Studies have indicated that eating disorders (EDs) have become a global phenomenon over the last two decades [1,2], with a consistent rise in incidences among males and females in both Western [3-7] and non-Western countries (e.g., ). Latzer et al.,  found no significant differences in disturbed eating attitudes (scores above 20) between Arab adolescent boys and girls in Israel. The prevalence of abnormal eating attitudes (scores above 20) was 17.7% for the full sample, with a breakdown of 16.4% for the boys and 18.7% for the girls. According to the scores of the Eating Attitudes Test (EAT-26), the risk of developing EDs among college students is on the rise. In Western countries, the prevalence among college students is about 25% , and in non-Western countries, a prevalence of 11%-13% was found among college students in Malaysia [10,11] and other Asian countries , 32.8% among college students in Morocco , 35.4% among female college students in Saudi Arabia , and 25% among Israeli Arab adolescents (20).
Research in both Western [7,15,16] and non-Western countries [17,18] has pointed to cultural differences in the prevalence of EDs. Several studies conducted in Israel – a country comprised of collectivist and individualist cultures and majority and minority groups [19-23] – have suggested that EDs might be perceived and experienced differently among Arabs and that typical features of the majority group (Jews) cannot always be applied to minority groups (Israeli Arabs) [24, 25]. Approximately 20.9% of the Israeli population is Arab, comprising three main religious groups: Muslims, Christians, and Druze . The Arab society in Israel is, in general, undergoing a transition from traditionalism to modernization. These processes are manifested by changes in the economy, education, the status of women, family structure, and by socio-cultural changes and transformations in patterns of coping with social problems. Regarding issues of body image, it is, on the one hand, a conservative society that does not believe in the ideal of thinness; on the other, it is exposed to Western Jewish culture and social media which presents different norms of ideal thinness and nutrition . It was reported that for Muslim respondents and consistent with numerous studies, weight is the largest contributor, whereas for Jews, weight is not a significant predictor. In addition, it was found that for Arab Muslims, self-criticism scarcely contribute to EDs, while for Israeli Jews, it is a significant predictor of EDs . Although a higher rate of EDs has been found among Israeli Arabs than Israeli Jews , to the best of our knowledge, only a few studies conducted in Israel have examined Jewish and Arab adolescents separately. Due to increasing rates of EDs among young adults, and specifically Israeli Arab females [20,21,22], it is important to examine gender and cross-cultural differences within this age group. The present study is aimed to compare the risk of developing EDs between participants from a Western culture (Israeli Jews) and a non-Western culture (Israeli Arabs) living in the same country.
A survey conducted by the World Health Organization showed that dieting behavior is higher among Israeli adolescent girls and boys than among their counterparts in 34 other countries . Latzer et al.  found adolescent boys to have lower levels of disordered eating pathology (DEP) than adolescent girls and younger adolescents (grades 8–9) to have higher levels of clinically relevant DEP than older adolescents (grades 10–12). This difference suggests that even at the same developmental stage, adolescent boys are not yet influenced by the same sociocultural standards and expectations as adolescent girls. However, it is also possible that adolescent boys are less sensitive to the cognitive and behavioral experiences than adolescent girls. Participants in the current study comprised young adult males and females.
Young adults with EDs have been found to present high levels of depression and anxiety and increased maladaptive family patterns. Early detection and identification of risk factors of EDs is crucial for preventing complications and increasing recovery . Notwithstanding factors that have been suggested as responsible for increasing the risk of EDs – such as genetic, biological, environmental (media), and psychological (e.g., depression) factors as well as a history of sexual harassment – some recent studies have indicated the need to also detect and examine the contribution of cultural and family factors .
In a review describing the role of the family in eating disorders , a series of factors have been presented, such as parental pressures, family discord, lack of parental care, depressive symptoms, changing in family structure (e.g., a parent leaving or a step-parent entering the family), low parental contact, and more family criticism about shape and weight. It was claimed that the findings on this topic are inconsistent, and that cross sectional and longitudinal studies yielded several limitations. Thus, for instance, these studies have lacked acceptable statistical power to detect risk factors related to relatively uncommon disorders such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN).
In light of the methodological shortcomings of retrospective/cross-sectional research, Le grange et al.,  suggested that family/parenting indices that precede the onset of AN or BN increase risk for psychopathology in general. General risks that interact with inherent and specific sources of biological weaknesses may give shape to specific phenotypes of disordered eating. Therefore, the researchers suggested cautiously considering the results of studies that perceive parents as guilty and responsible for their offspring's EDs and instead focus on involving parents in caring for children with EDs in case it is possible and beneficial.
