articles makes mention of the Hong Kong setting or the implications of these psycho-social disorders to Chinese individuals. The study will use the following on its search: ·         Online databases like o       Questia o       FindArticles o       Highbeam. ·         Search engines like o       Yahoo! o       Google ·         Websites of Hong Kong Based organisations (government and NGOs) dealing with eating disorders   The searched documents will be restricted to years from 1990. More specifically, the document search will be limited to those written in the English language. This is done such that time-delays caused by translations and other inconveniences like misconstruing the terms may be averted. Moreover, as stated in the earlier part of the dissertation, the papers to be reviewed will be limited to those that pertain to the Chinese setting. In doing so, the study manifests some level of distinction and sensitivity in its results. It is anticipated that the search would yield a rather small number of results. To this end, the researcher will still practice vigilance in looking at the validity of the studies uncovered. In the same respect, the study will also be looking for other relevant materials that will be used to compare the six articles placed under critical evaluation. The assessment of these studies will similarly be subjected to the selection criteria discussed in the subsequent part of this dissertation. If any article or study that has been deemed important by the researcher has been discovered and for some unfortunate reason failed to be covered by the strategies stated in this part of the dissertation, these articles are to be search in a separate manner.       8.2.  Selection Criteria The paper selection is going to acquire a couple of stages. The first stage will be considered the broad selection. In this stage, the inclusion criteria will look into certain parts of the retrieved studies. Elements like the abstract and the title will be the main determinants of studies that are to be added into the pool of data to be placed in a critical analysis. Specifically, the inclusion criteria in this broad selection process would include: ·         Studies that take into consideration bulimia nervosa, anorexia nervosa, binge eating, or any eating disorders. ·         Studies that refer to the experience of the Chinese in dealing with such disorders ·         Studies that satisfy the criteria regarding the year of when the conduct of the research was implemented. The subsequent action will be to acquire the full text of the study once the researcher has regarded it as a satisfactory entry to the pool of papers to be analysed. This will take away any possible doubt on the actual existence of these studies and in the same time will allow the researcher to consider whether these acquired documents will fall within the selection criteria presented in the second part of the selection process. The second part of the selection process will be based on the assessment of the researcher as to whether the entries in the pool based on the overall objectives of this dissertation. The papers will be analysed based on their content in their conceptual frameworks, the empirical analyses that they have employed in the paper, and the analysis of the possible implications of the research on the overall view of the topic. To provide a clear interpretation of these search criteria, the subsequent parts will discuss these three areas on which the researcher shall base the discussions and eventual findings in this dissertation.   8.3.  Boolean Search The primary online data based used is . This online library provides numerous articles and books relevant to this study. The following table summarises the outcome of the Boolean search conducted in this site. Table 1. Boolean Search in Key Words Total Number of Books Total number of Journals Total number of outcomes Eating AND Disorders 11, 639 1,804 13,443 Eating AND Disorders AND Anorexia 1,270 371 1,641 Eating AND Disorders AND Anorexia AND Bulimia 602 275 877 Eating AND Disorders AND Anorexia AND Bulimia AND Binge 278 115 393 Eating AND Disorders AND Anorexia AND Bulimia AND Binge AND Chinese 152 5 157 Eating AND Disorders AND Anorexia AND Bulimia AND Binge AND Chinese AND Hong Kong 49 2 51     The results presented above shows a rather lavish outcome for every keyword placed in the search of books and documents. This is also apparent in Table 2 as a search in Google is made using the same keywords. Having such a great number of sites that emerged from the search, the researcher has to manually conduct a manual screening on the search outcomes as per the selection criteria. Table 2. Boolean Search in Google Key Words Total number of outcomes Eating AND Disorders 7,330,000 Eating AND Disorders AND Anorexia 1,130,000 Eating AND Disorders AND Anorexia AND Bulimia 1,060,000 Eating AND Disorders AND Anorexia AND Bulimia AND Binge 568,000 Eating AND Disorders AND Anorexia AND Bulimia AND Binge AND Chinese 55,000 Eating AND Disorders AND Anorexia AND Bulimia AND Binge AND Chinese AND Hong Kong 13,500   8.3.1.     Reduction Strategy 8.3.1.1.          Review of Conceptual Frameworks The researcher will look at the individual conceptual frameworks used by the studies in the pool. This selection criterion is based on the major objectives of the study pertaining to the provision of a basic discussion on the basic understanding of the effects of the external environment on the eating behaviours of adolescents. The contents of the study should include: ·         A basic description of the specific eating disorder discussed by the paper. ·         Discussion on the basic theories that involves eating disorders in general ·         Analysis and examination of these prescribed theories and an attempt to provide a new view on the issue.    8.3.1.2.          