How lay is lay? Chinese students' perceptions of anorexia nervosa in Hong Kong

Using a locally devised self-report questionnaire that encompassed both professional and lay explanatory models, this study explored the perceptions of anorexia nervosa (AN) in a large sample of 842 Chinese undergraduates who had little biomedical exposure to this rare condition in Hong Kong. Anorexia nervosa, or yan shi zheng, was conceived as a chronic psychiatric condition of severe weight loss (34%) that arose from mixed psychosocial etiologies. Unlike the more exact professional categorizations but consonant with the lexical meanings of yan shi and Chinese anorectic patients' illness reality, appetitive complaints, sadness and fat phobia were believed to be the main expressions of AN. The illness was seen to affect young women of affluent societies, and to call for help from mental health professionals as well as family members. Although it was not stigmatizing, it would nearly never be admired. Factor analysis revealed a discernible resemblance between lay and professional epistemologies, particularly in the configuration of anorexic symptomatology into "specific" (fat phobic) and "general" types. This implies that in psychiatric disease categories with an uncertain etiology and a substantial cultural component, lay people may package and construct knowledge in a fashion similar to that of professionals. The findings of this study question biomedicine's positivistic claim to psychopathology, and suggest that lay and professional ethnopsychiatric theories and lived anorectic experience are interdependent facets of a socially constructed world.