Who is affected?
Almost anyone can develop an eating disorder. However, not all types of people are at equal risk of doing so. The most striking fact is that women develop eating disorders much more frequently than men. Only one in ten or fewer of people presenting for help with an eating disorder is male. However, the balance between boys and girls is less skewed in the youngest sufferers, that is, those who are in their early teens or even younger.
WHEN DO EATING DISORDERS OCCUR?
Eating disorders usually occur in young people. Although anorexia nervosa may begin as young as ten or occur for the first time in women in their thirties or later, the peak age for developing the disorder is in the mid to late teens. Bulimia nervosa tends to occur a little later, typically in the late teens and twenties, and is rare in those below fifteen. The age at which young women are at the greatest risk probably coincides with the age when the greatest proportion of women are uncomfortable or dissatisfied with their bodies. For girls, the physical changes involved in growing into adult women are greater, or at least more evident, than for men. Furthermore, these changes often seem to have greater personal and social meaning. Weight concern and slimming behaviour are common at these times.
WHO IS MOST AT RISK?
It may well be that the risk of developing an eating disorder is increased by any kind of slimming.
So it is hardly surprising that young women such as dancers, athletes and models, who are especially concerned about body weight and shape and who are especially likely to engage in slimming, are also at greater risk of developing an eating disorder. Of course, for every person who attempts to slim and then goes on to develop anorexia nervosa or bulimia nervosa, there are many more who set out to slim in a similar way but remain well. Later there will be discussion about what may tip the balance toward an individual developing an eating disorder. Nevertheless, if there are more people slimming there are likely to be more people who fall ill with eating disorders, just as the more people there are who drink alcohol the more people there will be who become problem drinkers. Far fewer men than women attempt to slim. The difference in rates of slimming behaviour is unlikely to be the sole explanation for the greater risk in young women, but it seems likely that it is an important reason.
In the past it was thought that most people who had eating disorders came from the better-off sections of society. Anorexia nervosa in particular was thought of as largely a problem of the so-called middle and upper classes. If this was ever truly the case, it is no longer so. Certainly, no social group is immune.
Other myths that go around are that most sufferers from anorexia nervosa are especially intelligent and especially ‘good’, as children, and that those with bulimia nervosa are striving upwardly mobile types who live life in the fast lane. These caricatures seem to be quite unjustified even as generalisations. Of course some people who develop eating disorders do broadly resemble these stereotypes but most do not. They are unhelpful.
MEN AND EATING DISORDERS
As was stated above only a small minority of people presenting for the treatment of eating disorders are male. There is almost certainly a large difference in rates of occurrence of the disorders between the two sexes. Bulimia nervosa seems especially rare in men.
Some people suggest that eating disorders may be becoming more common in men. The symptoms experienced by men are closely similar to those of women. Even the hormonal changes are more or less the same. However, it is possible that more men and boys go unrecognised and undiagnosed because eating disorders are often wrongly thought to afflict only women. In men, the reasons behind the development of an eating disorder, that is, the ideas that link eating restraint with wider personal issues, may involve the desire to be slim. They may, however, include ideas about fitness, health or quasi-religious fasting more often than in women.
HOW MANY PEOPLE HAVE EATING DISORDERS?
It is difficult to be sure how many people suffer from eating disorders. In the United Kingdom at present, the best estimates suggest that about one young woman in a hundred has bulimia nervosa and probably somewhat fewer have anorexia nervosa. But of course not all sufferers are young women. So in total perhaps two or three people per thousand have a diagnosable eating disorder. A further two or three people are likely to have atypical or partial syndromes. (Such people have some but not all of the symptoms of the typical eating disorders. Nevertheless they may have very significant problems.) This means that in this country there are tens of thousands of people whose lives revolve painfully around weight and eating and their control. Any group practice of family doctors is likely to have a dozen or so people with eating disorders on their list.
The number of people with eating disorders probably varies from country to country and from time to time. It is necessary to say ‘probably’ because there is only rather poor information about the rates of eating disorders in people in the past or today in many countries. However, there is some evidence that eating disorders are more common than they were 30 or 40 years ago. Indeed, bulimia nervosa was recognised and described as a distinct disorder only in the late 1970s. The numbers of women presenting with bulimia nervosa has risen steadily since that time. Now in most clinics they outnumber sufferers from anorexia nervosa. However, it is almost certain that for every one sufferer who presents for assessment and treatment there is at least one other who does not. Many people do not seek or do not successfully find professional help for their problem.