Review of Empirical Analyses This criterion seeks to establish the specific factors of the external elements that influence the eating behaviours of the adolescent and to present the condition of the Chinese adolescents about their eating disorders. The contents of the study should include: ·         Discussions of the perceived factors affecting eating disorders. ·         Discussions regarding the distinct elements present in the Chinese setting. 8.3.1.3.          Review of the Impact of the Research This criterion is supposed to look at the effectiveness of the research with regards to the implications to the development of the topic of eating disorders. Specifically, the said criterion seeks to achieve the study’s major objective of establish the external factors present in the Hong Kong setting influencing the eating behaviours of the Chinese adolescent. The studies should show: ·         Discussions reviewing the distinct features of the Chinese setting. ·         An analysis of the perceived implications of the study on the eating disorders in Hong Kong. ·         Recommendations on the improvement of the existing situation of adolescents in Hong Kong 8.4.  Data Extraction The acquired data, after being subjected to the inclusion requirements, are going to be subjected to mapping where the papers and studies acquired are to be divided based on their compliance with the general objectives of the paper. In doing this, the analysis of the data will encounter a lot more convenience and at the same time offer the researcher a chance to establish a deeper understanding on the individual claims of the acquired papers.   8.5.  Ethical Implications In doing this critical review, one must emphasise that ethical consideration upon the use of the works acquired has to be given. High regard on the intellectual property of the authors and academics that have completed the study has to be taken into account in the course of the study. For this matter, the researcher needs to find ways in averting any means that might be construed as a violation of these academics’ rights. Proper citation on the works used should be properly placed in the paper. Discussions using particular passages from the said works should also be regarded when they are extracted exactly the same from the said studies.  9.      Familiarising with the data The following discussions will be describing the articles critiqued in this paper. In the same manner, a summary of the articles will be provided based on the major objectives indicated in the previous parts of the paper. 9.1.  Body type preferences in Asian and Caucasian college students In the study of , , and  (2001, ), they have equated the issue of eating disorders on the context of body image. This work essentially connotes a combination of ethnographic study and a comparative study with the analysis of the issues of culture and ethnicity on its major objectives. The study was composed of a number of male and female respondents with “289 (62.0%) being Caucasian, 92 (19.7%) Asian, 29 (6.2%) African-American, 20 (4.3%) Hispanic, 28 (6.0%) mixed background, and 8 (1.7%) other.” To a certain extent, the presented respondents manifest some level of inconsistency with the major premise of the study, being solely directed to Asians and Caucasians. The researchers may have acquired a much clearer outcome and possibly save resources if they have limited their population into the two ethnic groups.      After reading the study, it has been seen that themes of body image, gender and culture were among the prevalently discussed. Given the ethnographic nature of the study, it would be rather understandable for the reader to realise that understanding culture differences in the context of eating disorders is the main intention of the authors. However, there has been a bold claim provided by the authors that gender has the greatest influence in issues of ethnicity and body image. This implies that regardless of the ethnic background of the individual, the prevailing values espoused in culture and the pressure of possessing the accepted body image or body shape is given to the female part of the population. However, it must be emphasised that the respondents in this paper are predominantly raised in a westernised setting, thus the actual weight of the implications of culture still hangs in the balance.     9.2.   Anorexia nervosa in Singapore There are two papers that have been done outside the Hong Kong setting but have as well been chosen given that they have a considerable relation to the topic. For instance, the study made by , , , and  (2005, ) focused on the issue of anorexia nervosa in Singapore. However, the study chose this because of the pre-existing assumption that there were scarce sources that could be seen in the web. In the same manner, the study chose this paper because the issues work on a predominantly Chinese community which is rather similar to the case of Hong Kong. Personally, this is possibly one of the most reliable studies among the amassed studies in for this paper. It deals with the actual Asian psyche and deals with only at least four ethnicities: Chinese, Malay, India, and others not specified by the authors. Moreover, the researchers in this study were not subjected to any biases and possible inconsistencies that could be acquired from direct interaction with the respondents. Their primary data were based on an accumulation of information from an existing database of a mental institution. This means that the statistical treatment of such data were free from any ambiguous responses. The problem in this instance is the fact that the acquired primary data were essentially second-hand data which may or may have not been subjected to the biases of the mental institutions consulted by the researchers. To some extent, this bias may have been apparent given that the emerging themes as seen in Table 3 definitely points out to a psychosocial leaning in the discussions.       