Review of the prevalence and incidence of eating disorders

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.     

Anorexia and Bulimia

ABSTRACT

Eating disorders are complicated mental illnesses that can have tremendous physical and psychological consequences. This article provides general information on the two most common eating disorders: anorexia nervosa and bulimia nervosa. It discusses the symptoms of these diseases, their effects, some of the factors in their development, and common forms of treatment. The article concludes with a bibliography of selected Internet resources that provide additional information on anorexia, bulimia, and other eating disorders.     

Eating pattern disturbances among women medical and graduate students

In this study, the Eating Disorder Inventory (EDI) was used to determine the incidence of disturbed eating patterns and other characteristics of anorexia nervosa and bulimia among women graduate and medical students. The EDI was given to 219 female graduate students and 132 female medical students by mail questionnaire (61% return rate). Excessive dieting concerns, as measured by the Drive for Thinness subscale, were significantly more common in medical students compared to graduate students (18.7% versus 12.9%; p < 0.05). The incidence of bulimic eating patterns was also insignificantly higher in the medical students. The prevalence of bulimia estimated from this survey is similar to that reported in undergraduate women, but the estimated prevalence of anorexia nervosa in both medical and graduate students is lower than reported for younger students. Our data suggest that a competitive environment alone does not appear to lead to greater expression of anorexia nervosa and bulimia.     

College students' mental models for recognizing anorexia and bulimia nervosa

Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge.     

Dissimilarities in eating attitudes,body image distortion,depression, and self-esteem between high-intensity male runners and women with bulimia nervosa

It has been suggested that high-intensity exercise regimens in males bear a resemblance to the features of eating disorders and that male runners may resemble women with anorexia nervosa and bulimia nervosa with regard to eating and weight attitudes, negative body image, and negative psychological adjustment. Twenty high-intensity male runners were compared with 20 sedentary-moderate exercising male controls and 20 women with bulimia nervosa. Compared with the bulimia nervosa subjects, the male runners were not anxious about eating, overly preoccupied with food, excessive in binge-eating or purging behavior, negatively preoccupied with their weight, intent on losing weight, high on personality traits presumed to underlie eating disorders, nor depressed or low in self-esteem. The male groups of high-intensity runners and controls were not significantly different on any measure. These results suggest that high-intensity exercising in males is not analogous to anorexia nervosa and bulimia nervosa.     

Temperament in eating disorders

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters. © 1995 by John Wiley & Sons, Inc.     

Knowledge about eating disorders in the community

One-hundred and forty-nine subjects (80 females and 69 males) were asked about their knowledge of anorexia and bulimia nervosa, the source of their knowledge, and the ways in which their knowledge of these disorders may have affected their attitudes towards eating, dieting, and related behaviors. Almost all subjects had heard of anorexia nervosa, whereas bulimia nervosa was less well known, particularly among males. Knowledge of anorexia nervosa was more detailed than that for bulimia nervosa. The mass media were the major sources of subjects' information about these disorders. Over one-third of females reported that their knowledge concerning anorexia and bulimia nervosa had affected their own eating or related attitudes in some way. The importance of the media in both promoting and preventing eating disorders is discussed.     

An ongoing cross-sectional study of the prevalence of eating disorders in freshman college students

Our third cross-sectional survey designed to elicit DSM-III inclusion criteria for bulimia was completed by 1836 students, 97.2% of those surveyed. Based on operationalized criteria, 4.7% of females reported a current eating disorder diagnosis. These included bulimia (4.3%), bulimia nervosa (2.2%), bulimia with weekly binge/purging behavior (1.1%), and anorexia nervosa (0.1%). Current bulimia was reported by 0.1% of males and current bulimia nervosa by 0.3%. Those women with current bulimia were more likely to report a history of treatment for alcoholism and drug abuse than those bulimic women in remission. The data suggest that fear of loss of control over eating is an important part of the diagnostic criteria for bulimia nervosa, while fear of being fat is less apt to differentiate between bulimic and nonbulimic women. The desire for low weight was more pronounced in bulimic female students in the current survey than in previous surveys. The percentage of women who reported a history of bulimia with weekly binge eating and purging went from 1% in 1980 to 3.2% in 1983 and to 2.2% in the current survey indicating that the prevalence for this disorder may have peaked and may be declining.     

Racial and socioeconomic: Influences in anorexia nervosa and bulimia

Eight black and 120 white patients with anorexia nervosa or bulimia were compared with each other and with 21 black control patients. Biack and white patients with eating disorders were similar in demographic features (except for later age of onset in blacks), in clinical characteristics, and in course of illness. Both racial groups with eating disorders had a significantly higher socioeconomic status than control patients. A diagnosis of anorexia nervosa or bulimia can be confidently made independent of racial designation. Socioeconomic status appears to be a risk factor for development of anorexia nervosa or bulimia in both black and white populations.     

