Distribution of Eating Disorders
HANS WIJBRAND HOEK
Epidemiological studies show that eating disorders are not distributed randomly among the population. Young females constitute the most vulnerable group. In clinical samples, only 5–10% of patients with an eating disorder are males. Eating disorders seem to be “Western” illnesses: They occur predominantly in industrialized, developed countries. One epidemiological study in Curaçao, with a mainly black population, did find an incidence rate of anorexia nervosa within the lower range of rates reported in Western countries. Most reports of eating disorders outside the Western World tend to be of an anecdotal nature and show that eating disorders are uncommon in non-Western countries. Immigrants (e.g., Arab college students in London and Greek girls in Germany) are more likely to develop an eating disorder than their peers in their country of origin. This type of evidence demonstrates that sociocultural factors play an important role in the distribution of eating disorders (see Chapters 45 and 47).
People in some professions seem to be particularly at risk; fashion models and ballet dancers, for instance, seem to be at greater risk for the development of an eating disorder than many other professional groups. However, what is not known is whether “preanorectic” persons are more readily attracted to the ballet world, or whether being a ballet dancer is the source of increased risk. In some countries, eating disorders are overrepresented among the middle and upper socioeconomic classes, but this social class bias might be connected with the structures, norms, and thresholds of the local health care system. In European countries such as the Netherlands, which has a rather generous state health insurance system, class differences seem to have less impact on the presentation and recognition of eating disorders.
Anorexia nervosa and bulimia nervosa are also widely regarded as relatively “modern” disorders. But, as discussed in Chapter 27, eating disorders similar to those seen today have existed for centuries. In recent years, there has been such an increase in the number of patients receiving treatment for an eating disorder that some people are suggesting there is an “epidemic.” Epidemiological data are not confirming that there has indeed been an equivalent increase in the number of cases in the general population.