9.3.  Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape Another study sharing an inclusion issue is the study made by , , and  (1999). This study focuses on the issues present in the Australian setting; however, the study included Hong Kong-born respondents as a major part of their comparative analysis. Again, this study shares the comparative method of analysing cultural issues present in the perspective towards body image and eating disorders. The great thing about this paper is that a good number of the respondents are Asians, particularly Hong Kongers. Though the totally Australian-born women still outnumber their Asian counterparts, the existence of respondents characterised as acculturised Hong Kong-born and traditional Hong Kong born respondents could very well display the implications of culture on the issue. Based on the predominant themes indicated in the paper, body image, gender and culture are the main elements that have been discussed by ,  and  (1999). The researchers have focused their attention directly to the female population since there have been studies prior to theirs indicating the propensity of females to have an eating disorder. This has been clearly indicated in their discussions in their literature review particularly the alarming increase of women exposed to western culture and is aware of the accepted body image as thin and slender.           The apparent problem in this paper is that the population used is rather minute which means that it could not be used convincingly to generalise the overall attitude of Hong Kong females of both traditional and acculturised nature. With a hundred and forty individuals, the results of this study only emphasises the attitudes of the women in Australian Universities. Nevertheless, this paper offers a good starting point for other studies intending to carry out similar objectives. Specifically, the design and measures used like the Eating Attitude Test (EAS) and the Figure Rating Scale (FRS) were rather scientific and could be effective in establishing a standardised way of measuring eating disorders in the future.   9.4.  Three different presentations of bulimia nervosa All in all, there are three studies that have exactly fallen on the inclusion criteria of this paper. To illustrate, the study of  and  (2000, ) share three case studies of patients suffering from bulimia nervosa. Their respondents were all from the Prince of Wales Hospital in Shatin Hong Kong. The study provides a discussion on the reasons for the emergence of bulimia and other eating disorders in the special administrative region. The use of a case study by the researchers show that there is a problem in HK with regards to recording the actual number of patients suffering not only of bulimia, but with the other severe eating disorders as well. In this manner, it is rather understandable why the researchers opted for the use of case study as a methodology. They have effectively presented the stages encounter by patients. The researchers even implied that the outcomes indicated in the three cases were rather similar to those described in textbooks on eating disorders. Moreover, with the prevailing themes such as body image, media, family environment, gender and culture mentioned in the study, it is apparent that the researchers regarded eating disorders as a psychosocial-induced illness. With the combination of highly technical medical jargons and commonly used terms, the reader would find some of the discussions rather difficult to comprehend. This indicates that the major audience expected to read such document would be those acquainted in the medical field. Basically, the respondents were all females residing in Hong Kong. Moreover, the one of the cases responded that the negative reactions of the relatives and other people she depended on were highly influential on the eating disorder aside from the pre-existing media-induced mentality similar to the western chic image of slim and slender limbs. All in all, the study was effective in carrying out its objective of presenting bulimia nervosa as an actual illness. It was informative to a certain extent, but it fails to present an objective observation on the conditions of the people suffering from bulimia in the Hong Kong proper.    9.5.  Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong Another study is seen in the paper of  and  (1997, ) which focused on the issue of body image and its implication of the eating attitudes of both male and female university students in Hong Kong. The study essentially covers adolescents since the respondents are strictly freshmen students of the University of Hong Kong.  and  (1997) study attempted a methodological approach in dealing with the issues of body image and eating disorders by using a quantitative research method. In this study, they used questionnaires and interviews to gather data from the respondents. This indicated that both men and women in the said administrative region have dissatisfaction on several body parts. ( and , 1997) In the said study, it found out that Chinese males in Hong Kong are more dissatisfied than women with regards to their weight. This indicates that male may have more tendencies towards eating disorders than women.   9.6.  