Eating disorders are first identified during the pre-adult years and are sometimes considered to be psychological problems of adolescence. When the problems persist, they are troublesome for adults as well. Eating disorders have emotional and behavioural consequences as well as physical ones. Two broad categories of the disorder are: anorexia nervosa (nervous loss of appetite) and bulimia nervosa (periodic episodes of ‘binge’ eating followed by ‘purging’ or strict dieting). (There is also a third disorder: compulsive eating.) Until the past decade, these were viewed as separate disorders with distinct characteristics, causes and treatments, but today clinicians have come to appreciate that the similarities between the two conditions are as important as the differences. Indeed, some sufferers of anorexia go on to develop bulimia and vice versa.
Anorexia nervosa occurs predominantly in females and usually appears between the ages of 14 and 16. In Britain, estimated incidence is higher than in the US, ranging from 10–40 per 1,000 females. To be diagnosed with anorexia, the individual must weigh less than 85% of her expected weight for age and height. The condition has been identified world-wide, although incidence does vary between cultures. For example, it is rare in China but common in Japan and rare among the black population in US, Africa and the UK.
In bulimia, as in the case of anorexia, the majority of sufferers are female (over 95%). However, the condition usually begins later than anorexia — not until the early 20s. The incidence of bulimia is higher than anorexia.
Case study
At the age of 15, Alma had been healthy and well developed. Her mother urged her to change to a school of higher academic standing and her father suggested she should watch her weight. She began a rigid diet and rapidly lost weight. In addition, she began a frenetic exercise programme, swimming for miles, playing tennis for hours, or doing callisthenics to the point of exhaustion. Alma feared she might become too fat, if she regained as little as an ounce. There was also a marked change in her character and temperament. Previously sweet, obedient and considerate, she became obstinate, arrogant and irritable.
Source: Kendall & Hammen (1997), page 526.
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