National Eating Disorders Association

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ANOREXIA

NEDA has gathered data on the prevalence of eating disorders from the US, UK, and Europe to get a better idea of exactly how common anorexia is. Older data from other countries that use more strict definitions of anorexia and bulimia give lower prevalence estimates:

  • In a study of 31,406 Swedish twins born from 1935-1958, 1.2% of the women had strictly defined anorexia nervosa during their lifetime, which increased to 2.4% when a looser definition of anorexia was used. 
  • For twins born between 1975 and 1979 in Finland, 2.2-4.2% of women and 0.24% of men had experienced anorexia during their lifetime. 
  • At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa
  • Several more recent studies in the US have used broader definitions of eating disorders that more accurately reflect the range of disorders that occur, resulting in a higher prevalence of eating disorders.
  • A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 0.9% of women and 0.3% of men had anorexia during their life
  • When researchers followed a group of 496 adolescent girls for 8 years, until they were 20, they found: 
    • 5.2% of the girls met criteria for DSM5 anorexia, bulimia, or binge eating disorder. 
    • When the researchers included nonspecific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.
  • Combining information from several sources, Eric Stice and Cara Bohon (2012) found that 
    • Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia 
    • Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females
  • Anorexia is the third most common chronic disease among young people, after asthma and type 1 diabetes.
  • Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers.
  • Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders.
  • Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among males as they are among females.
  • An ongoing study in Minnesota has found incidence of anorexia increasing over the last 50 years only in females aged 15 to 24. Incidence remained stable in other age groups and in males.
  • Eating disorder symptoms are beginning earlier in both males and females, which agrees with both formal research and clinical reports.

ARFID

  • In a group of adolescents with eating disorders receiving treatment at a specialist clinic, 14% met criteria for ARFID. Those with ARFID were more likely to be
    • Younger, and
    • Male
  • Many children with ARFID reported the following symptoms:
    • food avoidance 
    • decreased appetite
    • abdominal pain
    • emetophobia (fear of vomiting)
  • Nearly half of children with ARFID report fear of vomiting or choking, and one-fifth say they avoid certain foods because of sensory issues.
    • The same study found that one-third of children with ARFID have a mood disorder, three-quarters have an anxiety disorder, and nearly 20 percent have an autism spectrum condition

ATHLETES

  • In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.
  • Though most athletes with eating disorders are female, male athletes are also at risk—especially those competing in sports that tend to emphasize diet, appearance, size and weight. In weight-class sports (wrestling, rowing, horseracing) and aesthetic sports (bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. In female athletes in weight class and aesthetic sports, disordered eating occurs at estimates of up to 62%
  • Among female high school athletes in aesthetic sports, 41.5% reported disordered eating. They were eight times more likely to incur an injury than athletes in aesthetic sports who did not report disordered eating.
  • One study found that 35% of female and 10% of male college athletes were at risk for anorexia nervosa and 58% of female and 38% of male college athletes were at risk for bulimia nervosa.4 
  • The prevalence of eating disorders in college athletes is higher among dancers and the most elite college athletes, particularly those involved with sports that emphasize a lean physique or weight restriction (e.g., figure skating, wrestling, rowing).
  • Among female college athletes surveyed, 25.5% had subclinical eating disorder symptoms.
  • In a survey of athletic trainers working with female collegiate athletes, only 27% felt confident identifying an athlete with an eating disorder. Despite this, 91% of athletic trainers reported dealing with an athlete with an eating disorder. 93% of trainers felt that increased attention needs to be paid to preventing eating disorders among collegiate female athletes. 25% worked at an institution without a policy on managing eating disorders.
  • A study of female Division II college athletes found that 25% had disordered eating, 26% reported menstrual dysfunction, 10% had low bone mineral density, and 2.6% had all three symptoms.
  • Female high school athletes reporting disordered eating were twice as likely to incur a musculoskeletal injury as athletes who did not report disordered eating.

