Incidence of Eating Disorders on the … Decrease?

Reports that eating disorder (ED) rates are rapidly increasing seem nearly ubiquitous, but are rates actually increasing? Are EDs at an “epidemic” level? I came across a recently published study suggesting that this may not be the case; indeed, ED rates might actually be decreasing, at least in the Netherlands.

In the study, Smink and colleagues (2015) followed a group of general practitioners (GPs), servicing roughly 1% of the total population, asking them to record all the newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) between 1985-1989, 1995-1999, and 2005-2009. They were interested in whether incidence rates changed or remained stable over time.

Incidence refers to the number of new cases of a disease or disorder in a population over a certain time period; it is not the same as prevalence, which refers to the total number of individuals suffering from the condition at a given point in time … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 2

I previously looked at two retrospective studies of anorexia patients in Singapore, which primarily concerned female patients. In this study, Tan et al (2014) looked at 72 male-identified patients diagnosed with all forms of eating disorders.

  • 1% had anorexia nervosa (15.3% binge-purge subtype, 20.8% restrictive subtype)
  • 3% had bulimia nervosa (27.8% purge subtype, 5.6% non-purge subtype)
  • 5% had EDNOS
  • 9% had BED

The mean age at intake was 19.9 years old; patients were mainly students (41.7%) and national servicemen (41.7%). Compulsory army service (National Service) usually takes place in the two years after high school graduation, though some may defer until completing further studies. The typical age range for those in National Service is 19-24.

Of the patients in the study, 88.9% identified a precipitating factor for their eating disorder, including being overweight (59.7% reported pre-morbid obesity) and having people make comments about their body. 68.1% of patients … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 1

Some previous posts on this blog have explored whether eating disorders might (or might not) be considered culture-bound, or in other words specific to or presenting specifically in certain cultures. If you consider eating disorders to be “culture bound,” they would present primarily in Western cultures, with non-Western cultures ‘receiving’ eating disorder pathology through Westernization. In this post, I explore eating disorders in the Singaporean context to continue to unpack the relationship between culture and eating disorders. Singapore is an interesting place in which to look at eating disorders (not just because I live there) because it complicates the idea of “culture-boundedness.”

Studies have been conducted in Asia; primarily in Hong Kong and to a lesser extent Japan. Most notably, Lee (1991) found non-fat-phobic presentations in Hong Kong supported by Ngai, Lee & Lee (2000) (see this post for more on the Ngai study). Singapore is … Continue reading →

Serious Restrictive Eating Disorders Occur at Any Weight

Although the words “anorexia nervosa” typically conjure up images of emaciated bodies, eating disorders characterized by dietary restriction or weight loss can — and do — occur at any weight. However, precisely because anorexia nervosa is associated with underweight, doctors are less likely to identify eating disorders among individuals who are in the so-called “normal” or above normal weight range, even if they have all the other symptoms of anorexia nervosa.

Clearly, this is a problem.

For one, there is no evidence that eating disorder not otherwise specified (EDNOS) — a diagnosis given to individuals who do not fulfill all of the criteria for anorexia nervosa or bulimia nervosa — is less severe or less dangerous than full syndrome anorexia nervosa. As I’ve blogged about, individuals with EDNOS have comparable mortality rates (see: EDNOS, Bulimia Nervosa, as Deadly as Anorexia Nervosa in Outpatients) and similar (sometimes even more severe) Continue reading →

Eating Disorders in the Elderly

The first published case of a late-onset eating disorder (at the age of 40) was in 1930 by John M. Berkman. In 1936, John A. Ryle published a case study of an eating disorder in a 59-year-old woman. Just how common are eating disorders in late middle-age or elderly individuals?

One study of 475 community dwelling elderly women aged 60–70 years found that 3.8% met diagnostic criteria for eating disorders. A study of elderly Canadian women reported that symptoms of disordered eating were present in 2.6% of women aged 50–64 years, and in 1.8% of women aged 65 years or older (Gadalla, 2008). In an investigation of eating disorders in elderly outpatient males, a minority (11–19%) who were undernourished were found to have abnormal eating attitudes and body image, including inappropriate self-control around food (60%), unsuitable eating attitudes (26%), and distorted body image (3–52%) (Miller et al., 1991).

