Description

• Refusal to maintain normal body weight, with associated fear of weight gain, body-image disturbance, and amenorrhea
• Restricting and binge eating/purging subtypes
• System(s) affected: Cardiovascular; Endocrine; Metabolic; Gastrointestinal; Nervous; Reproductive

Epidemiology

• Predominant age: 13–20 years
• Predominant sex: Female > Male (20:1)
• Global distribution

Incidence
8–19 women/2 men per 100,000 population per year

• 0.9% in women
• 0.3% in men (higher in gay and bisexual men)

Risk Factors

• Female gender
• Adolescence
• Body dissatisfaction
• Perfectionism, obsessionality, rigidity
• Negative self-evaluation
• Academic and other achievement pressure
• Severe life stressors
• Participation in sports or artistic activities that emphasize leanness or involve subjective scoring: Ballet, running, wrestling, figure skating, gymnastics, cheerleading, weight lifting
• Type I diabetes mellitus
• Family history of substance abuse, affective disorders, or eating disorder

• Underlying genetic vulnerability likely but not well understood
• 1st-degree female relative with eating disorder increases risk 6–10-fold.

General Prevention

Prevention programs can reduce risk factors and future onset of eating disorders (1)[C]:

• Target adolescents and young women 15 years of age or older.
• Encourage realistic and healthy weight-management strategies and attitudes.
• Decrease body dissatisfaction.
• Promote self-esteem.
• Reduce focus on thin as ideal.
• Moderate overly high self-expectations.
• Decrease anxiety/depressive symptoms and improve stress management.

Pathophysiology

• Complex relationship among genetic, biological, environmental, psychological, and social factors that results in an unrealistic perception of fatness
• Subsequent malnutrition leads to disorder of multiple organs.

Etiology

• Serotonin neuronal systems are implicated.
• Multifactorial with psychological, biologic, genetic, environmental, and social factors

Commonly Associated Conditions

• Mood disorder
• Social phobia, obsessive–compulsive disorder
• Substance abuse disorder
• High rates of cluster C personality disorders