BINGE EATING DISORDER

NEDA has gathered data on the prevalence of eating disorders from the US, UK, and Europe to get a better idea of exactly how common eating disorders are. Although BED is not a new disorder, its new formal recognition in the research community has left far more gaps in the data on the incidence and prevalence of BED than for anorexia and bulimia.

  • A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 3.5% of women and 2.0% of men had binge eating disorder during their life
    • o This makes BED more than three times more common than anorexia and bulimia combined.
    • o BED is also more common than breast cancer, HIV, and schizophrenia.
  • When researchers followed a group of 496 adolescent girls for 8 years until they were 20, they found: 
    • o 5.2% of the girls met criteria for DSM5 anorexia, bulimia, or binge eating disorder. 
    • o When the researchers included nonspecific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.
  • Combining information from several sources, Eric Stice and Cara Bohon found that
    • o Between 0.2% and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder
    • o Subthreshold binge eating disorder occurs in 1.6% of adolescent females
  • Research estimates that
    • o 28.4% of people with current BED are receiving treatment for their disorder
    • o 43.6% of people with BED at some point in their lives will receive treatment
  • BED often begins in the late teens or early 20s, although it has been reported in both young children and older adults.
  • Approximately 40% of those with binge eating disorder are male.
  • Three out of ten individuals looking for weight loss treatments show signs of BED.

BULIMIA 

NEDA has gathered data on the prevalence of eating disorders from the US, UK, and Europe to get a better idea of exactly how common eating disorders are. Older data from other countries that use more strict definitions of anorexia and bulimia give lower prevalence estimates. Several more recent studies in the US have used broader definitions of eating disorders that more accurately reflect the range of disorders that occur, resulting in a higher prevalence of eating disorders:

  • At any given point in time, 1.0% of young women and 0.1% of young men will meet diagnostic criteria for bulimia nervosa.
  • A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 1.5% of women and 0.5% of men had bulimia during their life
  • When researchers followed a group of 496 adolescent girls for 8 years until they were 20, they found: 
    • o 5.2% of the girls met criteria for DSM5 anorexia, bulimia, or binge eating disorder. 
    • o When the researchers included nonspecific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.
  • Combining information from several sources, Eric Stice and Cara Bohon found that
    • o Between 1.1% and 4.6% of females and 0.1% to 0.5% of males will develop bulimia 
    • o Subthreshold bulimia occurs in 2.0% to 5.4% of adolescent females

Have these numbers changed over time? The answer isn’t clear. It does appear that, at least for the last two decades, the rates of new diagnoses of anorexia and bulimia have remained relatively stable.

  • A Dutch study published in the International Journal of Eating Disorders found that new diagnoses of anorexia and bulimia remained relatively steady in the Netherlands from 1985-1989 to 1995-1999.
  • Rates of bulimia increased during the 1980s and early 1990s, and they have since remained the same or decreased slightly 
  • A British study also found stability in new anorexia and bulimia diagnoses in both males and females, although rates of EDNOS diagnoses increased in both groups. (Please note that in the new DSM-5, EDNOS is no longer recognized and a new term of OSFED has been added, meaning Other Specified Feeding or Eating Disorder). 
  • Eating disorder symptoms are beginning earlier in both males and females, which agrees with both formal research and clinical reports.

BULLYING/WEIGHT SHAMING

  • The best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.
  • By age 6, girls especially start to express concerns about their own weight or shape. 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat. This concern endures through life.
  • 79% of weight-loss program participants reported coping with weight stigma by eating more food.
  • Of American elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape. 47% say the pictures make them want to lose weight.
  • Up to 40% of overweight girls and 37% of overweight boys are teased about their weight by peers or family members. Weight teasing predicts weight gain, binge eating, and extreme weight control measures.
  • Weight-based victimization among overweight youths has been linked to lower levels of physical activity, negative attitudes about sports, and lower participation in physical activity among overweight students. Among overweight and obese adults, those who experience weight-based stigmatization engage in more frequent binge eating, are at increased risk for eating disorder symptoms, and are more likely to have a diagnosis of binge eating disorder.
  • Children of mothers who are overly concerned about their weight are at increased risk for modeling their unhealthy attitudes and behaviors.
  • Weight stigma poses a significant threat to psychological and physical health. It has been documented as a significant risk factor for depression, low self-esteem, and body dissatisfaction.
  • Low self-esteem is a common characteristic of individuals who have eating disorders.
  • Perceived weight discrimination is significantly associated with a current diagnosis of mood and anxiety disorders and mental health services use.