Anorexic Eating: Two Case Studies in Hong Kong The third study relating to the Hong Kong study is seen in the paper of  and  (2002) which used a case study of two individuals ( and ). The discussions were based on the effects of anorexia nervosa on these two Hong Kong based women. The major themes discussed in this paper tend to imply body image, family environment, gender, and culture. Basically, the issue of body image is indicated largely by the two respondents claiming that they harbour these strong feelings against fat or any form of flab that they sense with their physique. For instance, one of them indicated that she was engaging in bulimic behaviour because she was fat-phobic. The other respondent indicated that the eating patterns of her sister affect her immensely which shows how the family environment affects bulimic patient. The major issue on this paper is the data acquisition used by the researchers. The interaction between the researchers and the respondents were all through email correspondence. There was no form of any face-to-face contact indicated in the study. Even though the respondents were free to convey their responses, there were no means of verifying that the responses were valid, accurate, and even if they withheld any more information from the researchers. All in all, the paper was rather abundant with shortcomings. The presentation of the data made up almost all the contents of the paper. It would have been its saving grace if there were tables showing the summary of the data and an analysis was comprehensively given. However, there was none of that. The discussion was limited to a 310-word paragraph.   Table 3. Theme by Paper Table Title Authors Theme 1 Theme 2 Theme 3 Theme 4 Theme 5     Body Image Media Family Environment Gender Culture Anorexic Eating: Two Case Studies in Hong Kong  and  (2002)           Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong.  and  (1997)           Body type preferences in Asian and Caucasian college students , , and  (2001)           Three different presentations of bulimia nervosa  and  (2000, )           Anorexia nervosa in Singapore , , , and  (2005)           Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape , , and  (1999)             10. ANALYSIS The following will provide an analysis of the individual articles using a thematic table in presenting the major ideas of the studies. 10.1.                   Generating Initial Codes The initial codes acquired in the reviewed papers are indicated to some extent in the presented summaries in the previous part of the study. Basically, the discussions highlighted that the study implied that the coding made in the process were predominantly data driven. ( and  2006, ) This indicates that the major themes that could be acquired are to be based on the data, in this case the articles and studies to be examined. In the same account, the coding was done manually which indicates that a clear and first-hand observation of the studies did take place. The third phase will be describing and presenting the codes through mapping. The presentation will be limited to the thematic maps created in the individual studies.   10.2.                   Searching, Reviewing, and Defining for Themes in the Studies This part of the study reflects the model of  and  (2006, ) relating to the consequent steps of their thematic analysis process regarding the identification of major themes. In the same account, some certain elements essential to the theme in the individual papers will be presented in this part of the paper. Basically, this paper intends to use theme maps to summarise the general themes of every studies analysed and specific factors that affects them. In this regard, the major and sub-themes will emerge as the discussion progress. 10.2.1.Body type preferences in Asian and Caucasian college students In the study of ,  and  (2001), the prevailing theme is the consideration of gender with its relationship with the eating disorders of the respondents. Basically, the title of the study suggests that the body type preference was the focus of the study.     Figure 2. , , and  (2001) Theme Map   However, with the use of only female respondents, the study is basically an analysis of how women of Asian and Caucasian descent, particularly how their body image is affecting their eating behaviour. Seen in the theme map above, gender is the prevailing theme in the study with sub-themes of culture and body image. Essentially, the study indicated that the culture of the respondents have a lot to do with the body image of an individual. 10.2.2.Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong The study of  and  (1997), the prevailing theme is culture with sub-themes of gender, media and familial influence. These sub-themes tend to highlight the variables on which  and  (1997) have used to examine their respondents. The theme map summarises the relationship of each theme and sub-themes. With the study of the both male and female reactions to these factors and their image of their individual bodies, the study presented the culture of Hong Kong and their general behaviours with regards to eating and their body images.     Figure 3.  and  (1997) Theme map   The study maintains that the respondents, both male and female, always have some level of dissatisfaction with any particular part of their bodies. Factors like mass media and even the relatives that have direct contact with exacerbate this level of dissatisfaction. To some extent, this dissatisfaction also creates differing levels as stated in the paper. 10.2.3.Anorexic Eating: Two Case Studies in Hong Kong This case study reflects a detailed analysis seeking to establish the needs of anorexia nervosa patients in their intent of rehabilitation. Basically, the study indicates that the body image of the respondents were the main element that should be considered in cases where anorexia nervosa is present. Figure 4.  