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Anorexia nervosa is characterized by refusal to maintain normal body weight, resulting in a body weight <85% of the expected weight for age and height. Bulimia nervosa is characterized by recurrent episodes of binge eating followed by abnormal compensatory behaviors, such as self-induced vomiting, laxative abuse, or excessive exercise. Weight is in the normal range or above. Binge eating disorder is similar to bulimia nervosa but lacks the compensatory behavior element. As a result, binge eating disorder is typically associated with obesity.

Both anorexia nervosa and bulimia nervosa occur primarily among previously healthy young women who become overly concerned with body shape and weight. Binge eating and purging behavior may be present in both conditions, with the critical distinction between the two resting on the weight of the individual. The lifetime prevalence of anorexia nervosa is 1%, that of bulimia nervosa 1–3%, but mild forms of occasional bulimia may occur in up to 5–10% of women. Binge eating disorder has a 4% prevalence. There is a 10:1 female to male ratio for both conditions; binge eating disorder is more evenly divided between women and men (2:1). The typical time of onset of anorexia is mid-adolescence, that of bulimia in early adulthood. Both can occur later, but onset is uncommon after age 40.

Anorexia and bulimia nervosa are disorders of the affluent, well-educated societies in Western cultures. Affected pts frequently exhibit perfectionist and obsessional tendencies. Pursuit of activities that emphasize thinness (ballet, modeling, distance running) are prevalent, as is a drive for high scholastic achievement. Risk factors are a family history of mood disturbance, childhood obesity, and psychological or physical abuse during childhood.

The diagnostic features of anorexia and bulimia nervosa are shown in Tables 210-1 and 210-2.


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