CO-OCCURRING DISORDERS

  • Two-thirds of people with anorexia also showed signs of an anxiety disorder several years before the start of their eating disorder.
  • Childhood obsessive-compulsive traits, such as perfectionism, having to follow the rules, and concern about mistakes, were much more common in women who developed eating disorders than women who didn’t.
  • A study of more than 2400 individuals hospitalized for an eating disorder found that 97% had one or more co-occurring conditions, including:
    • 94% had co-occurring mood disorders, mostly major depression
    • 56% were diagnosed with anxiety disorders
      • 20% had obsessive-compulsive disorder
      • 22% had post-traumatic stress disorder
      • 22% had an alcohol or substance use disorder
  • Approximately one in four people with an eating disorder has symptoms of post-traumatic stress disorder (PTSD).
  • In women hospitalized for an eating disorder, 36.8% regularly self-harmed
  • A 2009 study in the International Journal of Eating Disorders found that one in five women seeking treatment for an eating disorder had six or more signs of attention-deficit hyperactivity disorder (ADHD).
  • Personality disorders also commonly occur in individuals with eating disorders. 
  • Among those with anorexia,
    • Restricting type: 20% had obsessive-compulsive personality disorder, 10% had borderline personality disorder
    • Binge-purge type:12% had obsessive-compulsive personality disorder, 25% had borderline personality disorder
    • Among those with bulimia:11% had obsessive-compulsive personality disorder, 28% had borderline personality disorder
  • A 2014 study found that combined and analyzed data from 20 previous studies found signs of personality disorders in 
    • 38% of people with EDNOS/OSFED
      • 11% had obsessive-compulsive personality disorder
      • 12% had borderline personality disorder
    • 30% of people with binge eating disorder
      • 10% had obsessive-compulsive personality disorder
      • 10% had borderline personality disorder
  • Depression and other mood disorders co-occur with eating disorders quite frequently.
  • There is a markedly elevated risk for obsessive-compulsive disorder among those with eating disorders.
  • One study found that 73.8% of patients with binge eating disorder had at least one additional lifetime psychiatric disorder, and 43.1% had at least one current psychiatric disorder. Among lifetime disorders, mood, anxiety, and substance use disorders were most common. Among current comorbidities, mood and anxiety were most common.
  • Up to 69% of patients with anorexia nervosa and 33% of patients with bulimia nervosa have a coexisting diagnosis of OCD.
  • Binge eating disorder patients with a co-occurring psychiatric disorder also had significantly higher levels of current eating disorder psychopathology, negative affect, and lower self-esteem than did patients with binge eating disorder without a co-occurring condition.
  • Certain psychiatric disorders, particularly obsessive-compulsive disorder, mood disorders and personality disorders, frequently are found among those with eating disorders, with estimates ranging from 42-75%.
  • In a nationally representative survey, 95% of respondents with bulimia nervosa, 79% with binge eating disorder, and 56% with anorexia nervosa met criteria for at least one other psychiatric disorder. 64% of those with bulimia nervosa met criteria for three or more co-occurring psychiatric disorders.
  • In a study of women with eating disorders, 94% of the participants had a co-occurring mood disorder. 92% of those in the sample were struggling with a depressive disorder.
  • 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with major depressive disorder.
  • 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with anxiety disorder.