and  (2002) Theme Map   The body image of the patients was essentially the key on their realisation that they need help with their health. The sub-themes of culture, gender and the family environment highlights the significance of the external environment in the treatment process. In terms of gender, studies have noted that women are more susceptible to anorexia nervosa which justifies the selection process held by  and  (2002). Moreover, issues on family and culture fundamentally establishes the will of the patient to recuperate and in the same way trigger any relapse or set off any eating disorder to any individual. In the case studies, the family dynamics were able to help the patient in realising that she needs help and serves as a support group for her recovery. In the same regard, the study has indicated that the existing culture tends to boost the possibility of females in triggering eating disorders. Perceptions of flab and the presence of anything “fat” in their physique tends to encourage vulnerable individuals to succumb to drastic means of reducing weight which often leads to eating disorders.   10.2.4.Three different presentations of bulimia nervosa The case study made by of  and  (2000) presents the aetiology, diagnosis, complications, and treatment of bulimia nervosa. The prevailing themes in this study are that eating disorder is a psychosocial-induced illness. This figure below presents the relationship of the said theme with the sub-themes of body image, media, family environments, culture, and gender.   Figure 5.  and  (2000) Theme Map   At a certain point of the study, it presents that the image of a thin person is always tantamount to beauty and fashionable. Basically, the environment on which a person is subjected to contributes highly on the presence of bulimia nervosa of the respondents. At the same time, the social pressures that the individual encounters appears to be perceived by the study as considerably heavy as the cases that they reviewed claimed that the combination of the media, family environment, and culture was a perfect brew that pushed them over the edge and engage voluntarily in unhealthy eating behaviours.   10.2.5.Anorexia nervosa in Singapore , , , and  (2005) presented a study of the actual situation in Singapore with regards to the incidence of anorexia nervosa.        Figure 6. , , , and  (2005) Theme Map   The analysis was based on actual reported cases and statistics recorded from hospitals and other health facilities. The main theme at this study is that the culture that prevails in Singapore is the main culprit in the prevalence of anorexia nervosa and other eating disorder in the state. Given the fact that Singapore has become considerably a melting pot of different nationalities, foreign nationals ranging from Caucasians, Mainland Chinese and even the neighbouring Southeast Asian countries tend to include themselves in the lists discussed by , , , and  (2005). In the individual analysis of the data, the authors have realised that every nationality has its own regard on sub-themes like body image, media, gender, and family environment. Differing levels from one nationality to another establishes the incidence on how one culture could be susceptible to anorexia nervosa or any other eating disorder.   10.2.6.Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape Yet again, the theme of culture has become the prevailing element in a study carried out by , , and  (1999). In their study, the main respondents were people with direct descent from the special administrative region of Hong Kong. Basically, they categorised the respondents into those born in Hong Kong and those who have been acculturised in the Australian environment. The latter includes those who were of Hong Kong descent but has been born or have been living in Australia for a considerable number of years already.         Figure 7. , , and  (1999) Theme Map The findings of the study indicates that those who have been acculturised with the Australian body image of thin and slender has greater body dissatisfaction compared to those who have been born in the special administrative region. However, it must also be pointed out that gender once more is said to be one of the influential sub-themes as well as the body image of the individual. Nevertheless, the culture recognised by the individual respondent indicates the level of her/his body image and possibly her/his eating behaviour. 10.3.                   Thematic Analysis 10.3.1.General Discussions The thematic analysis will constitute a description of the major elements of the noted papers and relate them to the major objectives indicated in the earlier parts of the paper.     Table 4. Theme Table on the Critiqued Articles Paper Author(s) Objectives of the study Conceptual Frameworks Empirical Analyses Impact of the research Methodology Used Anorexic Eating: Two Case Studies in Hong Kong  and  (2002) Eating experience of anorectic females during the course of a struggle against anorexia nervosa Anorexic eating is related to family dynamics. Eating disorders are caused primarily by external factors Claims that a support system is required for a patient to overcome problems of anorexia Case Study Charting new territory: body esteem, weight satisfaction, depression, and self-esteem among Chinese males and females in Hong Kong.  and (1997) Explore the differences in the relationship of body esteem, weight satisfaction, depression and self-esteem among Chinese males and females in Hong Kong. Body image is directly related to eating disorders Eating disorders are caused primarily by external factors Establishes that Chinese women has a higher propensity to suffer from eating disorders caused by poor self-esteem Survey (Stratified Sampling) Body type preferences in Asian and Caucasian college students , , and  (2001)   to add to the literature examining ethnic differences in body type preference, and to examine the impact of ethnicity on gender differences in body type preference Body image is directly related to eating disorders Eating disorders are caused primarily by external factors Difference on Body preference based on ethnicity depends on gender. Survey Three different presentations of bulimia nervosa    and  (2000, ) Illustrate the varied clinical presentation, aetiology, diagnosis, complications, and treatment of this intriguing condition.   