Eating disorders are characterized by severe disturbances in eating behavior. This section includes two specific diagnoses, Bulimia Nervosa and Anorexia Nervosa. Bulimia Nervosa is characterized by repeated episodes of binge eating followed by unhealthy compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight. A disturbance in perception of body shape and weight is an essential feature of both Bulimia Nervosa and Anorexia Nervosa.

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Bulimia Nervosa

Specific Culture, Age and Gender Features of Bulimia Nervosa

Bulimia Nervosa has been reported to occur with roughly similar frequencies in most industrialized countries, including the United States, Canada, Europe, Australia, Japan, New Zealand and South Africa. Few studies have examined the prevalence of Bulimia Nervosa in other cultures. In clinical studies of Bulimia Nervosa in the United States, individuals presenting with this disorder are primarily Caucasian, but the disorder has also been reported among other ethnic groups. In clinical and population samples, at least 90% of individuals with Bulimia Nervosa are female.

Prevalence

The prevalence of Bulimia Nervosa among adolescent and young adult females ranges from 4% - 20%. The rate of occurrence of this disorder in males is approximately one-tenth of that in females. Studies show that between 60% - 75% of all Bulimia Nervosa patients have a history of physical and/or sexual abuse.

Course

Bulimia Nervosa usually begins in late adolescence or early adult life. The binge eating frequently begins during or after an episode of dieting. Disturbed eating behavior persists for at least several years in a high percentage of clinical samples. Hospitalization may be required to restore weight and to address fluid and electrolyte imbalances. The course may be chronic or intermittent, with periods of remission alternating with recurrences of binge eating.

Familial Pattern

Several studies have suggested an increased frequency of Bulimia Nervosa, Mood Disorders, and Substance Abuse and Dependence in the first-degree biological relatives of individuals with Bulimia Nervosa. A familial tendency toward obesity may exist, but this has not been definitively established.

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Anorexia Nervosa

Specific Culture, Age and Gender Features of Anorexia Nervosa

Anorexia Nervosa appears to be far more prevalent in industrialized societies, in which there is an abundance of food and in which, especially for females, being considered attractive is linked to being thin. The disorder is probably most common in the United States, Canada, Europe, Australia, Japan, New Zealand and South Africa, but little systematic work has examined prevalence in other cultures. Individuals from cultures in which the disorder is rare, who emigrate to cultures in which the disorder is more prevalent may develop Anorexia Nervosa as thin body ideals are assimilated.

Anorexia Nervosa rarely begins before puberty, but there are suggestions that the severity of associated mental disturbances may be greater among prepubescent individuals who develop the illness. However, data also suggests that when the illness begins during early adolescence, it may be associated with a better prognosis. More than 95% of cases of Anorexia Nervosa occur in females.

Prevalence

One percent of all females in late adolescence and early adulthood meet the full criteria for Anorexia Nervosa. The percentage of females attending College tends to be higher. The reported incidence of Anorexia Nervosa has increased in recent decades.

Course

The mean age at onset for Anorexia Nervosa is 17 years, with some data suggesting bi-modal peaks at ages 14 and 18 years. The onset of this disorder rarely occurs in females over age 40 years. The onset of illness is often associated with a stressful life event, such as leaving home for college, termination or disruption of an intimate relationship, family problems and physical or sexual abuse. There is a significant relationship between all Anorexia and Bulimia Nervosa patients who have a history of physical and/or sexual abuse. The course and outcome of Anorexia Nervosa are highly variable. Some individuals with Anorexia Nervosa recover fully after a single episode, some exhibit a fluctuation pattern of weight gain followed by relapse, and others experience a chronic deteriorating course of the illness over many years. Hospitalization may be required to restore weight and to address fluid and electrolyte imbalances. Of individuals admitted to university hospitals, the long-term mortality from Anorexia Nervosa is over 10%. Death most commonly results from starvation, suicide or electrolyte imbalance.

Familial Pattern

There is an increased risk of Anorexia Nervosa among first-degree biological relatives of individuals with the disorder. An increased risk of Mood Disorder has also been found among first-degree biological relatives of individuals with Anorexia Nervosa, particularly relatives of individuals with the Binge-Eating/Purging Type. Studies of Anorexia Nervosa in twins have found concordant rates for monozygotic twins to be significantly higher that those for dizygotic twins.

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Market Summary

• Industrialized affluent societies
• Primarily Caucasian
• Onset between the ages of 13 and 18
• Target age between 15 and 35
• Bulimia Nervosa: affects 4% to 20% of all females
• Anorexia Nervosa: affects 1% of all females
• Anorexia Nervosa or Bulimia Nervosa affects in excess of 20% of all college females
• Of all individuals exhibiting either disorder, 90% to 95% are female
• Of all females exhibiting either disorder, 60% to 75% have a history of sexual or physical abuse or a traumatic life event

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Psychographic Summary

Females suffering from eating disorders also tend to exhibit certain personality traits and tendencies. Most are driven to succeed in either a profession or a personal relationship. All place high value on external reinforcement and acceptance.

Cultural values, including significant emphasis on personal achievement, successful dating, group acceptance, religious conformity and cultural homogeneity all increase the likelihood of women in Utah developing an eating disorder.

Personality Traits

• Perfectionist
• Poor self-esteem
• Competitive careers
• Achievement oriented
• High stress familial settings
• Unstable intimate relationships
• History of trauma, sexual, physical and/or mental abuse

Eating disorders are complex illnesses that require intensive treatment. However, people suffering from eating disorders have an excellent chance for complete recovery.