COMPULSIVE EXERCISE

  • An estimated 90-95% of college students diagnosed with an eating disorder also belong to a fitness facility. 
  • An estimated 3% of gym-goers have a destructive relationship with exercise. Some studies have found that number may be even higher, including a 2008 Paris study that found that up to 42% of gym-goers have a destructive relationship with exercise.
  • A study involving fitness professionals revealed that 100% of the participants believed that they would benefit from further education and guidelines for identifying and addressing eating disorders.
  • There is a strong link between exercise compulsion and various forms of eating disorders. 
  • Between 40% and 80% of anorexia nervosa patients are prone to excessive exercise in their efforts to avoid putting on weight.

DIABULIMIA

  •  A review of studies published over the last 25 years on the prevalence of eating disorders and insulin restriction among people with diabetes shows that 30%-35% of women restrict insulin in order to lose weight at some point in their life. This number has remained relatively constant over the decades. 
  • A study of adolescents in 2000 across three Canadian cities found that young women with type 1 diabetes were 2.4 times more likely to have a diagnosable eating disorder and 1.9 times more likely to have sub-threshold eating disorder.
  • In a more recent study, 1/3 of female patients and 1/6 of male patients with Type 1 diabetes reported disordered eating and frequent insulin restriction.
  • People with diabetes often experience uncontrolled eating when they experience a low blood sugar. In Duke University’s study of 276 individuals with type 1 diabetes the frequency of uninhibited eating contributed to 31.3% of insulin omission for weight management. 
  • A study of adolescents from Norway revealed that in addition to age, negative attitude toward diabetes and negative beliefs about insulin had the highest association with insulin restriction and eating disorder behavior.
  • People with diabetes also have a higher risk for emotional states often associated with eating disorders. For example, an analysis of 42 studies found that diabetes doubles the likelihood of having clinical depression (1.7 – 2.9 times greater). 
  • While the majority of studies have been conducted within the type 1 diabetes population, there is case study and anecdotal evidence that the same prevalence and risk exists in any person with insulin dependence whether type 1 diabetes, type 2 diabetes or LADA (latent autoimmune diabetes of adults).

DIETING/”CLEAN EATING”

  • In a large study of 14– and 15-year-olds, dieting was the most important predictor of a developing eating disorder. Those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.
  • 62.3% of teenage girls and 28.8% of teenage boys report trying to lose weight. 58.6% of girls and 28.2% of boys are actively dieting. 68.4% of girls and 51% of boys exercise with the goal of losing weight or to avoid gaining weight.
  • Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
  • 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. Overweight girls are more likely than normal weight girls to engage in such extreme dieting.
  • Girls who diet frequently are 12 times as likely to binge as girls who don’t diet.
  • Even among clearly non-overweight girls, over 1/3 report dieting.
  • 95% of all dieters will regain their lost weight in 1-5 years.
  • 19.1% of teenage girls and 7.6% of teenage boys fast for 24 hours or more, 12.6% of girls and 5.5% of boys use diet pills, powders or liquids, and 7.8% of girls and 2.9% of boys vomit or take laxatives to lose weight or to avoid gaining weight.
  • 12.6% of female high school students took diet pills, powders or liquids to control their weight without a doctor’s advice.
  • Multiple studies have found that dieting was associated with greater weight gain and increased rates of binge eating in both boys and girls.
  • In elementary school fewer than 25% of girls diet regularly. Yet those who do know what dieting involves and can talk about calorie restriction and food choices for weight loss fairly effectively.
  • Middle school girls who dieted more than once a week were nearly four times as likely to become smokers, compared to non-dieters. 
  • A content analysis of weight-loss advertising in 2001 found that more than half of all advertising for weight-loss product made use of false, unsubstantiated claims. 

INSURANCE/LEGAL ISSUES

  • Eating disorders are associated with some of the highest levels of medical and social disability of any psychiatric disorder.
  • APA Practice Guidelines (2000 & 1993) reports these medical findings:
    • Physical consequences of eating disorders include all serious disorders caused by malnutrition, especially cardiovascular compromise.
    • Prepubertal patients may have arrested sexual maturity and growth failure.
    • Even those who “look and feel deceptively well,” with normal EKGs may have cardiac irregularities, variations with pulse and blood pressure, and are at risk for sudden death.
    • Prolonged amenorrhea (>6 months) may result in irreversible osteopenia and a high rate of fractures.
    • Abnormal CT scans of the brain are found in >50% of patients with anorexia nervosa.
  • In 1996, Congress passed the Mental Health Parity Act, a law that requires plans to provide the same annual and lifetime overall limits for mental health benefits as for other health conditions. Eating disorders ought to receive health care coverage and research funding that is equal to that of medical disorders as well as psychiatric conditions categorized as serious forms of mental illness.