Social pressures to conform with unrealistic standards is not the sole reason but definitely one of the major causes of eating bulimia in Hong Kong Eating disorders are caused primarily by external factors Sees the possibility of bulimia as a “fashionable” coping mechanism among young Chinese women. Case Study Anorexia nervosa in Singapore   , , , and (2005) To study the clinical characteristics and features of patients with anorexia nervosa in Singapore, and to compare the clinical features of the early versus the classical later-onset cases.   Western accounts of Anorexia Nervosa is similar with those incurred in Singapore Eating disorders are caused primarily by external factors Females have a higher propensity in having anorexia nervosa Review of Case Records Effect of Western Culture on Women’s Attitudes to Eating and Perceptions of Body Shape   , , and  (1999) Investigate the effect of culture on two factors implicated in the development of eating disorders, negative attitudes toward eating and dissatisfaction with body shape.   Body image is directly related to eating disorders Eating disorders are caused primarily by external factors Compared to their Australian-born counterparts, Hong Kong-born female students have minimal body dissatisfaction. Survey (Cross-sectional Study)   The table above is a summary of the themes evoked in the studies critiqued in this paper. The table presents that the study on eating disorders tends to vary depending to culture and depending on the gender of the patient. 10.3.2.Analysis of the Objectives Every study presented in this dissertation changes in terms of their individual focus. For instance, the study of  and  (2002) tried to look into the context of the “eating experience of anorectic females during the course of a struggle against anorexia nervosa.” This means that they placed their focus on a particular eating disorder and limited their research on female anorexics who are recuperating from the said disorder. This justifies their reason to take on case studies to provide a rather comprehensive perspective on the actual struggles and conditions encountered by a person who actually undergone the ordeal. Other studies discussed in this dissertation have similarly accepted the assumption that women are more susceptible to incur an eating disorder. This is seen in the studies of , , and  (1999) and , , and  (2001). Both studies focused on the context of body image and body type. In the same time, they employed survey techniques in data gathering. However, they differed in the basic objectives in their works. To illustrate,  (2001) said that they intend to “to add to the literature examining ethnic differences in body type preference, and to examine the impact of ethnicity on gender differences in body type preference.” On the other hand,  (1999) said that they seek to “investigate the effect of culture on two factors implicated in the development of eating disorders, negative attitudes toward eating and dissatisfaction with body shape.” It can be seen thus that even though they have acquired the same data acquisition method and gender assumptions on eating disorders, the study of  (2001) seeks to recognise the existing condition in the context of body preference in an area where the different nationalities and cultures coexist. On the other hand, as culture is similarly regarded in their study,  (1999) noted in their objectives that their study centres on the attitudes of the respondents about eating and their body shape. This means that the study made by  and  (1999) tend to consider the psychological and social elements that contribute to the eating behaviours of the respondents.     10.3.3.Analysis of the Conceptual frameworks In the context of the conceptual frameworks provided in the critiqued papers, four of them have pointed out that the individual perception of the body image of the individual does have an implication on the propensity of the person to subject him/her to eating disorders. This shows that there is a huge part of the literature that perceives the issue of eating disorders as predominantly psychological in nature. ( and , 1997; , , and , 2001; , , and , 1999) have established these in their conceptual frameworks.  However, the discussions the said studies have similarly implied that these psychological problems are similarly caused by the external environment. For instance, there has been studies that indicated that mass media has been culpable for inducing a standard body image of beauty in society, that is skinny and somewhat physically emaciated. (, 2004, ) Some of the studies above presented an analysis of gender differences on their studies have presented and essentially reinforced each other’s claims on the propensity of women to have issues on their eating attitudes and possibility of incurring eating disorders based on their body image. (, , , and , 2005;  and , 2000; , , and , 2001; and  and , 1997) On the whole, the entire literature acquired in this study indicates that for most parts, the issues eating attitudes and the possibility of suffering from eating disorders have to do with the external environment. To some extent, as seen in the study of  and  (2002), that even the recovery from the said disorders tend to depend highly, not on the individual, but on the environmental factors surrounding the patient, particularly the support group seen in the immediate family. Thus, based on the chosen literature, this analysis has established that the cause of eating disorders as well as the possible recovery from it tends to come from the external environment on which the individual is subjected in. Thus, for the most part, the issues of eating disorders tend to become more social than psychological. 11. DISCUSSION This part of the dissertation will be covering the personal views of the researcher regarding the critiqued articles. Basically, these discussions will be based on the previous arguments made in the earlier parts of the paper.   