Eating Disorders

Prevalence, Onset and Course of Eating Disorders

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Eating disorders are not as common as more familiar mental disorders like depression or anxiety, but they are not rare conditions. The National Institute of Mental Health (NIMH) estimates that 5 to 10% of the U.S. population has an eating disorder of one sort or another. Lifetime prevalence statistics suggest that about 0.5% of women and 0.05% of men will meet criteria for anorexia during their lifetimes. Between 2% and 3% of women will meet the criteria for bulimia during their lifetimes (as will between .02% and .03% of men). Binge eating is the most common eating disorder, affecting approximately 2% of all adults.

The number of individuals developing eating disorders appears to be on the rise. Rates of diagnosed eating disorders have literally doubled since the 1960s. Similarly, an increase in rates of anorexia in young women ages 15-19 has occurred in each decade since 1930. The incidence of bulimia in women between the ages of 10 and 39 has tripled between 1988 and 1993. In non-Western countries, the numbers are more difficult to come by, but also appear to be increasing over time.

Eating Disorders are particularly common in women. Only about 10% of patients diagnosed with anorexia or bulimia are male: (a 1:10 male to female ratio). However, some suggest that these data are likely an underestimate because males are more likely to deny having eating problems and less likely to seek help than women. Research also suggests that the number of males with eating disorders is increasing. Even though both genders experience eating disorders, the average age of onset (when the disease starts) is lower for women than it is for men. Despite these important differences in frequency and onset age, there is consensus within the scientific literature that eating disorders in the male population are otherwise very similar in nature to those in the female population.

Eating disorders typically begin in adolescence or early adulthood. Anorexia and Bulimia rarely begin before the age of puberty; 90% of cases are diagnosed before age twenty, while fewer than 10% of all cases occur before age ten. Clearly, the tumultuous events of adolescence, such as self-consciousness, puberty, and peer pressure, can play a big role in triggering these illnesses.

The onset of eating disorders is often associated with a stressful life event such as exposure to violence, family conflict, stress at school, or loss. Onset does not seem to be associated with racial identity or socioeconomic status (e.g., whether one is rich or poor). Instead, these disorders are equal opportunity problems affecting people from all walks of life.

The course and outcome of eating disorders vary significantly across different people. Experts believe that approximately 75%-80% suffer with these disorders for one to fifteen years , and that between 6% and 20% of eating disordered individuals will die as a result of their disease. Apparently, some men and women, especially those who do not seek treatment, suffer for their entire lives. However, there is hope! A majority of those who seek treatment do recover to some degree. Data suggest that eating disorders which begin during early adolescence may be associated with a better prognosis and recovery than disorders that begin later in life.

Young athletes, particularly gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers, are especially vulnerable to developing eating disorders. Because these individuals tend to be competitive by nature, and because their sports involvement often necessitates the practice of weight restriction, disordered eating can be reinforced or rewarded. Even established eating disorders may go undetected in athletes because they tend to look healthier for longer than would otherwise be the case, and because specific and/or strict dieting is typically expected behavior.

 




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