There was an interesting article the other day in the magazine Psychiatric Times about OCD in Egyptian Adolescents. Much of the article discussed how religion and culture can affect the manifestations of OCD, and I found these effects fascinating.

Writes psychiatrist Ahmed Okasha:

Previous Egyptian studies on psychiatric phenomenology have shown a prevalence of culturally determined symptomatology, where religion and prevailing traditions seemed to color not only the clinical picture of the condition, but also patients' attitudes about their disorder...The role of religious upbringing has been evident in the phenomenology of OCD in Egypt. The psychosociocultural factors are so varied that they can affect the onset, phenomenology and outcome of OCD. They can even affect response to treatment. The emphasis on religious rituals and the warding-off of blasphemous thoughts through repeated religious phrases could explain the high prevalence of religious obsessions and repeating compulsions among our Egyptian sample...The female gender is surrounded by so many religious and sexual taboos that the issue becomes a rich pool for worries, ruminations and cleansing compulsions in women susceptible to developing OCD.

(Emphasis mine)

It was the last sentence that really struck me, because it shows how culture impacts the expression of mental illness, and it enables us to look at the interplay without pointing fingers.

Here at ED Bites, I write a lot about biology. I spent much of my life in training to become a biologist of one sort or another, and I loves me some interesting science. This explains some of my emphasis on the biology of eating disorders (old habits die hard...), and some of the emphasis stems from the fact that the biological issues are, in general, much less discussed in popular media than the cultural aspects. This doesn't mean that I think culture is irrelevant; far from it. Your culture and your environment has a profound impact on who we become and what illnesses we may or may not have.

The religious atmosphere in Egypt doesn't cause OCD, but it does influence the content of your obsessions and compulsions, and the meaning you may attribute to them. Could living in a world where religious rituals reign supreme make you more likely to develop OCD? Perhaps. As Okasha points out, these rules certainly make a fertile feeding ground for ruminations and worries. And to someone susceptible to developing OCD, these feeding ground doesn't need much fertilizer for an obsession to grow.

I wish there were more articles looking at the intersection of culture and eating disorders in this way. In the stereotypical newspaper article about the pressure to be thin or dieting celebrities, these pressures are equated with causing eating disorders. And while that's not exactly true, that doesn't mean that culture is completely irrelevant. It appears that cultures where there has been less emphasis on the thin ideal, non-fat phobic anorexia appeared to be much more common than the Western fat phobic type. That doesn't mean there isn't a biological basis for body image distortion and fat phobia, just that it is only expressed under certain conditions. Recent research from Hong Kong has shown that as China has increasingly adopted Western ideas of weight control, the proportion of people suffering from fat phobic anorexia has also increased (Lee et al, 2009).

You can't win the fight of nature vs. nurture because it isn't a fight at all. That's just not how it works. Nature and nurture each have their push and pull on who we become, but it's not a tug of war and winner takes all. It's more of a dance, with both Nature and Nurture taking the lead at different times. If only this could explain why the heck I have two left feet...