JEWISH COMMUNITY

  • In one study of ultra-Orthodox and Syrian Jewish communities in Brooklyn, 1 out of 19 girls was diagnosed with an eating disorder, which is a rate about 50 percent higher than the general U.S. population.

LGBTQ+ COMMUNITY

  • Transgender individuals experience eating disorders at rates significantly higher than cisgender individuals. 
  • Research is limited and conflicting on eating disorders among lesbian and bisexual women.
  • While research indicates that lesbian women experience less body dissatisfaction overall, research shows that beginning as early as 12, gay, lesbian, and bisexual teens may be at higher risk of binge-eating and purging than heterosexual peers.
  • In one study, gay and bisexual boys reported being significantly more likely to have fasted, vomited, or taken laxatives or diet pills to control their weight in the last 30 days. Gay males were 7 times more likely to report binging and 12 times more likely to report purging than heterosexual males.
  • Females identified as lesbian, bisexual, or mostly heterosexual were about twice as likely to report binge-eating at least once per month in the last year.
  • Elevated rates of binge-eating and purging by vomiting or laxative abuse was found for both males and females who identified as gay, lesbian, bisexual, or “mostly heterosexual” in comparison to their heterosexual peers.
  • Compared to other populations, gay men are disproportionately found to have body image disturbances and eating disordered behavior. Gay men are thought to only represent 5% of the total male population but among men who have eating disorders, 42% identify as gay.
  • In a 2007 study of Lesbian, Gay and Bisexual (LGB)-identified participants, which was the first to assess DSM diagnostic categories, rather than use measures that may be indicative of eating disorders (e.g., eating disorder symptoms), in community-based (versus those recruited from clinical or academic settings) ethnically/racially diverse populations. Researchers found:
  • Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder.
  • There were no significant differences between heterosexual women and lesbians and bisexual women in the prevalence of any of the eating disorders.
  • Respondents aged 18–29 were significantly more likely than those aged 30–59 to have subclinical bulimia.
  • Black and Latino LGBs have at least as high a prevalence of eating disorders as white LGBs
  • A sense of connectedness to the gay community was related to fewer current eating disorders, which suggests that feeling connected to the gay community may have a protective effect against eating disorders

MARGINALIZED VOICES

  • Despite similar rates of eating disorders among non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, people of color are significantly less likely to receive help for their eating issues.
  • Although eating disorders affect a higher proportion of males who identify as gay or bisexual than females, the majority of males with eating disorders are heterosexual.
  • 15% of gay and bisexual men and 4.6% of heterosexual men had a full or subthreshold eating disorder at some point in their lives.
  • Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging.
  • In a study of adolescents, researchers found that Hispanics were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers. The researchers also reported a trend towards a higher prevalence of binge eating disorder in all minority groups.
  • From 1999 to 2009, hospitalizations involving eating disorders increased for all age groups, but hospitalizations for patients aged 45-65 increased the most, by 88 percent. In 2009, people over the age of 45 accounted for 25% of eating disorder-related hospitalizations.
  • Teenage girls from low-income families are 153% more likely to be bulimic than girls from wealthy families.
  • From 1999 to 2009, the number of men hospitalized for an eating disorder-related cause increased by 53%.
  • A 2014 study found that rates of disordered eating have increased across all demographic sectors, but at a faster rate in male, lower socioeconomic, and older participants.
  • In a survey of college students, transgender students were significantly more likely than members of any other group to report an eating disorder diagnosis in the past year.
  • A study of 2,822 students on a large university campus found that 3.6% of males had positive screens for eating disorders. The female-to-male ratio was 3-to-1.
  • Subclinical eating disordered behaviors are nearly as common among males as they are among females.
  • There were no significant differences between heterosexual women and lesbians and bisexual women in the prevalence of any of the eating disorders.
  • When presented with identical case studies demonstrating disordered eating symptoms in white, Hispanic and African-American women, clinicians were asked to identify if the woman’s eating behavior was problematic. 44% identified the white woman’s behavior as problematic; 41% identified the Hispanic woman’s behavior as problematic, and only 17% identified the black woman’s behavior as problematic. The clinicians were also less likely to recommend that the African-American woman should receive professional help.

