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(9) Anorexia

VIDEO

The Truth About Eating Disorders: Anorexia

ANI

Does anorexia only occur among teenagers?

The majority of new cases of anorexia are diagnosed in adolescents and young adults, most commonly between the ages of 13 and 18.

The illness appears to have two peak ages of onset, one at puberty, and the other in late adolescence.*

However, anorexia does affect people of all ages and has been reported in patients as young as 7 and as old as 80. Recent research, in fact, indicates that older patients are being seen in increasing numbers. According to Carol Tappen and Holly Grishkat, Directors of the Eating Disorders Institute of St. Louis Park, Minnesota, and the RenfrewCenter, respectively, eating disorders treatment centers have seen a significant increase in the number of patients over age 30. Experts suggest that factors such as growing public awareness, social pressure to be thin, and an aging population of “image conscious” baby boomers have produced this shift in the eating disorders treatment landscape.

Cases of anorexia that begin in midlife and later adulthood have traditionally been considered rare. More commonly, we find that an older person with anorexia has experienced symptoms for quite some time, often beginning in adolescence.

Often these patients either were misdiagnosed or did not seek prior treatment. Others may have experienced long-term struggles with body image, or sub-clinical symptoms of an eating disorder, and later developed anorexia after a precipitating event in adulthood. Yet the RenfrewCenter reports that in 2005 about 20% of their adult eating disorder patients said they were age 30 or older when they first encountered symptoms. These numbers reflect an historical shift that has been witnessed by eating disorder professionals in recent years.

Indeed, the most current scientific literature suggests a vulnerability to developing eating disorders throughout the lifespan. Challenges such as divorce, childbirth, widowhood, menopause, and other age-related changes are examples of later-life events that may represent an increased vulnerability for at-risk individuals. Additionally, eating disorder experts believe that chronic dieting may pose a particular risk for anorexia and other eating disorders in women as they age.

We also know that body dissatisfaction, one of the most consistent risk factors associated with dieting and eating disorders, appears to be relatively stable across the lifespan. Studies show that middle-aged and older adults express high levels of dissatisfaction with their bodies, just as younger people do.

According to a 1997 survey in Psychology Today, weight gain tops the list of negative influences on body image for both men and women between 13 and 90 years of age. Of those surveyed, two-thirds of the women and one-third of the men said weight gain had the greatest detrimental effect on their self-image. Thankfully, many healthcare professionals are becoming more aware of the possibility that eating disorders can develop later in life, and a number of treatment facilities offer specially designed treatment tracks for older patients.

Special Considerations for Mature Adults

The following are some special considerations for older adults regarding symptoms of anorexia:

• Even a person without a history of an eating disorder can develop anorexia at a later age. Be careful not to dismiss symptoms in an older person.

• Healthcare professionals may be less likely to suspect an eating disorder in an older adult, especially if a person has been functional for most of his or her adult life. If you suspect that you or a loved one may have anorexia later in life, persist at finding help and treatment with a qualified eating disorders professional.

• Thorough health and medical assessments are important. Physical illnesses, such as cancer, diabetes, Parkinson’s disease, cardiovascular illness, and certain  infections can result in weight loss; therefore, it is vital to obtain an accurate diagnosis.

• While complications of anorexia are similar in patients both young and old, older patients may be more vulnerable to these complications.

• It is important for a healthcare professional to consider and rule out loss of appetite due to other mental illnesses, such as depression and dementia. Such illnesses can also co-occur with anorexia.

• It may be important with an elderly patient to include the family in treatment, especially with a non-emancipated individual.

Special Considerations for Children

There are also unique and important considerations when you suspect anorexia nervosa in a younger child. Some things to keep in mind:

• Other childhood disorders can have a similar presentation to an eating disorder, so accurate diagnosis is essential.

• Feeding Disorders in children are a serious concern. The three most common feeding disorders in children are pica, rumination disorder, and failure to thrive. Other feeding behaviors such as food refusal, spitting out of food, food-related tantrums, and “picky” eating can be early risk factors for developing anorexia later in life. Be sure to discuss any unusual feeding practices with your child’s pediatrician.

• Children with weight concerns before the age of 14 and those who report a higher incidence of stress or behavioral problems at a young age may be at a higher risk for eating disorders.

Eating Disorders Statistics

General:

 

• Almost 50% of people with eating disorders meet the criteria for depression.1
• Only 1 in 10 men and women with eating disorders receive treatment. Only 35% of people that receive treatment for eating disorders get treatment at a specialized facility for eating disorders.2
• Up to 24 million people of all ages and genders suffer from an eating disorder (anorexia, bulimia and binge eating disorder) in the U.S.3

• Eating disorders have the highest mortality rate of any mental illness.4

Students:

• 91% of women surveyed on a college campus had attempted to control their weight through dieting. 22% dieted “often” or “always.”5

• 86% report onset of eating disorder by age 20; 43% report onset between ages of 16 and 20.6

• Anorexia is the third most common chronic illness among adolescents.7

• 95% of those who have eating disorders are between the ages of 12 and 25.8

• 25% of college-aged women engage in bingeing and purging as a weight-management technique.3

• The mortality rate associated with anorexia nervosa is 12 times higher than the death rate associated with all causes of death for females 15-24 years old.4

• Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, and smoking cigarettes, vomiting, and taking laxatives.17

• In a survey of 185 female students on a college campus, 58% felt pressure to be a certain weight, and of the 83% that dieted for weight loss, 44% were of normal weight.16

Men:

• An estimated 10-15% of people with anorexia or bulimia are male.9


• Men are less likely to seek treatment for eating disorders because of the perception that they are “woman’s diseases.”10

• Among gay men, nearly 14% appeared to suffer from bulimia and over 20% appeared to be anorexic.11

Media, Perception, Dieting:

• 95% of all dieters will regain their lost weight within 5 years.3

• 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders.5

• The body type portrayed in advertising as the ideal is possessed naturally by only 5% of American females.3

• 47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.12

• 69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.13

• 42% of 1st-3rd grade girls want to be thinner (Collins, 1991).

