| Mortality and Recovery Rates |
| Each year millions of people in the United States develop serious and sometimes life-threatening eating disorders. The vast majority--more than 90 percent--of those afflicted with eating disorders are adolescent and young adult women. One reason that women in this age group are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure. Researchers have found that such stringent dieting can play a key role in triggering eating disorders. Approximately 1 percent of adolescent girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. Another 2 to 3 percent of young women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other "purging" behaviors to control their weight. These eating disorders also occur in men and older women, but much less frequently. The consequences of eating disorders can be severe, with 1 in 10 cases leading to death from starvation, cardiac arrest, or suicide. Fortunately, increasing awareness of the dangers of eating disorders--sparked by medical studies and extensive media coverage of the illness--has led many people to seek help. Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get treatment. Family members and friends can help recognize the problem and encourage the person to seek treatment. Eating disorders have captured the public imagination. Images of severely emaciated young women suffering from anorexia nervosa appear often in glossy women's magazines and current affairs programs, while public disclosure of bulimia nervosa has become commonplace. This publicity tends to obscure the continuing puzzle created by these enduring, hard-to-treat, and sometimes fatal conditions. It is therefore timely to review the clinical dilemmas provided by eating disorders. Anorexia nervosa is not new, having first been described in the 17th century. The clinical presentation appears essentially unchanged since the first comprehensive accounts were produced in the late 19th century. Patients with anorexia nervosa are characterised by a relentless pursuit of thinness, resulting in weight loss and a refusal to maintain a normal body weight. This refusal has been described as a "normal weight phobia". Anorexia nervosa is not common. Worldwide, the true point prevalence is certainly no more than 0.5% of the female population over 15 years of age, and may be considerably less. Two studies of prevalence have been conducted in Australia: one reported a prevalence of 0.1% among a large group of schoolgirls, and the other reported a lifetime prevalence of 0.4% among a large group of twins. Evidence for changes in the incidence of anorexia nervosa is controversial. Reports of recent increased incidence in specific populations have been criticised on methodological grounds. Increased use of hospital services may reflect a change in the threshold for admission, as much as changing incidences.In our experience, demand for hospital services for these patients has not changed substantially. Anorexia nervosa can be fatal. Although death rates vary between studies and may be falling, a rule of thumb is that one patient per two hundred treated will die as a result of starvation or suicide during each treatment year. For patients who do survive, the burden of disability and distress remains considerable. Overall outcome varies between studies, but about 40% of patients make a good five-year recovery, 40% remain symptomatic but function reasonably well, and 20% remain severely symptomatic and are chronically disabled. Summary Industrialized affluent societies Primarily Caucasian Onset between the ages of 13 and 18 Target age between 15 and 35 Bulimia Nervosa: effects 4% to 20% of all females Anorexia Nervosa: effects 1% of all females Anorexia Nervosa or Bulimia Nervosa effects 20% plus 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 Eating Disorders are a public health problem in the US, Canada and other western nations. · Approximately 0.5% of adolescents and young adult women meet the criteria for anorexia (This is a conservative estimate). · The average age of onset for anorexia is 17, with a high proportion of girls developing the disorder at ages 14 and 18. · Approximately 5% of adolescents and young adult women meet the criteria for bulimia. · The most prevalent time for bulimia to develop is between adolescence and age 25. · Approximately 35% of US adults are obese (58 million people). ·Eating disorders are more prevalent in groups that emphasize weight and body shape (ballet, athletics, modeling, etc.). · While eating disorders primarily affected white affluent females, they now affect a wide variety of the population including all classes, ethnic and racial groups. · Of all psychiatric disorders, eating disorders have the highest morbidity and mortality rates. · It is estimated that approximately 5-10% of eating disorders die from physical consequences and related suicide. · Approximately one-third of all eating disorders will make a full recovery, one-third will struggle with partial recovery, and one-third will stay ill. · Family therapy is important in treatment, particularly for young girls and married women. · Eating disorders are primarily female, though a small percentage of men suffer (one out of 12). · Many times other psychiatric conditions such as depression and anxiety co-exist with eating disorders. · The medical consequences related to eating disorders can be severe and at worse, lead to death. · Someone with an eating disorder spends a lot of time thinking about food, body image and weight, however, there are other issues involved in treatment. · Help is available. Early intervention increases the likelihood of success. |
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