MEDIA

  • According to The Nielsen Company, a U.S.-based global marketing and research firm that tracks media habits and trends worldwide, the average American spends more than 11 hours a day using media—that is more than the average time spent sleeping or working each day.
  • Among American youth ages 8-18, media are an ever-increasingly large part of their daily routines, fueled by the growing availability of internet-enabled mobile devices, which accounts for almost half of all their screen time. Teens ages 13-18 spend an average of 9 hours a day and tweens ages 8-12 average 6 hours a day using entertainment media. These amounts vary by race, income, and gender, and do not include using media in school or doing homework. 
  • Teens and tweens use media for a variety of activities and have different favorites depending on their gender – boys like to play video games, and girls prefer using social media.
  • 10,500 women and girls in 13 countries and found that beauty and appearance anxiety continue to be critical global issues and media are a key factor driving their concerns. 
    • Approximately 7 in 10 women and girls report a decline in body confidence and increase in beauty and appearance anxiety, which they say is driven by the pressure for perfection from media and advertising’s unrealistic standard of beauty.  
    • Almost 8 in 10 girls (79%) and even more women (85%) admit to opting out of important events in their lives when they don’t feel they look their best.
    • Nine out of 10 women say they will actually not eat and risk putting their health at stake when they feel bad about their body image. And 7 in 10 girls said they're more likely to be less assertive in their decisions when they're feeling insecure.
    • To counteract these unreal messages, a majority of women and girls around the globe are challenging media to portray more diverse physical appearances, age, race, body shapes, and sizes. 
  • In a study on social media, nearly all girls (95%) say they see the onslaught of negative beauty critiques on social media posts, comments, photos, and videos, and a majority see them at least once a week (72%) and wish social media were a space that empowered body positivity (62%).
  • According to Common Sense Media, 41% of teen girls say the use social media to “make themselves look cooler.” Teens feel pressure to look good and cool online, but also feel social media helps their friendships and connections.
  • One study of teen girls found that social media users were significantly more likely than non-social media users to have internalized a drive for thinness and to engage in body surveillance. 
  • Another study found social media use is linked to self-objectification, and using social media for merely 30 minutes a day can change the way you view your own body.

MEN

  • From 1999 to 2009, the number of men hospitalized for an eating disorder-related cause increased by 53%.
  • The most widely-quoted study estimates that males have a lifetime prevalence of .3% for anorexia nervosa (AN), .5% for bulimia nervosa (BN) and 2% for binge eating disorder (BED). These figures correspond to males representing 25% of individuals with AN and BN and 36% of those with BED. They are based on DSM-IV criteria.
  • In a study of 1,383 adolescents, the prevalence of any DSM-5 ED in males was reported to be 1.2% at 14 years, 2.6% at 17 years, and 2.9% at 20 years.
  • A study of 2,822 students on a large university campus found that 3.6% of males had positive screens for ED. The female-to-male ratio was 3-to-1.
  • In looking at male sexuality and eating disorders, higher percentage of gay (15%) than heterosexual males (5%) had diagnoses of ED but when these percentages are applied to population figures, the majority of males with ED are heterosexual.
  • Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse and fasting for weight loss) are nearly as common among males as they are among females.
  • Various studies suggest that risk of mortality for males with ED is higher than it is for females.
  • Men with eating disorders often suffer from comorbid conditions such as depression, excessive exercise, substance disorders, and anxiety.
  • A gender-sensitive approach with recognition of different needs and dynamics for males is critical in effective treatment. Males in treatment can feel out of place when predominantly surrounded by females, and an all-male treatment environment is recommended—when possible.