There … Continue reading →

Living in a Large City: A Risk Factor for Bulimia Nervosa?

The link between urban living and mental disorders such as schizophrenia and depression has been known for quite some time (Sundquist et al., 2004). In one study, Sundquist et al found that individuals living in a densely populated area had a 68-77% higher risk of developing psychosis and 12-22% higher risk of developing depression.

The question then arises, do eating disorders follow a similar pattern? And if yes, what are some possible explanations? Certainly we know that both genetic and environmental factors are involved in the development of eating disorders, but what specific factors and to what extent remains unclear.

In this study, Gabrielle E. van Son and colleagues set out to explore whether increasing urbanization was an environmental risk factor for the development of eating disorders.

In order to answer this question, the researchers had a network general practitioners (GPs) record each newly diagnosed case of anorexia … Continue reading →

Lifetime Prevalence of Eating Disorders Among Eating Disorder Professionals

How many professionals that treat eating disorders have a personal history of struggling with an eating disorder? It is a crucial question to ask (and answer) because there are important implications for patient treatment and for the health of the afflicted professionals. It is true that many (or most?) individuals who go into mental health do so because of personal experiences–whether due to their own personal history or the experiences of a loved one–so it is useful to ask, just how common are eating disorders among ED treatment professionals?

This is the question that Nicole Barbarich asked in a survey mailed to 823 members of the Academy for Eating Disorders.

Barbarich developed a 14-item self-report questionnaire that assessed everything from basic demographics to personal eating disorder history and their employer’s hiring policies. Out of 823 potential participants, 399 completed the questionnaire.

SUMMARY OF MAIN FINDINGS

Demographics of Survey RespondersContinue reading →

Characteristics of Women with Midlife-Onset Eating Disorders

Since the late 1990’s, Remuda Ranch Program for Eating Disorders has experienced a 400% increase in patients 40 years of age and older, according to the authors of this paper. However, we don’t really know what the similarities and differences are between women who develop eating disorders in adolescence and those who develop their eating disorders in midlife (40-65 years of age).

It has been theorized that EDs in midlife may be triggered by midlife transitions, such as loss of parents, siblings, or children; divorce; traumatic illness; and empty nest syndrome (Harris & Cumella, 2006; Maine & Kelly, 2005; Shellenbarger, 2004). […] Two quantitative studies found a high correlation between the fear of aging and disordered eating in older populations (Gupta, 1995; Lewis & Cachelin, 2001).

In this paper, Edward Cumella and Zina Kally present a summary of 50 women who first developed eating disorders at the age of 40 … Continue reading →

How Common Are Eating Disorders? Incidence, Prevalence and Mortality Rates

Six month of blogging and I have yet to do a proper post on the prevalence of eating disorders. I think it is about time. I see all sorts of numbers thrown around, often depending on the purpose of the article and the author’s bias. Is it 1 in 1000, 1 in 100, 1 in 20 or maybe even 1 in 2? Who is right?

Well, it is a tricky question to answer.

The number depends on how the particular study was conducted. Here are some factors that may influence the final rates: the population being studied, the sample size, the definition of eating disorder, the methods used by researchers to identify and screen for individuals with eating disorders, the number of years over which data is collected, and so on. In other words, a lot! That’s why in order to get a better sense of the true … Continue reading →

Does Too Much Exposure to Thin Models Cause Eating Disorders? Anorexia, Bulimia in Blind Women

As many of you already know, Vogue has recently banned models that are “too-thin” (and “too young”). It is a big step in the right direction, no, a huge step, and one deserving an applause, that’s according to an article on allvoices.com. Cue a drop in the prevalence of eating disorders, right? The logic in most articles, whether implicit or explicit, seems to be: no more skinny models = no more girls aspiring to be like skinny models = no more eating disorders.

Health of models belonging to both genders has been a growing issue in the past, especially after the death of two models in 2006-2007 from what the doctors blame to their acute eating disorders. This important step by Vogue targets not just skinny models, but also the impact they have on the young minds of girls and boys by presenting an image of perfection that

Continue reading →