On the one hand current knowledge refutes the idea that family patterns are either the exclusive or even the primary mechanisms increasing the risk of Eds [e.g., 33]. On the other, a few recent studies examining a specific intergenerational pattern, differentiation of self (DoS), pointed to the importance of this pattern and to the possible detrimental role of parental inaction in relation to EDs among adolescent and adults [e.g. 34 ]. Thus, for example, it was reported that alexithymia and psychological distress mediated the relationships between low DoS and EDs symptoms among adolescents , that family patterns were significantly related to the risk of developing EDs [35,36] and that DoS might contribute to the development and severity of EDs .
DoS is an important family pattern, shaped by one’s family of origin and likely to be a regulating factor of psychological and physical distress. At the interpersonal level, DoS is defined as the ability to balance intimacy with and autonomy from significant others. At the intrapersonal level, it is defined as the ability to balance rational thinking and emotions; poor DoS in the intrapersonal realm may lead to difficulties in recognizing emotional situations and expressing one’s own emotions . DoS includes four metrics: emotional reactivity (people with high levels feel overwhelmed when facing stressful situations); I-position (people with high levels can express their desires, thoughts, and needs assertively); emotional cutoff (people with high levels tend to disconnect from people physically or emotionally when they fear intimacy); and fusion with others (people with high levels tend to create dependent relationships with blurred boundaries) [38,39]. The lower the individual’s level of emotional reactivity, emotional cutoff, and fusion with others and the higher their level of I-position, the higher their level of DoS.
A number of studies examining DoS have observed gender differences in specific dimensions (although not in the total score). For example, males reported higher levels of I-position and emotional cutoff , while females reported higher levels of emotional reactivity and fusion with others [41,42]. Regarding cultural differences, several studies in Israel found differences between Arabs and Jews. For example, Arab Druze mothers reported higher levels of I-position and fusion with others than Jewish mothers , and Muslim and Christian Arabs reported higher levels of emotional cutoff, while Jews reported higher levels of emotional reactivity and fusion with others .
DoS affects how people cope with distress, anxiety, and frustration. High levels of DoS have been negatively associated with dissatisfaction, anxiety, depression, and alexithymia [45,46] and positively associated with satisfaction with quality of life [47-49]. In a few studies people with higher risk of EDs reported low levels of DoS [40,51] and high levels of distress and alexithymia [52, 53]. A recent study of Israeli Arabs and Israeli Jews found cultural and gender differences in EDs and in a few dimensions of DoS . Doba et al.  suggested that low levels of DoS may increase confusion between one’s own internal emotions and those of others, thereby decreasing the ability to identify emotions and share them with significant others. This, in turn, can lead to a misunderstanding of emotional situations and to distress, which is likely to be expressed through extreme preoccupation with weight or eating . Therefore, DoS is an important factor in understanding the development of psychological distress and risk of EDs.
As seen above, Israeli Arabs reported higher prevalence of EDs and levels of emotional cutoff and lower levels of emotional reactivity and fusion with others than Israeli Jews [19-23], and Israeli Arab females reported higher risk of EDs, emotional reactivity, and fusion with others than males [55,56]. In light of these findings, our first research aim was to further investigate cultural and gender differences in DoS and the risk of EDs among young adults in Israel. Due to differences in DoS between Jews and Arabs, it was assumed that Arabs would report higher risk of EDs and levels of emotional cutoff and lower levels of emotional reactivity and fusion with others than Jews (Hypothesis 1). It was also expected that women would report higher risk of EDs and levels of emotional reactivity and fusion with others than men (Hypothesis 2).
In addition, despite evidence that DoS is a central factor that may increase vulnerability to certain physiological pathologies, such as EDs, by increasing susceptibility to psychological distress [34,50], only a few studies have examined this issue (e.g., among men  and among adolescent girls ). Given this evidence and the paucity of literature examining the relationship between DoS and EDs among young adults belonging to collectivist and individualist cultures, our second research aim was to determine whether low DoS contributes to the risk of developing EDs among male and female Israeli Jews and Arabs. Specifically, we assumed that the risk of EDs (dieting, bulimia, and food preoccupation, oral control, total EAT-26 score) would be negatively associated with DoS (high emotional reactivity, low I-position, high emotional cutoff, and high fusion with others) (Hypothesis 3).