MORTALITY

  • Eating disorders are serious conditions that can have a profound mental and physical impact, including death. This should not discourage anyone struggling—recovery is real, and treatment is available. Statistics on mortality and eating disorders underscore the impact of these disorders and the importance of treatment.
  • A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder. 
  • Anorexia has an estimated mortality rate of around 10%.
  • Among those who struggle with anorexia, 1 in 5 deaths is by suicide
  • A Swedish study of 6,000 women who were treated for anorexia nervosa found that, over 30 years, women with anorexia nervosa had a six-fold increase in mortality compared to the general population. The researchers also found an increased mortality rate from ‘natural’ causes, such as cancer, compared to the general population. Younger age and longer initial hospitalizations were associated with improved outcomes, while comorbid conditions (e.g., alcohol addiction) worsened the outcome. 
  • Researchers studied records of 1,885 individuals evaluated for anorexia nervosa, bulimia nervosa, and EDNOS at the University of Minnesota outpatient clinic, over 8-25 years. Researchers found an increased risk of suicide for all eating disorders studied. Crude mortality rates were 4% for anorexia nervosa; 3.9% for bulimia nervosa; and 5.2% for EDNOS, now recognized as OSFED.

PICA

  • Between 4%-26% of institutionalized individuals are believed to have Pica. 

SUBSTANCE ABUSE

  • According to the National Center on Addiction and Substance Abuse, up to 50% of individuals with eating disorders abused alcohol or illicit drugs, a rate five times higher than the general population.
  • Up to 35% of individuals who abused or were dependent on alcohol or other drugs have also had eating disorders, a rate 11 times greater than the general population.
  • The substances most frequently abused by individuals with eating disorders or with sub-clinical symptoms of these disorders include: caffeine, tobacco, alcohol, laxatives, emetics, diuretics, appetite suppressants (amphetamines), heroin, and cocaine.
  • In a study looking at calorie restriction prior to alcohol consumption in college freshmen, 14% of the subjects reported restriction calories, with 6% reporting the behavior to avoid weight gain and 10% to enhance alcohol’s effect.
  • Bulimic women who were alcohol-dependent reported a higher rate of suicide attempts, anxiety, personality and conduct disorders and other drug dependence than bulimic women who were not alcohol-dependent.
  • Eating disorders and substance abuse share a number of common risk factors, including brain chemistry, family history, low self-esteem, depression, anxiety, and social pressures.  Other shared characteristics include compulsive behavior, social isolation, and risk for suicide.
  • Roughly 20% of men and women being treated for substance use disorders reported binge eating.
  • 24.8% of binge eating disorder sufferers have also struggled with a substance use disorder. Of men with BED, 40.4% report having struggled with a substance use disorder.
  • In a study of women with bulimia nervosa, 31% had a history of alcohol abuse and 13% had a history of alcohol dependence.
  • 25% of people with anorexia, 34% of people with bulimia, and 21% of people with binge eating disorder abuse or are dependent on alcohol. 
  • 27% of people with anorexia, 37% of people with bulimia, and 23% of people with binge eating disorder abuse or are dependent on other substances.