11.1.                   In Comparison with the Preliminary Literature Review The study’s preliminary literature review is basically a general version on the more specific perspectives noted in the studies pointed out in this paper. There isn’t much of a difference in the discussions as the results of the analyses in the themes of the six papers pointed towards a socio-cultural consideration of the problem of eating disorders. Basically, this shows that the issue holds a more social perspective which triggers a more deep-seated issue of eating disorders as psychological disorders. Media images and social pressures are among the elements that cause these disorders and are also shared by both the preliminary literature and the studies presented in this paper. With regards to the implications of the family on the problem, both the preliminary literature and the critiqued papers shared the stand pointing to its importance both as a trigger and on the recovery and the issues of eating disorders.      11.2.                   Implications on the Issue of Eating Disorders The findings of the study reinforce the established findings pertaining to eating disorders as a socio-cultural, psycho-social issue. Moreover, the findings in this paper have similarly uncovered several limitations in the conduct of studies focusing on the Hong Kong setting as well as the Chinese people. This study has found out several issues which will be discussed further in the recommendation parts of the paper. As presented in the articles above along with the prevailing themes indicated, culture, media and gender tends to have a great influence in the eating behaviours of the adolescent. For some reason, issues related to eating disorders are often connected with gender. Similarly, with the considerable strength of the established images in mass media, changing the culture may be similarly hard. As indicated in the claims of , , and  (1999), the emergence of the western consciousness in terms of beauty and accepted appearance may well influence even the traditional Asian populace. Moreover, as indicated in the papers which employed case studies for their methodology, having a support system in the form of family and friends could always help the patient on his/her way to recovery. In the same manner, the discussions on the said papers have implied that the satisfaction on the body image of the individual is largely based on the way they are treated by family and friends. This means that to some extent, the attitude of these people will be influential in avoiding any eating disorder on the young individual.      11.3.                   Perceived Limitations of the Study The limitations indicated in the earlier chapters of this dissertation have resonated in the findings. This means that the perils of using qualitative approach in conducting research has subjected the discussions above to some extent. However, the main limitation that the researcher has found out in the course of the analyses as well as the data collection is the use of a rather constricted set of criteria in the inclusion and exclusion of articles. Basically, the limit of using only those studies written in English has been rather detrimental for the researcher particularly in acquiring recent works and a more comprehensive range of sources.     11.4.                   Implications for Practice Majority of studies presented in this paper holds a rather descriptive research. This is apparent in those that made use of surveys as their primary means of data acquisition method. To illustrate, the study of , , and  (2001) basically presented the existing condition and the relationship with ethnicity and body type preference. There was no recommendation on how to improve on the said conditions. This is the same with the study of  and  (1997) as it only presented the conditions the psychological states of Chinese males and females in Hong Kong. The intended audience of this study are apparently those in the academic as the sole recommendation is to conduct future studies to determine whether actual changes in the variables studied in this context actually took place.   Those which took case study methods have provided a specific recommendations and valuable information with regards to dealing with eating disorders. For instance, the study of  and  has indicated that the family could help facilitate effectiveness of the treatment for anorexia. Family dynamics is thus given importance in the context of anorexia. Basically, the findings indicated that the mere presence of family members during meals encourages the patient to rise above the disorder. In the context of bulimia,  and  (2000) pointed out the actual process and certain stages of bulimia encountered by actual patients recovering from bulimia. Basically, the study of  and  (2000) provided vital information regarding the treatment done for bulimic patients in Hong Kong. Essentially, a combination of drug treatment and psychosocial intervention has been highlighted as the more accepted treatment as noted in the study. These case studies would be very valuable for clinicians in their intervention with patients with similar cases.    11.5.                   Personal Reflections Based on the claims above, eating disorders is basically a universal phenomenon. This is seen in the fact that countries like Hong Kong and Korea tend to encounter similar problems. Nevertheless, it has also indicated that the issue is psychological in nature; this may indicate that the conditions are treatable and even avoidable. The incidence of eating disorders of Hong Kong adolescents are not thus limited to those who actually reside in the special administrative region. To some extent, the analysis provided above manifested that even those out of the country, and especially those who have highly acculturised the culture of the west on beauty, tends to subject themselves voluntarily on health-compromising eating disorders.   