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Eating Disorders: Overview and Risk Factors

Anorexia Nervosa and Bulimia Nervosa are the most well known eating disorders.

Up to 3% of American women meet diagnostic criteria for an eating disorder, and up to 20% of college–aged women engage in some form of binging and purging behavior.1

Anorexia Nervosa is characterized by a refusal to maintain normal body weight. Patients have a distorted body image, a body weight less than 15% below the expected value, amenorrhea, and abnormal eating behaviors that may include binge eating, purging, and restricted food intake. About half of patients develop concurrent bulimic symptoms.

Bulimia Nervosa is characterized by recurrent episodes of binge eating and inappropriate methods to prevent weight gain, such as self–induced vomiting and laxative abuse.

The etiology of eating disorders is likely multifactorial, with genetic, psychological, environmental, and social factors implicated. Some have speculated that a cultural preoccupation with thinness and dieting in the United States and other Western countries has set the stage for eating disorders. Equally plausible is the possibility that the increasing prevalence of overweight and obesity in the United States and other countries has triggered an unhealthy response to weight problems. Nearly 40% of adolescent girls in the United States believe they are overweight, and nearly 60% are attempting to lose weight. A substantial number of these girls have reported that they tried vomiting or laxatives to control their weight.2

Significant morbidity and mortality are associated with severe or long–standing eating disorders, including osteoporosis, decreased gray matter, electrolyte and metabolic abnormalities, heart disorders, gastrointestinal dysfunction, dental erosion, and infertility. Osteoporosis, decreased gray matter and dental erosion are often not reversible, even with appropriate treatment and weight recovery. Comorbid psychiatric disorders, including depression, anxiety, and obsessive–compulsive disorder, are present in more than half of patients.

Risk Factors

About 90% of cases of eating disorders occur in women, with onset typically occurring in late adolescence and early adulthood. Additional risk factors include:

History of obesity and/or dieting. A history of obesity is linked to increased risk for eating disorders. Adolescents who reported dieting during mid–adolescence were significantly more likely to develop eating disorders.3

Participation in activities that emphasize leanness. Examples include ballet, gymnastics, and running.

Family history. Women who have a first–degree relative with an eating disorder are up to 10 times more likely to develop an eating disorder themselves.4 Eating disorders are also associated with a family history of depression.

Psychiatric history. Histories that include depression, substance abuse, sexual abuse, weight dissatisfaction, and low self–esteem are linked to higher risk for eating disorders.

Early puberty. Early sexual development may lead to increased self–consciousness regarding body image and is associated with subsequent dieting behaviors.


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