The current status of treatment for anorexia nervosa and bulimia nervosa

A survey investigating the current status of treatment for anorexia nervosa and bulimia nervosa was distributed at the International Conference on Eating Disorders in 7988 and again in 1990. Respondents answered questions regarding treatments they had endorsed for their last patient with anorexia nervosa and for bulimia nervosa. One hundred and seven medical doctors and psychologists completed the survey in 1988 and 115 in 1990. The results indicate that: (1) less than 50% of the respondents believe there is a consensus regarding the treatment of eating disorders; (2) talking therapy is overwhelmingly endorsed for the treatment of both anorexia and bulimia nervosa; (3)there is a trend in clinical practice towards using drug therapy more frequently in treating patients with bulimia nervosa than in treating patients with anorexia nervosa; (4)physicians are more likely than psychologists to endorse drug therapy when treating patients with anorexia and for bulimia nervosa; and (5) about one third of the respondents endorse drug therapy for treating anorexia nervosa. © 1992 John Wiley & Sons, Inc.     

Comparison of DSM-III and DSM-III-R bulimia nervosa classifications for psychopathology and other eating behaviors

Although recent studies on bulimia nervosa have yielded lower incidence rates for the disorder when using the DSM-IIIR, rather than the DSM-III criteria, none measured differences in emotional disturbances between those bulimics who meet the revised criteria and those who do not. Young women (50 ballet dancers and 56 nondancers) from a larger study on the complications of amenorrhea were grouped into three categories; nonbulimics, DSM-III bulimics, and DSM-IIIR (revised criteria) bulimics. Women were surveyed for eating disturbance, concurrent psychopathology, past histories of anorexia nervosa, and family history of emotional and eating disorders. Differences between bulimic groups were found for nondancers, as DSM-IIIR bulimics scored significantly higher than nonbulimics on measures of bulimic thought and behaviors, depression, and emotional disturbance. In addition, a significantly higher proportion of DSM-IIIR bulimics than nonbulimics reported that they had had anorexia nervosa in the past and that they had relatives with bulimia nervosa. For dancers, other than the measure of interpersonal distrust, no significant differences were found between the three groups. Results of the study indicate that bulimia nervosa as defined by the revised criteria (DSM-IIIR) is associated with more emotional problems than is bulimia nervosa according to the DSM-III.     

Relationship of gender and eating disorder symptoms to reported cravings for food: construct validation of state and trait craving questionnaires in Spanish

Using confirmatory factor analysis, we cross-validated the factor structures of the Spanish versions of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T; ) in a sample of 304 Spanish college students. Controlling for eating disorder symptoms and food deprivation, scores on the FCQ-T were higher for women than for men, but no sex differences were observed on the FCQ-S. Eating disorder symptomatology was predictive of trait cravings, whereas food deprivation was predictive state cravings. Trait cravings, but not state cravings, were more strongly associated to symptoms of anorexia and bulimia nervosa than with other psychopathology. We suggest that cravings can be conceptualized as multidimensional motivational states and that our data support the hypothesis that food cravings are strongly associated with symptoms of bulimia nervosa.     

Binge eating and psychological distress in ethnically diverse undergraduate men and women

Binge eating symptomatology affects African Americans and Caucasians at similar rates. Moreover, compared to anorexia nervosa (AN) and bulimia nervosa (BN), binge eating and BED are more evenly distributed across genders. Undergraduates are likely to be affected by binge eating, yet, relatively few studies have investigated this behavior and its correlates in college samples. This study examined the influence of alexithymia, depression, and anxiety on binge eating among ethnically diverse undergraduates. Results indicated that these variables significantly predicted eating symptomatology among Caucasian and African American women but not among Caucasian men. Further, among Caucasian women, depression was the only unique predictor of eating pathology. In contrast, anxiety was the only unique predictor of disordered eating in African American women. There were no differences between Caucasians and African Americans in severity of disordered eating symptomatology; however, in both ethnic groups, women reported greater eating pathology than men. Eating disorders of all types may be more prevalent among African American undergraduates than previously thought. These results highlight the need to study binge eating and its correlates in this traditionally underserved group.     

Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service

OBJECTIVE: In view of inconsistent findings from previous studies, the aim was to investigate possible seasonal variation in month of birth in patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. METHOD: We examined the month of birth in a cohort of 1,305 adult patients with a DSM-IV eating disorder diagnosis at first presentation to a specialized eating disorders service. RESULTS: When compared to general population data, we found no evidence of significant variation in month or season of birth in anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. CONCLUSION: The authors question whether people who develop eating disorders differ from the general population in their season of birth. Caution is expressed about further speculation regarding the etiological significance of season of birth in eating disorders.     