TRAUMA/PTSD

  • What is “traumatic” to any given individual is best understood in light of the “three E’s,” i.e., Event, Experience, and Effects
  • Available evidence suggests that eating disorder patients may be particularly sensitive or vulnerable to stress and its consequences.
  • PTSD symptoms include (American Psychiatric Association, 2013): Re-experiencing symptoms (e.g., flashbacks, nightmares, intrusive imagery)
    • Hyperarousal symptoms (e.g., irritability or angry outbursts, exaggerated startle, problems concentrating, insomnia, being overly watchful and anxious)
    • Avoidance symptoms (e.g., numbing, forgetting and avoiding trauma-related material)
    • Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred (e.g., partial amnesia, negative beliefs about oneself, others, or the world, self-blame, constantly expecting the worst)
  • Over one-third of individuals with an index episode of PTSD still had the full syndrome 10 years later.
  • Unresolved trauma and/or PTSD can be an important perpetuating factor in the maintenance of symptoms.
  • Two major national representative studies have shown that individuals with bulimia nervosa, binge eating disorder or any binge eating have significantly higher rates of PTSD than individuals without an eating disorder. The highest rates of lifetime PTSD were 38% and 44% respectively in the BN groups. When partial or subclinical forms of PTSD are considered, then well over half of individuals with bulimic symptoms have PTSD or significant PTSD symptoms. In addition, traumatized people with eating disorders demonstrate high levels of dissociative symptoms, such as amnesia of traumatic material (being unable to remember the traumatic event), which are also factors that contribute to a negative medical. 
  • When partial or subclinical forms of PTSD are considered, then well over half of individuals with bulimic symptoms have PTSD or significant PTSD symptoms.
  • In much the same way abuse of certain substances is used to self-medicate, binge eating and/or purging appear to be behaviors that facilitate: 
    • Reducing the hyperarousal or anxiety associated with trauma
    • The numbing, avoidance, and even forgetting of traumatic experiences

These behaviors are reinforcing, making it difficult to break the cycle. As a result, traumatic experiences and their destructive effects are not effectively processed and continue to cause problems.

  • Individuals with an eating disorder complicated by trauma and PTSD require treatment for both conditions using a trauma-informed, integrated approach.
  • Although the best approach to address PTSD in the context of an eating disorder remains elusive, work so far has focused primarily on cognitive processing therapy (CPT) integrated with traditional treatment for the eating disorder.
  • Future research is likely to shed light on how best to treat this comorbid combination.
  • Unresolved trauma and/or posttraumatic stress disorder (PTSD) can be an important perpetuating factor in the maintenance of eating disorders symptoms.
  • Binge eating and/or purging appear to be behaviors that facilitate reducing the hyperarousal or anxiety associated with trauma, and the numbing, avoidance, and even forgetting of traumatic experiences. These behaviors are reinforcing, making it difficult to break the cycle. As a result, traumatic experiences and their destructive effects are not effectively processed and continue to cause problems.
  • Individuals with bulimia nervosa, binge eating disorder, or any binge eating have significantly higher rates of PTSD than individuals without an eating disorder. Two major national representative studies found high rates of lifetime PTSD—38% and 44%—in those with bulimia nervosa.
  • When partial or subclinical forms of PTSD are considered, well over half of individuals with bulimic symptoms have PTSD or significant PTSD symptoms.
  • Traumatized people with eating disorders demonstrate high levels of dissociative symptoms, such as being unable to remember the traumatic event.
  • Individuals with an eating disorder complicated by trauma and PTSD require treatment for both conditions using a trauma-informed, integrated approach. Although the best approach to address PTSD in the context of an eating disorder remains elusive, work so far has focused primarily on cognitive processing therapy (CPT) integrated with traditional treatment for the eating disorder.
  • Researchers found that women who were victims of assault were 1.86x more likely  to develop bulimia than those who had not been victimized (26% v. 13.3%).
  • One study of veterans showed that military sexual trauma lead to nearly a two-fold increased likelihood of eating disorder diagnoses, especially amongst male veterans. 
  • According to one study, the majority of individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with bulimia nervosa and binge eating disorder. Subthreshold PTSD was more prevalent than threshold PTSD among women with bulimia nervosa and men with binge eating disorder. 
  • The National Institutes  of Health (NIH) 2017 budget for PTSD research was $93 million, compared to $30 million for all eating disorders research.
  • According to one study, rates of sexual violence were up to 48% of females & 68% of males with anorexia nervosa, up to 41% of females & 24% of males with bulimia nervosa, and up to 35% of females & 16% of males with binge eating disorder.

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