MODULE 10

Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Eating Disorder Not Otherwise Specified
• Commonly Associated Disorders
  
• General Interventions
• When to Refer
• Resources
• Special Topic: Obesity

Eating Disorders

Eating problems and disorders fall along a continuum, ranging from concern with body size or shape and unhealthy dieting practices to life-threatening disorders such as anorexia nervosa and bulimia nervosa.

Once considered a problem of upper-class white females, eating disorders affect male and female children and adolescents of all ethnic, racial, and socioeconomic groups.¹ These disorders can be challenging to identify, and as a result more than half of all cases are never diagnosed.²

Treating these chronic illnesses presents long-term challenges. Studies indicate that between 44 and 50 percent of patients with anorexia nervosa and 45 to 60 percent of patients with bulimia nervosa will have good long-term outcomes; 30 percent and 29 percent, respectively, will have intermediate long-term outcomes; and 24 percent and 21 percent, respectively, will have poor long-term outcomes, with mortality rates of 5 percent and 1 percent, respectively.^{1, 2}

Key Facts:

• More than 7 percent of high school girls and 4 percent of high school boys in the United States reported taking diet pills, powders, or liquids to lose weight. More than 6 percent of girls and 2 percent of boys reported vomiting or taking laxatives in the past month. And more than 16 percent of girls and 7 percent of boys reported not eating for 24 or more consecutive hours in the past 30 days to control weight.³
• The desire to be thin and dieting behavior have been identified in girls as young as 6.⁴
• Young women have a 0.5 to 1 percent risk of developing anorexia and a 2 to 5 percent risk of developing bulimia.²
• Eating disorders are more commonly seen in females, although males are also affected. Estimates of the male-female prevalence ratio range from 1:6 to 1:10.¹
• Eating disorders have one of the highest mortality rates of any mental disorder. Anorexia nervosa has an aggregate mortality rate of approximately .56 percent per year of illness (5.6 percent per decade). Suicide and starvation-related effects are the most common causes of death.¹

References

1. American Psychiatric Association. (2006). Practice guideline for the treatment of patients with eating disorders, third edition. American Journal of Psychiatry, 163 (7 Suppl), 4-54.
2. Pritts, S. D., & Susman, J. (2003). Diagnosis of eating disorders in primary care. American Family Physician, 67 (2), 297-304.
3. Eaton, D. K., Kann, L., Kinchen, S., Shanklin, S., Ross, J., Hawkins, J., et al. (2008). Youth Risk Behavior Surveillance -- United States, 2007. MMWR Surveillance Summaries 2008, 57 (SS04), 1-131.
4. Dohnt, H., & Tiggemann, M. (2006). The Contribution of Peer and Media Influences to the Development of Body Satisfaction and Self-Esteem in Young Girls: A Prospective Study. Developmental Psychology, 42 (5), 929-936.