The development and validation of the body shape questionnaire

Concerns about body shape are common among young women in Western cultures, and, in an extreme form, they constitute a central feature of the eating disorders anorexia nervosa and bulimia nervosa. To date there has been no satisfactory measure of such concerns. A self-report instrument, the Body Shape Questionnaire (BSQ) has therefore been developed. The items that constitute this measure were derived by conducting semistructured interviews with various groups of women including patients with anorexia nervosa and bulimia nervosa. The BSQ has been administered to three samples of young women in the community as well as to a group of patients with bulimia nervosa. The concurrent and discriminant validity of the measure have been shown to be good. The BSQ provides a means of investigating the role of concerns about body shape in the development, maintenance, and treatment of anorexia nervosa and bulimia nervosa.     

Sociocultural influences on eating disorders in professional female ballet dancers

Fifty-five white and eleven black female dancers in nine regional and national ballet companies in America and Europe (mean age 24.9) were surveyed for eating disorders. The dancers, as a whole, weighed 12% below their ideal weight for height. None of the black American dancers reported anorexia nervosa or bulimia, while 15% of the white American dancers reported anorexia nervosa and 19% reported bulimia. All instances of anorexia nervosa were in national rather than regional companies, making the incidence among whites in the former 22%. Self-reported anorectics scored higher on the EAT-26, had lower weights, exhibited more psychopathology, and a poorer body image than the nonanorectics. In addition, all but one of the self-reported anorectics weighed, or had weighed, less than 20% of ideal weight for height. The bulimics valued their careers less, dieted more, and exercised less frequently than the nonbulimics. Weight did not differ for these two groups. The data suggest that the anorectic dancers differ from dancers with no eating disorders and that sociocultural factors are related to the report of eating disorders. Specifically, level of competition is related to reported anorexia nervosa and ethnicity to anorexia nervosa and bulimia.     

A case of comorbid anorexia nervosa,bulimia nervosa,and munchausen's syndrome

Reports of comorbid eating disorders and Munchausen's syndrome are rare. As part of a follow-up study of the outcome of anorexia nervosa, medical records and direct structured psychiatric interview data were collected on all women treated for anorexia nervosa in Christchurch, New Zealand between 1981–1984. On interview, one participant received diagnoses of anorexia nervosa, bulimia nervosa, and factitious disorder (Munchausen's syndrome). The subject interwove symptoms of her eating disorders with factitious presentations on several occasions. This diagnosis had not been apparent prior to compilation of all medical records. © 1996 by John Wiley & Sons, Inc.     

Drug use in women with anorexia and bulimia nervosa

Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.     

Stigmatization toward People with Anorexia Nervosa,Bulimia Nervosa,and Binge Eating Disorder: A Scoping Review

Research about stigmatization in eating disorders (EDs) has highlighted stereotypes, prejudices, and discrimination against people with EDs, as well as their harmful effects on them, including self-stigma and a difficult recovery process. Whereas a recent review focused on the consequences of ED stigma, our work aimed to provide a broader synthesis of ED stigma, including its consequences, but also its content and distribution. More precisely, we focused on three EDs—namely, anorexia nervosa, bulimia nervosa, and binge eating disorder. Based on a systematic search of four major databases in psychology, the present scoping review includes 46 studies published between 2004 and 2021. We did not conduct any quality assessment of the studies included, because our aim was to provide a wide-ranging overview of these topics instead of an appraisal of evidence answering a precise research question. The review confirmed the existence of a common ED stigma: all individuals affected by EDs reviewed here were perceived as responsible for their situation, and elicited negative emotions and social distance. However, our review also depicted a specific stigma content associated with each ED. In addition, the demographic characteristics of the stigmatizing individuals had a notable influence on the extent of ED stigma: men, young adults, and low-income individuals appeared to be the most stigmatizing toward individuals with EDs. It is important to note that ED stigma had a negative effect on individuals’ eating disorders, psychological wellbeing, and treatment-seeking behavior. There is an urgent need for further research on the adverse effects of ED stigma and its prevention.     

Patterns of punitiveness in women with eating disorders

The level and direction of hostility in patients with bulimia nervosa, anorexia nervosa and a comparison group were measured using the Hostility and Direction of Hostility Questionnaire. A semistructured interview developed by Harris, Brown, and Bifulco (Psychological Medicine, 16, 641-659, 1986) was used to assess childhood care to examine whether a link exists between childhood exposure to aggression or parental neglect and adult hostility. Patients with eating disorders had significantly higher hostility levels and were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more hostile than patients with anorexia nervosa. Anorexia nervosa patients were more likely to direct hostility inwardly, rather than outwardly, when compared with bulimia nervosa patients. Impulsivity was associated with extrapunitiveness whereas intropunitiveness was associated with depression. Although some measures of poor childhood care correlated with adult hostility levels no clear pattern emerged. © 1995 by John Wiley & Sons, Inc.