Distribution and Incidence

Once considered to be extremely rare, the reported incidence of anorexia nervosa has more than doubled during the past 20 years (Herzog and Copeland

1985).The disorder is especially prevalent among adolescent and young adult women. Ninety to 95 percent of anorectics are young and female, and as many as 1 in 250 females between 12 and 18 years of age may develop the disorder. The exact incidence of anorexia and other eating disorders is difficult to determine, however, because of problems in conducting reliable epidemiological studies and the small samples on which many such studies are based (Crisp, Palmer, and Kalucy 1976).

The onset of anorexia nervosa occurs most often during adolescence, although some patients have become anorexic as early as age 11 and as late as the sixth decade of life. Patients are typically high achievers, with normal or above average intelligence. They also tend to come from middle - or upper-class families, although evidence of anorexia nervosa among working-class and poverty-class women is growing (Bulik 1987; Gowers and McMahon 1989; Dolan 1991).

Anorexia nervosa is comparatively rare in men: Approximately 5 to 10 percent of anorectics are male. The clinical picture for male anorexic patients is also much different from that for women. In general, male anorectics tend to display a greater degree of psychopathology, are often massively obese before acquiring the disorder, are less likely to be affluent, and are even more resistant to therapy than their female counterparts (Garfinkel and Garner 1982). There is growing evidence, however, that anorexia nervosa and bulimia are more common among men than previously believed. This is particularly true among homosexual men, who tend to experience more dissatisfaction with body image than do heterosexual men (Yager et al. 1988; Silberstein et al. 1989; Striegel-Moore, Tucker, and Hsu 1990).

Anorexia nervosa was also once thought to be comparatively rare among American blacks, Hispan-ics, Native Americans, lesbians, first - and second-generation ethnic immigrants, and individuals from disadvantaged socioeconomic backgrounds (Herzog and Copeland 1985). Recent research in this area, however, has indicated that the incidence of anorexia and other eating disorders among these groups is much higher than previously thought (see the section “Geographic and Demographic Features”).