The environment, on which the individual dwells, tends to have a considerable impact on the emergence of eating disorders. It is therefore important to note the responsibility of the family to be more vigilant in monitoring the development of their adolescent members.  To a certain extent, adolescents with eating disorders tend to be easily detected. Significant changes in weight are noticeable physical indicators of an eating disorder. Other determinants like depression also tend to be more noticeable. Early detection could provide the young individual time to realise that he/she is suffering from a disorder and that it should be rectified. In any case, the primary source of strength of the adolescent is still his/her family. Being the support system for the young individual will help him/her in his/her formative years as an adolescent. 12. RECOMMENDATIONS The following recommendations are based on the discussions provided above. Specifically, these recommendations seek to pertain to the future literature on eating disorders. <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Search for current data</li> </ul> The studies presented above show some indication that the data dates at least three years ago. Though the most recent article discussed above is published at least two years ago, the data seems to manifest a considerable lack of recentness. Though the findings in the said studies may have been instrumental in describing the milieu of eating disorders, the rather dated nature of the data may have affected the conclusions of the said papers. Again, with the seeming importance of their data, they may be rather incomplete when used as reference for studies made on eating disorders in this year. The worse case scenario may possibly be that they are no longer relevant, especially for studies focusing on the Hong Kong setting.   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Provide more sufficiency in terms of the details in such studies</li> </ul> Almost every article discussed in the study has some flaws in its detail, particularly on its parts that would establish the validity and reliability of their findings. For instance, there is a seen problem in the indication on whether the collection process and selection criteria of their respondents would reveal a non-biased, impartial, and objective presentation of the conditions naturally occurring in its environment.    <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> There is an inherent problem regarding the generalisability of the conclusions</li> </ul> The findings of the papers provided in this study appear to bear an understandable problem on its generalisability. Given the fact that the problem of eating disorders tend to manifest a rather differentiated outcome for every case, thus the findings may not be applicable to the overall conditions surrounding eating disorders. In the same manner, the extent to which the number of respondents and the range of the studies reviewed above provide an impression that these types of academic works could only be made within a prearranged numbers of respondents. To this end, the applicability of the cited literature and the reviewed articles may well have problems in relating to other specific environment and cases relating to eating disorders.   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Look for sufficient evidence for the conclusions </li> </ul> In looking at the articles critiqued above, there is an underlying propensity among the writers and academics to overly advocate and lean towards their individual hypotheses. This makes the discussions rather leaning and biased to some extent. In the same manner, the observations that the authors have provided in their works tends to rest on their individual opinion, in an attempt to make a new theory, which to some extent undermines the findings and conclusions of their paper.    13. CONCLUSION The discussions above have provided a detailed description of the eating disorders that are prevalent in modern society. It has established the possible causes and possible risks for individuals who may have succumbed to eating disorders. It should also be noted that the majority of the studies cited in this paper are articles relating to adolescent behaviour and eating disorders. The findings of the study are seen to be not that different from that of the discussions in the preliminary literature review. In addition, the preliminary literature and those reviewed relating to Hong Kongers still share common themes: culture, body image, gender, family environment, and mass media. Each and every element has been deemed once in both preliminary and those included in the respondent articles as a major theme or an incontrovertible part of the sub-themes of the studies. This indicates that to a certain extent, the issues surrounding eating disorders tend to become more universal as time progresses. Given the emergence of elements of the external environment as well as a more complex set of dynamics, one could only hope that the trend does not rise to uncontrollable and unmanageable proportions. In the context of the creation of literature, the issues discussed above regarding the shortcomings of the critiqued studies reveal that focus on the improving the data collection and inclusion criteria should be taken seriously by academics seeking to provide future studies on this topic. There is nothing to lose and everything to gain in continuously carrying out studies and analysis on the state statistics related to eating disorders and its psycho-social implications on the adolescents regardless of descent. 14. REFERENCES

CHAPTER 1

A CROSS-SECTIONAL STUDY OF EATING ATTITUDES ASSOCIATED WITH PSYCHOSOCIAL FACTORS AMONG CHINESE ADOLESCENTS IN HONG KONG ...