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For anorexia nervosa, there has been a traditional belief of an upper social class preponderance In reviewing the evidence, Gard and Freeman (1996) concluded that the relationship between anorexia nervosa and high socio-economic status is unproven, due to data collection biases including sample size, clinical status and referral patterns A recent study on a large comprehensive clinical database, covering 692 referrals to a UK national specialist centre over a time lapse of 33 years, challenges this conclusion: McClelland and Crisp (2001) found referrals for anorexia nervosa from the two highest social classes to be almost twice as high as expected They present evidence that their ndings are unrelated to differences in clinical features or in access to their service For bulimia nervosa, Gard and Freeman (1996) conclude that similar to most psychiatric disorders there seems to be a preponderance in the low socio-economic groups.

Level of Industrialization It is commonly thought that anorexia nervosa is a western illness: there appears to be a developmental gradient across countries, with a predominance in industrialized, developed countries, linking the disorder to an af uent society (Hoek, 1993) This gradient has been hypothesized to be connected with the sociocultural theory, which holds that eating disorders are promoted by a western culture favouring slimness as a beauty ideal for females By consequence, eating disorders would be less prevalent in underdeveloped, non-western cultures Unfortunately, up to date few developing countries have the facilities and means needed to arrive at reliable epidemiological data Some recent publications cast doubts on the validity of the sociocultural theory, at least for anorexia nervosa For example, Hoek et al (1998) found an incidence of anorexia nervosa on the Caribbean island of Cura ao within the range of rates reported in western countries.

tials for the oxidation and reduction of water). For reviews, see Xu, J., Granger, M. C., Chen, Q. et al. Anal. Chem. News Features 1997, 591A; Notsu, H., Yagi, I., Fujishima, A. Electrochemistry 1999, 67, 389 (in Japanese).

c A methodological problem of this type of study is the de nition and assessment of what typi es a culture as non-western For more discussion on this matter, the reader is referred to 8 in this book and Nasser et al (2001) Level of Urbanization Hoek et al (1995) report that the incidence of bulimia nervosa is three to ve times higher in urbanized areas and cities than in rural areas, while anorexia nervosa is found with almost equal frequency in areas with different degrees of urbanization The drift-hypothesis, relating urbanization differences to migration for educational reasons, is rejected because the differences remain after adjusting for age Other social factors involved might be an increased pressure to be slender and decreased social control in urbanized areas.

All patients who are symptomatic or have noted lesions should undergo a vulvar exam including evaluation of the vulva following the application of 4% acetic acid with gauze followed by inspection with a colposcope or a handheld magnifying glass. This technique was outlined in the background section. Because of the possibility that these lesions represent VIN, at least one of the patient s lesions should be biopsied for a de nitive diagnosis. Biopsy technique is important, as a poorquality or tangentially cut biopsy can obscure the exact diagnosis.

If these hold true, this would imply that anorexia nervosa is less sensitive to social factors than bulimia nervosa, has a more biological origin, and is more driven by other factors such as a tendency towards asceticism and compulsive behaviour Occupation Some occupations appear to run a greater potential risk of being linked to the development of an eating disorder (Vandereycken & Hoek, 1993) Typical examples of these are professions within the world of fashion and ballet We do not know whether this is a causal factor or the result of disturbed attitudes around body and shape In other words, are pre-anorexics.

GSM and UMTS: The Creation of Global Mobile Communication Edited by Friedhelm Hillebrand Copyright q 2001 John Wiley & Sons Ltd ISBNs: 0-470-84322-5 (Hardback); 0-470-845546 (Electronic)