• 81% of 10 year olds are afraid of being fat (Mellin et al., 1991).

Collins, M.E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208.

Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 23-37.

For Women:

• Women are much more likely than men to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia are male.14

• An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa in their lifetime.14

Research suggests that about 1 percent of female adolescents have anorexia.15

• An estimated 1.1 to 4.2 percent of women have bulimia nervosa in their lifetime.14

• An estimated 2 to 5 percent of Americans experience binge-eating disorder in a 6-month period.14

• About 50 percent of people who have had anorexia develop bulimia or bulimic patterns.15

• 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems.18

Mortality Rates:

Although eating disorders have the highest mortality rate of any mental disorder, the mortality rates reported on those who suffer from eating disorders can vary considerably between studies and sources. Part of the reason why there is a large variance in the reported number of deaths caused by eating disorders is because those who suffer from an eating disorder may ultimately die of heart failure, organ failure, malnutrition, or suicide. Often, the medical complications of death are reported instead of the eating disorder that compromised a person’s health.

According to a study done by colleagues at the American Journal of Psychiatry (2009), crude mortality rates were:

• 4% for anorexia nervosa

• 3.9% for bulimia nervosa

• 5.2% for eating disorder not otherwise specified

Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., Mitchell, J.E. (2009) Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry 166, 1342-1346.

Athletes:

• Risk Factors: In judged sports – sports that score participants – prevalence of eating disorders is 13% (compared with 3% in refereed sports).19

• Significantly higher rates of eating disorders found in elite athletes (20%), than in a female control group (9%).20

• Female athletes in aesthetic sports (e.g. gymnastics, ballet, figure skating) found to be at the highest risk for eating disorders.20

• A comparison of the psychological profiles of athletes and those with anorexia found these factors in common: perfectionism, high self-expectations, competitiveness, hyperactivity, repetitive exercise routines, compulsiveness, drive, tendency toward depression, body image distortion, pre-occupation with dieting and weight.21

1.Mortality in Anorexia Nervosa. American Journal of Psychiatry, 1995; 152 (7): 1073-4.

2.Characteristics and Treatment of Patients with Chronic Eating Disorders, by Dr. Greta Noordenbox, International Journal of Eating Disorders, Volume 10: 15-29, 2002.

3. The RenfrewCenter Foundation for Eating Disorders, “Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources,” 2003.

4. American Journal of Psychiatry, Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.

5. Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of Eating Disorders, 18 (3): 209-219.

6. National Association of Anorexia Nervosa and Associated Disorders 10-year study, 2000

7. Public Health Service’s Office in Women’s Health, Eating Disorders Information Sheet, 2000.

8. Substance Abuse and Mental Health Services Administration (SAMHSA), The Center for Mental Health Services (CMHS), offices of the U.S. Department of Health and Human Services.

9. Carlat, D.J., Camargo. Review of Bulimia Nervosa in Males. American Journal of Psychiatry, 154, 1997.

10. American Psychological Association, 2001.

11. International Journal of Eating Disorders 2002; 31: 300-308.

12. Prevention of Eating Problems with Elementary Children, Michael Levine, USA Today, July 1998.

13. Ibid.

14. The National Institute of Mental Health: “Eating Disorders: Facts About Eating Disorders and the Search for Solutions.” Pub No. 01-4901. Accessed March 19, 2013. http://health.nih.gov/topic/EatingDisorders

15. Anorexia Nervosa and Related Eating Disorders, Inc. website. Accessed March 19, 2013. http://www.anred.com/

16. Nutrition Journal. March 31, 2006.

17. Neumark-Sztainer, D. (2005). I’m, Like, SO Fat!. New York: The Guilford Press. pp. 5.

18. The Renfrew Center Foundation for Eating Disorders, “Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources,” published September 2002, revised October 2003, http://www.renfrew.org

19. Zucker NL, Womble LG, Williamson DA, et al. Protective factors for eating disorders in female college athletes. Eat Disorders 1999; 7: 207-218.

20. Sungot-Borgen, J. Torstveit, M.K. (2004) Prevalence of ED in Elite Athletes is Higher than in the General Population. Clinical Journal of Sport Medicine, 14(1), 25-32.

21. Bachner-Melman, R., Zohar, A, Ebstein, R, et.al. 2006. How Anorexic-like are the Syhttp:

Statistic Reference:  National Association of Anorexia Nervosa and Associated Disorders (ANAD): http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ (accessed on March 19, 2013)

Terms:

Sub-clinical - The stage of development of an illness before symptoms are observed; or the presentation of symptoms of an illness that do not meet the full diagnostic criteria of an illness or condition.

Precipitating event - A triggering event that precedes and/or contributes to the development of an illness.

Pica - A disorder characterized by the persistent eating of non-nutritive substances, such as dirt, clay, paper, or chalk.

Rumination disorder - A disorder in which a person, usually a child, regurgitates partially digested food before rechewing the food or spitting it out.

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