The Changing Faces of Eating Disorders

3 Main Types of EDs. The 3 main types of EDs are anorexia nervosa, bulimia nervosa (BN), and binge eating disorder. Eating disorders are serious, biologically determined disorders and not a personal choice, as is often believed. Early detection is essential to improve prognosis.

Anorexia Nervosa. Nearly 1% (0.9%) of US women suffer from anorexia in their lifetime and it is the third most common chronic illness among adolescent girls. Anorexia has the highest mortality rate of all mental disorders, at 5% per decade. Young people aged 15-24 years with anorexia have 10 times the risk of dying vs their same-age peers.¹

Bulimia Nervosa. Rates of BN are growing significantly, particularly among older adults, with 1.5% of US women suffering from BN in their lifetime.¹ Despite the rapid increase, BN is often hard to recognize due to often normal body weight appearance in patients. 

Binge Eating Disorder. Approximately 2.8% of US adults are affected by binge eating disorder and about 40% of people with this disorder are men. Binge eating disorder is often characterized by obesity, but patients may also have a normal body weight depending on the stage of the disorder. Binge eaters will often consume large amounts of food in a short period of time, often in public, although they hide food as well. 

EDs in Men. Studies have shown no difference in ED behaviors between the sexes - men have the same symptoms of anorexia, BN, and binge eating as women.^2,3 Anorexia is now diagnosed in boys as young as 8 years old.³

Older Women. Adult women in their 30s, 40s, and 50s are increasingly diagnosed with EDs, however, it is unclear whether these are new-onset cases or represent a long, undiagnosed pattern. Studies of middle-aged women have shown higher incidence of bulimic and binge eating behaviors vs classic anorexia.^9,10

The Elderly. EDs are typically associated with young populations and so early warning signs in older adults may be missed.¹¹ Early warning signs include increased sensitivity to cold, behavioral changes, hair loss, and dental damage.¹¹ In a 2010 review that evaluated EDs in 48 people (mean age 68.6 years), 81% of cases were anorexia, 69% had late onset, 60% had comorbid psychiatric conditions (usually depression), 42% were treated successfully, and 21% died as a result of an ED. 

The Military. In a 2009 study of the US military, 5.5% of women and 4% of men had an ED at the start of the study, which increased to 8.8% and 6.6%, respectively, with continued service.⁴ In a more recent study of 1788 military personnel, overall ED rates increased from 2.5 in 2013 to 2.7 in 2017 and overall rates of ED were highest among women and those aged <29 years.⁵ EDs in the military are mainly attributed to multiple traumatization not caused by combat, but more likely are associated with the daily stress of adjusting to military life, including adherence to strict weight requirements.^6-8